保险公司应对欺诈的诉讼研究

有效应对保险欺诈对保险公司具有重要价值,可以防止因欺诈识别错误而承受惜赔责难。通过对北京某人寿保险股份有限公司2005～2010年诉讼、和解的调研数据进行描述性统计和回归分析,结果发现:投保方索赔欺诈是个不争的事实,媒体关于保险公司败诉的报道夸大了保险公司惜赔程度,保险公司诉讼基本是理性行为。而且,城区投保方索赔欺诈,远甚于郊区县;与寿险相比,意外险、健康险更容易引发索赔欺诈;投保方比保险公司更愿意上诉。

On the Lawsuits for Insurance Companies to Fight against Insurance Frauds

It is essential for insurance companies to fight against insurance frauds effectively,which can prevent the blames on underpayment due to the mistakenly identified frauds.This article describes the statistics and makes regression analyses on the data of the lawsuits and conciliations in a Beijing-based life insurance stock limited company during the period from 2005 to 2008.It finds an indisputable fact that the insurance applicants make fraudulent claims.The underpayment has been exaggerated by media which report the lawsuit failures of insurance companies.The lawsuits made by insurance companies are basically rational.Moreover,the fraudulent claims are more severe in cites than in suburbs.Compared with life insurance,accident insurance and health insurance are more prone to fraudulent claims.The insured applicants are more willing to make an appeal than insurance companies.