保险欺诈风险的关键因素及法律规制  

Key Factors and Legal Regulation of Insurance Fraud Risks

作　　者：刘轶[1,2] 董捷[3] Liu Yi;Dong Jie(Law 3.School School,National Police University for Criminal Justice,Baoding 071000,China;School of Economics,Hebei University,Baoding 071000,China;of Economics,Beijing Technology and Business University,Beijing 100048,China)

机构地区：[1]中央司法警官学院法学院,河北保定071000 [2]河北大学经济学院,河北保定071000 [3]北京工商大学经济学院,北京100048

出　　处：《金融理论探索》2018年第4期60-70,共11页Exploration of Financial Theory

基　　金：中国法学会部级法学研究课题"保险欺诈防范与保险消费者保护--基于大数据时代的保险诉讼案例分析"(CLS[2017]D88);保监会部级课题"保险欺诈风险及其法律监管对策"(CIRCRP2017-021);河北省社会科学发展研究课题"保险业供给侧结构性改革背景下欺诈监管研究"(201704020102)

摘　　要：保险欺诈侵蚀保险机构的偿付能力,增加行业的潜在风险,触及保险制度的根基。保险监管的目的是维护市场秩序,保护保险消费者的利益,对欺诈等违法行为采取有效管控。保险反欺诈法规的制定、执行和司法适用都影响潜在违法者的决策。法律诉讼作为解决保险欺诈的一种方式,虽然不是最优选择,但却是化解纠纷的最终途径,其目标与保险监管相同。通过提取典型保险诉讼案例的欺诈关联因子,建立回归模型,探寻保险欺诈的作用机理,明确保险欺诈的制度诱因。在实证研究的基础上评估不同领域的保险欺诈风险,最后提出:阐明如实告知义务制度中保险人解除权的基础,完善如实告知义务制度、重构告知内容标准,提高保险欺诈的法律成本和法律执行率并引入惩罚性赔偿机制,作为完善我国保险欺诈监管法规的具体对策。Insurance fraud erodes the solvency of insurance institutions, increases the potential risks of the insurance industry, and influences the foundation of the insurance system. The purpose of insurance supervision is to maintain the market order, protect the interests of the credit insurance consumers and take effective control on the illegal acts such as fraud. The formulation,execution and judicial application of the anti-insurance fraud regulations all affect the decision of the potential violators. As a way to solve insurance fraud, litigation is not the best choice, but it is the final way to resolve disputes, and its tasks are the same as insurance supervision. This document extracts the factors associated with fraud in typical insurance litigation cases, establishes regression models, attempts to explore the function mechanism of insurance fraud, defines the institutional incentives of insurance fraud.On the basis of empirical research, the risk of insurance fraud in different areas is assessed. Finally, it proposed to clarify the basis for the insurer ＇s right to cancel in the truthful disclosure obligation system, improve the truthful disclosure obligation system, reconstruct the disclosure content standards, increase the legal costs and law enforcement rate against insurance fraud, introduce a punitive compensation mechanism,which are concrete measures to improve China＇s insurance fraud regulations.

关 键 词：信息不对称 如实告知义务 法律成本 保险欺诈风险规制 法律执行率 

分 类 号：F842[经济管理—保险]