《保险研究》20211107-《保险欺诈主体的构成与法律责任》（李玉泉、乔石）

［摘   要］随着我国保险业的迅速发展,保险欺诈事件时有发生,且呈快速上升趋势,严重侵害了保险人和广大投保人、被保险人、受益人的合法权益,阻碍了保险业的健康发展。以互联网、大数据和云计算为基础的新科技发展,有效提升了不同行业之间数据的共享程度和识别水平,助力保险业增强反欺诈能力。与此同时,科技手段的进步也给保险欺诈实施者带来了便利,保险欺诈的方式也发生了新的变化。突出体现为幕后操纵者与保险合同当事人之间的分离,保险从业者与投保人、被保险人、受益人相互勾结等。本文从保险行业实践的视角出发,对保险欺诈的主体构成与法律责任作了系统的研究,提出了具体的建议。

［关键词］保险欺诈；保险欺诈主体；保险诈骗；法律责任

［作者简介］李玉泉,法学博士、研究员、资深仲裁员,中国保险学会法律专业委员会主任,中华联合保险集团股份有限公司独立董事,曾任中国人民保险集团股份有限公司执行董事、副总裁；乔石:法学博士,中国人民养老保险有限责任公司法律合规部/纪委办公室总经理助理。

Composition of Insurance Fraud Principals and Legal Liabilities

LI Yu-quan,QIAO Shi

Abstract：Along with the rapid development of China′s insurance industry,insurance frauds occur quite frequently,and increase rapidly.This has not only gravely eroded lawful rights and interests of the insurer,the broad-based policyholders,the insureds,and the beneficiaries,but also hindered healthy development of the industry.Development of new technologies such as the Internet,big data and cloud computation has facilitated data sharing across different industries and fraud detection capabilities,enabling the insurance industry in fight against fraudulent activities.But technology also makes it easier for conducting frauds,thus methods of fraud are also evolving.Some particular new phenomena include the separation of wire-puller and insurance contractual subjects,and the collusion among insurance practitioners,policyholders,the insureds,and the beneficiary,etc.The paper proceeded from the perspective of the insurance industry practices,made a systematic study on the composition of insurance fraud principals and related legal liabilities,and put forwards concrete suggestions.

Key words：insurance frauds;insurance fraud principals;insurance swindling;legal liabilities