【作者】 王碧波；

【导师】 朱铭来；

【作者基本信息】 南开大学 ， 保险学， 2012， 博士

【摘要】 本文以总结分析国际反保险欺诈之经验，试图完善中国大陆地区人寿保险公司运行之对策与机制，全文共分为以下七章：第一章，“引言”部分，介绍本文的研究意义与研究方法。从有保险之日起，保险欺诈就如影随形。保险业之历史有多长，保险欺诈就有多久。一旦保险欺诈泛滥，将会造成保险公司交易成本提升，而将该交易成本转嫁由消费者负担；对消费者而言，将可能因保险欺诈而面临保险费提高的潜在损失。长此以往，社会互助机制可能就此瓦解，从而使作为分散个体的投保人处于无避险之境地，以至于陷于更大之风险困境。正因保险欺诈涉及国家经济制度层面，自有加以抑止之必要。本文主要采用历史与逻辑研究法、比较研究法和实证分析研究法等方法。第二章，“相关文献回顾与基本问题探讨”，介绍国内外保险欺诈研究之主要成果和文献，并对保险欺诈基本理论知识进行探讨。重点讨论保险欺诈之含义、保险欺诈与保险犯罪之关系、保险欺诈与违反据实说明义务之关系、保险欺诈与道德风险之关系，并对保险欺诈行为进行经济学之定性与定量分析。第三章，“保险欺诈之基本要素”，以台湾地区为例，分析讨论保险欺诈之要件、保险欺诈之特性、保险欺诈之成因以及保险欺诈之类型。本文认为，保险欺诈之构成要件有四：一是客观要件，即必须保险欺诈行为人实施有欺诈行为；二是主观要件，即保险欺诈行为人必须具有欺诈之故意；三是事实要件与结果要件，即必须有保险人因错误而为意思表示之结果；四是因果关系要件，即保险金赔付与欺诈行为之间具有因果关系。保险欺诈之特征有四，即主体多元、二是行为复杂、危害深远、犯罪黑数高。保险欺诈之成因与类型都较为复杂。第四章，“反保险欺诈机制与立法比较研究”，通过对美国、英国、法国、日本、韩国、台湾地区、中国大陆等七个国家和地区之反保险欺诈机构与机制、反保险欺诈相关立法之归纳总结与对比分析，得出各国反保险欺诈行为主要举措之一些基本特点。第五章，“保险欺诈案例特征之分析”，选取台湾地区部分人身保险典型案例，从保险欺诈行为人特征与动机、保险欺诈手法与特征等角度进行简要分析，以总结人身保险各类型欺诈之共同而又主要之特征，为本文构建中国大陆地区反保险欺诈之对策与机制进行理论与实务之准备。第六章，“中国大陆地区反保险欺诈制度之建构”，首先，就中国大陆地区反保险欺诈现行运行机制存在之问题进行梳理分析；其次，从政府机构、保险公司、保险教育、保险监管等角度，就完善中国大陆地区反保险欺诈运行机制提出对策建议。第七章“结论与建议”总结全文之论述，并提出有关防制保险欺诈之有关建议。更多还原

【Abstract】 This dissertation summarizes and analyzes the experience of international anti-insurance fraud, attempts to improve the operation of measures and mechanisms of the Life Insurance Company in China, the text includes seven chapters, and is structured as follows:The first chapter,"Introduction", describes significance of this research and methods of this research. Insurance fraud occurs with the emergence of the insurance hand in hand. How long history of the insurance industry is, how law is insurance fraud. Insurance fraud will increase transaction costs caused by insurance companies, and pass the transaction costs borne by consumers; to the consumers, because of insurance fraud may face the potential loss of premium increase. Over time, System of social solidarity may collapse and there is no way to avoid the risk insured. This paper studies with methods of the historical and logical law, comparative study and empirical analysis.Chapter II,"Review of the literature and discussion of the basic theory and practice of insurance fraud", gives an introduction to the basic problem of insurance fraud, and explores the basic theoretical knowledge of insurance fraud, Focused on the meaning of insurance fraud, the relationship between insurance fraud and the insurance crime, the relationship between insurance frauds and breaching of duty truthful relationship, the relationship between insurance fraud and moral hazard. And this chapter will give a study of economic quantitative and qualitative analysis on the insurance fraud.Chapter III,"the basic elements of insurance fraud", discusses the elements of insurance fraud. This chapter includes the characteristics of insurance fraud, the causes of insurance fraud and types of insurance fraud type. This paper argues that there are four constituent elements in insurance fraud:First, the objective element, the implementation of a fraud perpetrator; the second, subjective element, that is insurance fraud must have a deliberate fraud; The third element is the fact that elements with the results that there must be insured for the meaning of that error results; The fourth, causal elements, namely, s loss and insurance fraud causal. There are four characteristics of insurance fraud that the wide range of subject, complex behavior, serious harm, and high dark figure of crime. The causes and types of insurance fraud are even more complex.Chapter IV,"a comparative study on mechanism and legislation of anti-insurance fraud", studies institutions and mechanisms of anti-insurance fraud in the United States, Britain, France, Japan, Korea, China Taiwan, China’s mainland and other countries and regions, anti-insurance fraud-related Legislation is summarized and compared and analyzed the main national anti-insurance fraud initiatives of some of the basic features.Chapter V,"Characteristics of insurance fraud case", selects some typical case of life insurance fraud in Taiwan, discuss the common the main characteristics and motives of the person who engaged in insurance fraud, summarizes methods and characteristics of insurance fraud, and gives recommendations to China’s mainland’s anti-insurance fraud policy.Chapter VI,"China’s mainland’s construction of the system against insurance fraud", first of all, Analysis system problems of insurance fraud in China’s mainland; Secondly, give Recommendations and countermeasures on anti-insurance fraud in China’s mainland from the point of government agencies, insurance companies, insurance education, insurance regulation in this paper.Chapter VII of the "Conclusions and Recommendations," the resolution of this dissertation will be inducted, and some suggestions to legislative of the Insurance Fraud will be made in the end.更多还原