Our reporter Leng Cuihua

　　Nanning police recently released news that they successfully cracked a family-style insurance fraud case.

A gang member first purchased personal accident insurance from a number of insurance companies, then self-injured and self-harmed, hospitalized, and then forged invoices to initiate claims to the insurance company, defrauding millions of yuan.

　　Industry insiders believe that the reason why accident insurance has become a tool for criminals to defraud insurance is that it has a high leverage attribute; the second is the lack of risk control of insurance companies; the third is that some personnel are indifferent to the law.

To solve this problem, we need to work together.

　　Exposure of fraudulent methods

　　According to the details of the case reported by the Nanning Police on February 18, in July last year, the Xixiangtang Branch of the Nanning Public Security Bureau received a report from the Guangxi Insurance Association that Song Moumou and other 7 people were purchasing personal accident insurance from a number of insurance companies. Soon after, he was hospitalized due to his injuries. After he was discharged from the hospital, he forged a hospital invoice and filed a claim with the insurance company and received compensation. The amount involved in the case was more than 500,000 yuan.

　　After receiving the case, the Nanning police investigation found that the case was committed by a family-style insurance fraud gang headed by Yang Moumou, and his wife, daughter, and son-in-law were all members of the gang.

Yang Moumou has many years of experience in the insurance industry and is familiar with the insurance claims process and industry loopholes. He was sentenced to fixed-term imprisonment twice for the crime of insurance fraud.

　　The investigation found that the gang’s modus operandi is mainly divided into four steps. The first step is to identify people with bad criminal records or illnesses who have an urgent need for funds, and use “free treatment and remuneration” as the bait to lure people successively. The criminal suspect Song Moumou and others joined the fraud gang; the second step was to insure the gang members; the third step, the gang members self-injured and admitted to the hospital; the fourth step, forged invoices to apply for insurance claims.

　　According to the police handling the case, the insurance fee for criminal suspects is generally one or two hundred yuan. If they are injured and hospitalized, they can receive insurance compensation of 10,000 to 15,000 yuan. Then they apply for compensation to multiple insurance companies by forging invoices, and they can cheat insurance of 200,000 yuan at a time. to 300,000 yuan.

　　According to police verification, the case involved 8 cities and counties in 5 provinces (autonomous regions) including Henan, Guangxi, and Guangdong, and the amount of fraudulent insurance was as high as one million yuan.

　　Why does accident insurance become a tool for criminals to cheat insurance?

Li Shitong, co-founder of BestLawyers, told the "Securities Daily" reporter that there are three main reasons. First, accident insurance has the characteristics of lower premiums and higher insured sums, and its high leverage attribute makes the cost of fraudulent insurance lower for criminals; Some insurance companies have relatively weak risk control in the underwriting process, or have limited risk control methods; third, some places, especially remote areas, are chaotic in terms of medical management, leaving opportunities for insurance fraud.

　　Reducing fraudulent insurance requires multi-party efforts

　　From the perspective of insurance companies, the price of accident insurance is very cheap, and most of them are sold through third-party channels, and insurance companies actually collect less premiums.

In addition to normal compensation, insurance companies also face the problem of insurance fraud, which adds another layer of pressure to accident insurance operations.

　　The industry data obtained by the reporter shows that from 2018 to 2020, the underwriting profits of property insurance companies operating accident insurance were -1.110 billion yuan, -923 million yuan and -158 million yuan respectively, and the underwriting profit margins were -3.18% and -1.94 yuan respectively. % and -0.32%.

Although the proportion of underwriting losses of property and casualty insurance companies is gradually shrinking from a vertical perspective, the industry will still be in a state of operating losses until 2020.

　　To improve the operation of accident insurance, we need to carry out many aspects of work, one of which is to do a good job in insurance anti-fraud work and reduce potential losses.

The reporter found through the Judgment Documents website that from 2011 to 2021, the number of insurance fraud cases were 7, 31, 113, 449, 616, 742, 756, 883, 923, 1035, 557.

Although this data is not precise data, the changing trend of insurance fraud in recent years is evident.

　　So, how to do insurance anti-fraud work?

Li Shitong believes that we need to work together from three aspects. First, insurance companies need to improve their awareness of risk control, conscientiously implement the guidelines for anti-insurance fraud organizations in the insurance industry, and do not relax underwriting risk control for the sake of business.

The second is to promote industry information sharing.

It is necessary to promote information sharing in a reasonable and legal way in terms of mechanism, so that information can play a role in risk control.

The third is to promote insurance companies to access the central bank's credit information system, and to inquire about the credit information of policyholders during the underwriting process, so as to prevent risks from the front end.

　　According to reports, in reality, due to the difficulty of sharing industry information and accessing the central bank's credit information system, some insurance companies with strong risk control awareness generally exchange information by "building groups" when underwriting. , the insurance company learns the behavior of the policyholder by asking the peer company. If the policyholder's cumulative limit in different insurance companies "exceeds the standard", the relevant business will not be covered.

　　Strengthen legal awareness

　　In response to insurance fraud, industry insiders generally said that both insurance companies and the general public should strengthen their legal awareness and abide by the law.

　　"Once you commit insurance fraud, you will violate the criminal law, and its nature is very serious." Li Shitong said.

According to Article 198 of the "Criminal Law of the People's Republic of China", those who engage in insurance fraud activities will be sentenced to imprisonment or criminal detention of different periods and a fine according to the amount.

　　It is worth noting that anyone who defrauds insurance money through the following acts is an insurance fraud: the insured deliberately fabricates the subject matter of insurance; the insured, the insured or the beneficiary fabricates false reasons for the insurance accident or exaggerates the extent of the loss; The insured, the insured or the beneficiary fabricates an insurance accident that has never happened; the insured or the insured intentionally causes property damage; the insured or the beneficiary intentionally causes the insured to die, be disabled or sick.

　　According to industry insiders, in reality, the phenomenon of exaggerating the extent of losses in insurance claims is relatively common, and the relevant personnel do not realize the seriousness of its nature.

Therefore, it is also very important to strengthen legal education and let the public know and abide by the law to reduce insurance fraud.

(Securities Daily)