Analysis of life insurance fraud:

The current form of domestic life insurance fraud generally have the following:

 

1, breach of the duty of the insured, sick.

 

From the actual claim this is a form of the most common life insurance fraud, occurs in the health, medical insurance. The insured intentionally or negligently not truthfully inform the insurer of insurance is health, buy insurance in case of illness, and claims that after the effective date of the contract, request the insurer pays insurance gold behavior.

 

Investigation techniques:This is one of the most common life insurance fraud, the investigation for this behavior, should first be investigated for life insurers, followed by residents of the local health habits analysis and insurant disease to analyze the possible medical specialist hospital, again is to be prudent to access insurance people in the surrounding people get past health insurance and medical conditions (specifically when the hospital where the doctor), the last is the insured may be associated with the hospital detailed inventory, thus obtaining the insured prior diagnosis information.

    

2, without the occurrence of insurance accident that the accident occurred insurance, an insurance scam.

 

This kind of insurance fraud is often linked with hospital. The insured in the insurance, clearly not sick in hospital, but the doctor to cooperate with the hospital (buying or hospital related department staff), let the doctor issued false records, for false admission procedures, providing false claims data, so as to achieve the purpose of defrauding insurance.

 

Common case:The insurant or the insured person in the hospital (medical institutions) have the relationship of relatives and friends, and use this relationship, forgery of patient medical records, discharge summary and other claims data swindle insurance compensation.

 

Investigation techniques:A detailed analysis of the related medical information (records, inspection, inspection report data), on the other hand is mainly aimed at the related department staff visits or negotiations.

 

3, the first loss, insurance, a perjury intentionally defrauds insurance money.

"To be or get out of danger, insurance", also called "inverted list general". This is a very common fraud, common in the accident injury insurance. This form of fraud, that the actual "time difference", will hurt accident insurance before the occurrence of the insured, forgery happened after insurance accident, or an accident after the insured defrauds insurance money, in order to achieve the purpose of.

 

Investigation techniques:The fraud the so-called "reverse sign", analysis of the specific investigation techniques as "insurance fraud and investigation skills (on)" -1.

 

4, take another's place by counterfeiting defrauds insurance money.

 

This kind of fraud is used in family medical insurance, health insurance and enterprise group insurance. At present, China's insurance density is not high, a family or units of the insured, only some people participated in insurance, once the uninsured person accident, the insured will often use fake techniques, take another's place by counterfeiting defrauds insurance money.

 

Investigation techniques:Investigating the fraud hand need insurance company underwriting, underwriting departments, check the original records, on the other hand is the scene of the accident investigation and the surrounding personnel with access and identity for the insurance personnel for further verification, to obtain relevant evidence and analysis.

 

The death of 5, died as an accident.

 

"Property insurance" with high coverage low premium, in life insurance provision, including liability liability payments is relatively high. Because of this characteristic, caused by the insured or the beneficiary died in Dutch act, in order to obtain the high accident liability insurance, the insured accidental forged documents, the pseudo accidental death, so as to obtain the accident insurance compensation.

 

Case:In 2000 August, the insured Zhang for her husband Lee insure safe accident insurance 100000 yuan. In 2001 October the insured that the insured to ride a bicycle accidents fell to death, investigators in the investigation found that the cause of death there are doubts. After many setbacks, the investigators found evidence, confirmed that the insured had died of heart disease. Finally, according to the payment.

 

Investigation techniques:Such fraud mainly through two aspects to achieve the purpose of evidence exclusions. The real reasons for investigating the death of the insured, the related personnel or personnel around to visit that, on the other hand, the insured past actual health knowledge and related medical institutions of interrogation, obtaining the insured medical records.

 

6, cause insurant intentionally death, disability or illness, accident insurance, insurance scam.

 

In person insurance contract, according to the contract, the insured event of the scope of liability insurance of death, disability, illness, the insurer shall to the insurant, the insured or the beneficiary pay insurance gold. In order to achieve the purpose of obtaining high insurance, the insured person will regardless of the legal and moral constraints, rush into danger, deliberately harm accident, the insured.

