Key word.Insurance claims in insurance fraud
   [AbstractTo]Since China restored the domestic insurance business, the rapid development of the insurance industry. However, at the same time, the rapid development of auto insurance has insurance concern - fraud. According to the statistics, China automobile insurance fraud amount each year about stands for the sum of 20%, thus caused by fraud future Juxian rate broke surface will damage the interests of insurance consumers.
   The author of this article by the China insurance market fraud situation analysis, in view of the present situation to give advice and suggestions, put forward some solutions to China's auto insurance fraud countermeasures and suggestions, for the majority of insurance practitioners reference.

One, the current our country insurance market fraud situation

The current insurance is the insurance fraud losses suffered the most serious, show Insurance Regulatory Commission statistics, in the city of Beijing2000Years-2006Years, fraud caused insured losses of about28Billion yuan. Vehicle insurance fraud there is a direct result of our country insurance payment rate maintained at a relatively high level.

2004Years4Month, CIRC Beijing Bureau announced:2003The insurance company of Beijing23About auto insurance claims billion yuan in20%-30%Belongs to the fraud, the insurance rate is used in non life insurance actuarial technology, auto insurance rate is based on the historical data of actuarial risk determined, therefore caused by fraud future Juxian rate broke surface will damage the interests of insurance consumers.

Two measures, to solve our country insurance fraud problem

(a) the solutions proposed insurance company external personnel involved in the fraud

The insurance company external personnel involved in the fraud has three factors: one is the fraud success in the interests of; two is fraud is found the punishment; three is the insurance company to identify fraud levels.

1, reducing the external personnel involved in the fraud profits

(1Use of the automobile industry chain thinking)

At present, the majority of fraud are implemented through loss of car, car parts and repair cost is high and low level of cheating lose interest, thinking from the perspective of the industrial chain of automobile insurance, automobile insurance and automobile manufacturing, vehicle maintenance and repair is an important link of the automobile industry chain, automobile insurance should be strengthened and the auto industry cooperation, such as the industry has implemented protocol repair factory mode, open the property insurance companies in the automotive repair industry for bidding, and to restrict its spare parts and repairs, reduce the accident occurred insurance car parts and repair costs, thereby reducing the claim amount, and then reduce the insurance company the external personnel involved in the fraud profits.

(2Establishment of real time update) perfect car spare parts quotation system

Auto parts price is the key of vehicle insurance, insurance company insurance departments to establish real-time updates for the car to improve spare parts quotation system, help the insurance company to fully grasp the true auto parts price, and to give the insured automobile improve security and reduce the loss of gold, but also reduce the participation of insurance fraud Chinese foreign ministry staff benefits.

2Increased the penalties, external personnel fraud was discovered by

(1To strengthen the legal sanctions)

China's "insurance law" article138Article: "the insured, the insured and beneficiary of the insurance fraud, which constitutes a crime, shall be investigated for criminal responsibility according to law. The insurance company to found fraud case, according to the insurance law to terminate the insurance contract and does not return the insurance premium." For large fraud case and serious fraud case, the insurance company should be through the judicial public prosecution, the typical case role specification of automobile insurance market, deter illegal cheats compensate staff, so that its role in fraud losses become large and stop fraud activities.

(2The public opinion pressure)

To be found fraud involved, should be regularly given announced through the media, are critical to guide social the dishonest behavior, make fraudulent claims personnel social reputation, promote its is no longer involved in the fraud, and for other fraud also play a deterrent role.

3To improve the ability of recognition, the insurance company fraud levels

(1Credit information exchange platform to build) insurance property insurance industry

2006At the end of the year, seven insurance companies Chinese Bao, Chinese peace for the first time to set up "anti fraud network service platform", the company claims database will be the first to realize the sharing, the computer will automatically analysis, determination, suggesting fraud suspected cases, effectively raising the level of recognition of fraud. China has not yet been auto insurance information exchange platform, if the platform can be successfully established, can greatly improve the recognition of frauds, effectively prevent fraud gangs, and promote the healthy development of the insurance industry.

(2Vehicle insurance fraud) set up a special report telephone, verifying the circumstances give prizes to report the masses

The insurance fraud report telephone set, use of social forces, strengthen the fraud case information collection ability, increase the insurance company for the whole case comprehensive, correct understanding, is conducive to the insurance company and accurate decisions.

(3) to strengthen the occupation skill training claims personnel, improve the professional quality of the Claims Officer

At present our country insurance system mainly for internal claims department insurance companies, therefore, to improve the claims officer occupation skill, improve the professional quality of the Claims Officer is the priority among priorities to improve the insurance company that cheats compensate level.

(two) the solutions proposed insurance company claims personnel involved in the fraud

In our current system of insurance claims, claims personnel involved in the fraud has the following two aspects or factors: one is the incentive mechanism of the Claims Officer compensation; two is the insurance company the retrial system.

1Establish reasonable incentive mechanism, the Claims Officer

(1The claims officer salary)

Improve the basic wage claims personnel, thus making the Claims Officer cherish jobs, increase participation in the fraud of opportunity cost, and can cause other departments of supervision of its. The claims officer salary subsidies by six parts of basic salary, allowance, commission, bonus, Sanjin, business survey.

(2Set claims bonus)

Set the Claims Officer monthly salary bonuses, prize money and claim amount. The formula is as follows:

Monthly salary = a * (proportional coefficient1+ the benchmark rate of payment-The actual compensation rate), the proportion coefficient here specific scope of certain to be insurance companies according to their actual situation estimation.

(3The establishment of special bonuses) refused to fraud

Refuse to claim special bonus has important significance, his presence probability in a certain sense can make claims personnel involved in the fraud is greatly reduced, and to some extent can incentive the Claims Officer strengthen their ability to identify fraud, its value should be with the fraud cases of difficulty and the amount of the claim size, that is to say fraud more difficult, involving greater add award amount, the specific range by the claims department according to the actual situation of the case to estimate.

(4The establishment of insurance) claims personnel accountability system

The establishment of the system of investigating the responsibility of insurance claims, was found to be involved in the fraud claims personnel, for the first time offenders can only on the monthly wages for punishment, as a warning; the repeated fraud insurance company should be quickly dismissed, never palliative, and its inclusion in the industry blacklist, to the future in the insurance industry can not be engaged in the work of.

2Insurance companies, improve the system of retrial

(1The establishment of claims department)

The claims officer work claims the supervision department supervision and the two survey, which claims department members of the insurance companies have been relegated to second-line Claims Manager, with professional knowledge of its rich experience and claims of the claims, strictly review part, this approach can not only improve the claims officer level, more it is important to supervise the Claims Officer, the moral risk prevention.

(2The establishment of leadership claims) examination and approval system

Leadership approval system mainly refers to each claim, must pass through the company leadership approval to pay. Leaders claim approval system can effective deterrent to participate in fraud idea claims personnel, is to improve the level of system guarantee a claim.