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MBA硕士论文_车险人身伤害保险欺诈风险的防控研究DOC

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文本描述
摘要
近年来,改革开放带来经济腾飞,国内人民生活水平节节高升,汽车这一
曾经的高档消费品越来越多的进入家庭消费领域。随之而来,国内财险公司数
量和规模都高速发展,车险业务快速膨胀,同时也增加了理赔欺诈风险的监管难
度。车险经营一直处于亏损边缘,很重要的原因之一就是在于车险欺诈的泛
滥。目前占财险总保费收入 70%左右的车险保费收入中,人伤案件数量占比不足
1 /4,但赔款占比却超过 1/3。研究车险人身伤害保险反欺诈有重要意义

本文在对车险理赔欺诈和风险识别的国内外现状进行综述的基础上,分别
概述了车险人身伤害保险欺诈的概念、成因、特点及危害;紧接着以 R 财险公
司特别是宁波市分公司为例,从业务、组织、流程角度分析了 R 财险公司车险
理赔的现状及车险人伤欺诈风险防控的现状和不足;之后结合现实中车险人身
伤害反欺诈成功案例,从欺诈实施主体角度,即被保险人欺诈、内外勾结欺
诈、第三方欺诈分析了车险人伤欺诈的主要表现形式;最后,结合我国车险市
场的实际情况提出了符合我国国情的车险人伤欺诈防控对策。保险业的欺诈平
均损失大约在 10%-30%,反欺诈已成为财产险公司理赔工作中的重点。财产保险
公司经营面对的诸多难题中,识别车险市场欺诈特别是人伤欺诈的风险因素,
减少损失、管控风险,肯定是位列其中的;因此,车险人伤欺诈防控研究也就
显得十分有意义

关键词:机动车辆,人身伤害,保险欺诈,R 财险公司II
Research on the Prevention and Control of Personal Injury
Insurance Fraud -In The Case Of R Insurance Company
Abstract
In recent years, with the economic development and the growth of people’s living standard
brought by the reform and open up, motor vehicle has become more and more common in each
family’s consumption. Meanwhile, the motor vehicle insurance has witnessed its rapid growth as
well as the premium of the insurance companies and the quantities of newly-established insurance
companies. However, the motor vehicle insurance has always been on the edge of deficit mainly
because of the widespread of motor vehicle fraud. At present, motor vehicle insurance premium
takes about 70% of the total premium among which the personal injury cases account for less than
one fourth with the claim accounted for more than one third.So it is of great significance to study
the anti fraud of personal injury insurance.
This paper summarizes the present situation of insurance fraud and risk identification at home
and abroad, the causes of personal injury insurance auto insurance fraud are overview,
characteristics and hazards; followed by the R property insurance company, especially Ningbo City
branch as an example, from the business process, organization, analysis of the R Property
Insurance Company Auto insurance claims the current situation and the auto insurance fraud risk
prevention and injury status; after the combination of the reality of personal injury insurance fraud
case, from the angle of the main body of the implementation of fraud, namely the insured fraud,
collusion fraud, third party fraud analysis of auto insurance injury mainly in the form of fraud.
Finally, combined with the actual situation of China&39;s auto insurance the market presents the auto
insurance fraud injury prevention and control measures in line with China&39;s national conditions.
The average fraud loss of the insurance industry is around 10% to 30%. Therefore, anti-fraud has
become the priority for the insurance company. Among the various problems, the recognition of
fraud is certainly on the insurance company’s list as well as risk control and loss decreasing. All the
above forms the meaningful research in this thesis. In brief, strengthening the control of motor
vehicle claim and the analysis of influential aspects of the fraud is significantly important in
building the harmonious society.
Key Words:Motor Vehicles, Personal Injury, Insurance Fraud, R Insurance CompanyIII
目 录
1.绪论1
1.1 选题的背景和意义..1
1.1.1 选题背景......... 1
1.1.2 选题意义......... 2
1.2 国内外研究综述....... 2
1.2.1 国外研究综述2
1.2.2 国内研究综述3
1.3 研究思路和方法....... 4
1.4 论文的创新和不足... 4
2 机动车辆保险人身伤害保险欺诈概述 .... 5
2.1 车险人伤保险欺诈概念界定 .......... 5
2.1.1 欺诈的界定..... 5
2.1.2 机动车辆保险人伤欺诈的界定 ....... 6
2.2 车险人伤欺诈的成因........... 6
2.2.1 险种本身的原因 ........ 6
2.2.2 保险公司及行业自身反欺诈及管理能力不足 ...... 7
2.2.3 社会因素......... 8
2.2.4 调查和惩罚力度不足 8
2.3 车险人伤欺诈的特点........... 9
2.4 车险人伤欺诈的危害......... 10
2.4.1 对保险人和被保险人的影响.......... 10
2.4.2 经济方面的影响 ...... 10
2.4.3 社会方面影响 .......... 10
3 R 财险公司车险人伤现状和问题分析——以宁波市分公司为例...... 11
3.1 R 财险公司概况 ...... 11
3.2 R 财险公司车险人伤理赔现状 ..... 11
3.2.1 R 公司车险理赔业务的现状........... 12IV
3.2.2 R 公司车险理赔组织和流程的现状 .......... 13
3.3 R 公司车险人伤理赔欺诈风险防控现状和不足15
3.3.1 车险人伤欺诈风险防控的现状 ..... 15
3.3.2 车险人伤欺诈风险防控的不足 ..... 17
4 车险人伤保险欺诈的典型案例分析 ...... 19
4.1 被保险人主动实施的欺诈19
4.1.1 伪造人身伤亡案件实施欺诈.......... 19
4.1.2 调包逃避责任免除 .. 20
4.2 内外勾结,骗取保险金...........
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