 

Case:A farmer in Hebei Province, Zhaoxian County, for his dear sister insured the high accident insurance, 230000 insurance coverage, the paid a man to her sister to kill, and then to the insurance company claims, in order to achieve the purpose of defrauding insurance gold, but ultimately failed to escape legal sanctions.

 

Investigation techniques:For this purpose, the accident is a real existence, so the survey will be very difficult. In the investigation process, should pay attention to the insured accident insurance motive and the process in detail, also should cooperate with the public security organs to carry out the investigation, if necessary, can also obtain information from public security mechanism investigation.

 

Analysis of automobile insurance fraud

For the owners, automobile insurance is an important safeguard for many owners and the legitimate rights and interests of others, but now many criminals are using insurance claims the flaw on the program, with the insurance company designated repair qualified auto repair factory collusion, cheating insurance company high reparations.

 

Cases of insurance fraud related to vehicle supplier, auto repair factory, the insurance company claims, loss and other links, the criminal suspect to cheat the purpose, use unscrupulous divisive tactics, engage in fraudulent activities through various ways of minority staff collusion or by the unit and the Department of. Some common methods of motor vehicle insurance fraud:

 

1, intentionally manufacturing vehicle damage insurance accident.

 

The so-called "pengci", or fabricate has not had a traffic accident, the fictional facts, forges evidence, defrauds insurance money.

Investigation techniques:One is the analysis of field investigation, on the other hand is the survey members from the traffic police department, the insurance company shall at the scene details the scene of the accident, for accident scene photos, finally is regarding the accident related party (i.e., driver, car owners, the three car owners, the driver) for the necessary access, the whole process of a detailed understanding of the accident.

 

2, the occurrence of traffic accidents and fabricate false reason, defrauds insurance money.

 

Many traffic accidents are due to the driving without a license or driving under the influence caused by the insurance company shall, pursuant to the contract exclusions, but cheat the grantor for the others driving (i.e. replacement or fictional driver), in order to defraud insurance money.

 

Investigation techniques:Such cases are mainly concentrated in the drunken driving or driving, the survey mainly from the traffic police, insurance survey members, and both the accident related persons access to, through careful inquiry after the accident and antecedents and consequences, alarm, hospital and so on, consistency related personnel. The analysis, in addition, through the analysis of relevant phone related parties submit call list, to the community or the traffic police department to find relevant video, visit the scene of the accident personnel channel check accident the truth.

 

3, in the absence of the lost car case, its vehicle theft, swindle insurance gold.

Some vehicle purchasing pilfer rush to deal with an emergency of the insured, in order to defraud insurance company insurance compensation, clearly mark car didn't lost or stolen, but the insured person has lied about the car theft (ROB) behavior.

 

Investigation techniques:One is asked in detail about the related parties related to vehicle stolen after all on the other hand, vehicle examination entry documents submitted by the parties, the last is to cooperate with the public security departments to start the investigation (necessary from the public security access to the survey data)

 

4, the value of fictional vehicles.

 

The use of BMW, Mercedes Benz and other luxury second-hand car purchase a car cost is low, the high cost of insurance company management, parts characteristics of reparations high, through illegal means, fictional or raise the vehicle value, defrauds insurance money from.

 

Investigation techniques:Vehicle insurance coverage is mainly based on the vehicle itself value and, therefore the investigation of such cases should focus on the source and vehicle vehicle itself, so the transfer of information, the initial registration information, use fixed number of year, daily use to do a comprehensive verification analysis, to determine the vehicle real value, also should be the Insurance Company underwriting, underwriting. Department of verification, to understand what the vehicle insurance.

 

5, an accident repeatedly claim or claim to the insurance companies respectively.

 

Lie on the same accident insured, inventing a different time and place repeatedly claim to the insurance company, or will the same accident claims to different insurance company.

 

Investigation techniques:In such cases, in addition to the prudent access to related parties, is mainly completed through analysis together with the car out of the scene of the accident and collision traces and comparative analysis of the insurance company claims, claims department colleagues.

 

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Richard.luo

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