山东省财产保险欺诈与反欺诈研究

发布时间：2018-04-18 19:33

本文选题：财险市场 + 保险欺诈　；参考：《山东大学》2014年硕士论文

【摘要】：近年来随着山东财产保险行业的发展,其社会价值得到了政府部门和监管机构的肯定和认可。与此同时,财产保险欺诈案件呈上升趋势,它扰乱了正常的保险经营活动,而且使保险公司的社会威信和信誉度受到严重挑衅和质疑。本文的重要特点就是对保险欺诈与反欺诈做系统性的介绍,目的是要曲突徙薪,防患于未然。山东财险市场上保险欺诈案件形成的原因,既有客观性又有主观性,例如：社会的某些不良习气的存在；某些被保险人法律意识的淡薄进而置法律于不顾,铤而走险；还有保险人自身内部管控制度不严格或者本身就从事欺诈活动等。因此,研究该类问题,是一项系统工程。监管部门和立法机构制定切实可行措施,消除各类保险欺诈案件形成的要素,把案发量降到最低。这对维护保险公司社会保障功能、保护消费者的合法权益具有重大的现实意义。本文由以下几个章节组成：第一章介绍选题背景和现实意义。首先介绍了现在保险欺诈出现的新的表现形式,保险公司打击保险欺诈的重要性。本文的整体研究框架结构和研究方法,特别是介绍本文的创新之处以及下步需要改进的地方。第二章介绍了国内外关于保险欺诈理论的研究成果。对文章参考的文献分类进行介绍以及对本文进行的理论指导。第三章介绍国外的反欺诈的组织和法律保障,回归国内保险欺诈案件的发展趋势和反欺诈的现状。再对山东财产保险公司保险欺诈与反欺诈情况进行重点分析介绍。第四章结合作者本人在工作岗位中参与的山东地区保险欺诈调查,运用微证寻案案例分析方法对欺诈风险点和应对措施进行详细介绍,区别了普通保险欺诈案件。第五章从具体操作可行性为出发点,对山东财产保险公司下一步如何提升全程各个环节反欺诈能力提出了思考和对策。第六章进一步强调保险欺诈和反欺诈是个系统的、长期的、博弈的过程。只有整个社会的共同参与,才能达到保险反欺诈理想的效果。总之,本文对于保险欺诈理论和现状进行系统介绍和分析,结合具体欺诈案例表现形式和解决方法,从可操作性、简便性等贴近实战的角度来分析,从而有针对性的提出保险反欺诈的对策,本文研究对山东财产保险准确地识别欺诈行为,增强防范,维护正常市场秩序有着重要的意义。本文实用价值有利于不断增强和严格财产保险公司内部的管控制度,强化责任追究。无论是保险机构的管理人员,还是在一线的案件调查人员都有非常大的帮助作用。
[Abstract]:In recent years, with the development of Shandong property insurance industry, its social value has been affirmed and recognized by government departments and regulators.At the same time, the property insurance fraud cases are on the rise, which disturbs the normal insurance business activities, and makes the social prestige and credibility of the insurance companies seriously challenged and questioned.The important feature of this paper is to introduce insurance fraud and anti-fraud systematically.The reasons for the formation of insurance fraud cases in Shandong property insurance market are both objective and subjective, such as: the existence of some bad social habits;There is also the insurer's own internal control system is not strict or itself engaged in fraudulent activities and so on.Therefore, it is a system engineering to study this kind of problem.Regulators and legislatures have worked out practical measures to eliminate the elements of various insurance fraud cases and to minimize the number of cases.It is of great practical significance to safeguard the social security function of insurance companies and protect the legitimate rights and interests of consumers.This article consists of the following chapters:The first chapter introduces the background and practical significance of the topic.Firstly, the paper introduces the new manifestation of insurance fraud and the importance of insurance company to combat insurance fraud.The whole research frame structure and research method of this paper are introduced, especially the innovation of this paper and the next step need to be improved.The second chapter introduces the research results of insurance fraud theory at home and abroad.This paper introduces the literature classification and the theoretical guidance of this paper.The third chapter introduces the organization and legal protection of foreign anti-fraud, return to the development trend of domestic insurance fraud cases and the current situation of anti-fraud.Then the Shandong property insurance company insurance fraud and anti-fraud are analyzed and introduced.The fourth chapter combines the investigation of insurance fraud in Shandong area in which the author participates in the work station, and introduces the fraud risk point and countermeasures in detail by using the case analysis method of micro-proof seeking case, and distinguishes the common insurance fraud case.The fifth chapter from the concrete operation feasibility as the starting point, proposed the thought and the countermeasure to the Shandong property insurance company next how to enhance the whole course each link anti-fraud ability.Chapter 6 further emphasizes that insurance fraud and anti-fraud are systematic, long-term and game-based processes.Only the participation of the whole society can achieve the ideal effect of anti-fraud insurance.In a word, this paper systematically introduces and analyzes the theory and current situation of insurance fraud, combining with the manifestation and solution of specific fraud cases, from the point of view of maneuverability, simplicity and so on close to the actual combat.Therefore, it is of great significance for Shandong property insurance to identify fraud accurately, strengthen prevention and maintain normal market order.The practical value of this paper is conducive to strengthening and tightening the internal control system of the property insurance company and strengthening the accountability.Both insurance executives and investigators in front-line cases are of great help.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：D922.284;F842.65

【参考文献】