投保方欺诈还是保险公司惜赔  

Is the Insurant Fraud or the Insurance Company Underpaid?

作　　者：周建涛[1] 周建波[2] 秦炳山 徐迎迎[1] 

机构地区：[1]北京航空航天大学经济管理学院,北京100191 [2]北京大学经济学院,北京100191

出　　处：《河北经贸大学学报》2014年第2期115-120,共6页Journal of Hebei University of Economics and Business

基　　金：教育部规划基金项目"中国健康;意外保险欺诈的识别及预警研究"(11YJA790223);北京市哲学社会科学"十一五"规划项目"北京市保险公司诉讼现状及应对策略研究"(09BaJG252)

摘　　要：保险理赔诉讼涉及投保方、保险公司、法院三方，到底是投保方欺诈，还是保险公司惜赔，法院判决具有客观公信力。对2000-2011年170个人身意外伤害保险理赔诉讼样本进行实证分析发现：投保方索赔金额远大于保险公司愿赔金额，法院判决金额介于索赔金额与愿赔金额之间，惜赔金额大于欺诈金额；投保方欺诈金额与索赔金额、保险费正相关，北京甚于外地，残疾甚于其他伤害，年龄61～70岁弱于其他年龄段，新法实施后弱于新法实施前；保险公司惜赔金额与愿赔金额负相关，但与保险金额正相关，北京弱于外地，地市分公司弱于区县支公司，死亡甚于其他伤害，中毒、溺水甚于其他事故，年龄51～60岁甚于其他年龄段，新法实施后甚于新法实施前。Insurance claim suit is involved with three parties, the insured, the insurance company, and the court, is it the insured fraudulent or the insurance company underpaid？ The court＇s judgment is objectively impartial. This article describes and regresses the 170 accident insurance sample data of claiming litigations between 2000 and 2011, finding that the insured＇s offer is far larger than the insurance company＇s accept, the court＇s judgment is between the insured＇s offer and the insurance company＇s accepted, fraud amount is lower than underpayment amount, fraudulent claim is proportional to insured fee, Beijing is worse than other districts, disability is worse than other hurts, age 61-70 is weaker than other age groups, fraud in new insurance law is weaker than before; the insurance company underpayment is proportional to insured amount, Beijing is weaker than other districts, city division company is weaker than county branch company, death is worse than other hurts, poisoning and near-drowning are worse than other accidents, age 51-60 is worse than other age groups, underpayment in new Insurance law is worse than before.

关 键 词：欺诈金额 惜赔金额 投保方特征 保险公司类型 机会欺诈 保险理赔 新《保险法》 

分 类 号：D923[政治法律—民商法学]