A criminal gang composed of more than 70 members who committed dozens of crimes and defrauded more than 7 million yuan in just a few years has surfaced——
Big data collides with a series of fraudulent insurance cases of "people hurt scalpers"
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Due to the many links and complicated procedures involved in the settlement of traffic accident claims, a special group has emerged in the society - the intermediary of traffic accident claims, also known as "human-injured scalpers".
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In order to obtain more compensation, some "human-injured scalpers" conspired with a small number of injury appraisers and individual litigation agents to "raise" the level of disability. Defrauding insurance companies to pay more than they should.
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The investigators used civil judgments and injury appraisal opinions involving disputes over liability for traffic accidents as a breakthrough. After establishing a digital model, they found that these cases showed a concentration of litigation agents or injury appraisers. Objection was raised.
Through the collision and comparison of big data, the investigators found the connection in the insurance fraud case of "Human Hurts to Scavengers", and brought the members of the insurance fraud gang to justice.
More than 70 defendants were convicted for the crime of insurance fraud after a public prosecution by the Shanghai Pudong New Area Procuratorate.
On June 28 this year, a series of false litigation civil supervision cases were transferred to the court by the Pudong New Area Procuratorate, along with procuratorial suggestions for retrial of the series of cases.
At present, relevant cases are being further processed.
An anomalous data caught the attention of prosecutors
"An insurance company reported that some traffic accident victims may have falsified in the process of personal injury claims, in order to defraud more insurance claims. Due to the complexity of the case and the large number of people involved, we intervened in advance to guide the investigation as soon as possible." Luo Zaozhi, prosecutor of the Pudong New Area Procuratorate recalled.
During the early stage of investigation, an abnormal data caught the attention of the prosecutor: after comparing the city's traffic accident claims amount and disability rate with similar data from other provinces and cities, it was found that the results were significantly higher.
"It's not a little higher, but several times higher, which we think is abnormal." Luo Zaozhi said.
By further sorting out the case, the prosecutor found other clues: the modus operandi was similar, and they all obtained higher compensation by "higher" the disability level.
However, why do so many injured people who have no intersection with each other adopt the same method invariably?
With this question in mind, the investigators decided to use big data to "collide" to reveal the truth.
They used civil judgments and injury appraisal opinions in cases involving traffic accident liability disputes as a breakthrough, established digital models, conducted collision comparison and correlation analysis, and found that these cases showed a concentration of litigation agents or injury appraisers, and insurance companies Most companies have raised objections to the injury appraisal.
"Agents ad litem and injury appraisers are the two key factors we found." After that, the investigators conducted a big data search, screening and comparison of civil judgments involving these two factors, and found more suspected insurance fraud In cases of disputes over liability for traffic accidents, the injury appraisal was rearranged one by one.
As a result, a gang of "Human Husbands", consisting of more than 70 members, committed dozens of crimes in just a few years and defrauded more than 7 million yuan, surfaced.
Initiate civil litigation supervision and issue retrial procuratorial recommendations
Due to the many links and complicated procedures involved in the settlement of traffic accident claims, a special group has emerged in the society - the intermediary of traffic accident claims, also known as "human injury scalpers".
They are familiar with the claims process, and they specialize in claim settlements for accident victims and collect service fees from them.
In order to obtain more compensation, some "human-injured scalpers" conspired with a small number of injury appraisers and individual agents ad litem. Opinion, by filing a civil lawsuit, deceive the insurance company to pay more than it should pay.
When reviewing this series of insurance fraud cases, the prosecutors of the criminal prosecution department of the Pudong New Area Procuratorate promptly transferred the false litigation clues involved to the civil and administrative procuratorial departments, and shared the evidence materials immediately, which greatly improved the efficiency of case handling.
The prosecutor of the civil administrative procuratorial department initiated civil litigation supervision in accordance with the law, obtained the dossier materials of the original trial and the relevant criminal file materials, listened to the opinions of the parties, and organized two centralized public hearings.
The review confirmed that the level of disability constituted by the injured persons identified in the injury appraisal opinion in the original trial was inconsistent with the actual situation after re-appraisal, which was sufficient to prove that the civil cases involved in this series of insurance fraud cases were false lawsuits.
"Their exaggerated descriptions of the injuries and disabilities of the injured have led the court to accept these false injury appraisal opinions, and made excessive determinations on disability compensation, lost work fees, and nursing expenses." Issue a retrial prosecutorial recommendation to the court.
Traceability governance promotes industry standardization and rectification
In fact, as early as November 2021, the Ministry of Justice and the China Banking and Insurance Regulatory Commission jointly issued a notice to put forward clear requirements for forensic appraisal of insurance claims, emphasizing that forensic appraisal institutions and forensic appraisers must not issue false appraisal opinions, seek illegitimate interests, etc. For violations of laws and regulations, insurance institutions and parties are encouraged to jointly entrust appraisals, and insurance institutions are encouraged to send personnel to witness when conditions permit; judicial administrative organs at all levels and banking and insurance regulatory departments at the same level are required to build a joint law enforcement mechanism to severely crack down on parties , "Human injury to scalpers", "Judicial scalpers" colluded to manipulate judicial authentication to conduct insurance fraud and other violations of laws and regulations.
In response to the regulatory loopholes found in the handling of the insurance fraud case of "Human Husbands", the Pudong New Area Procuratorate's Criminal Procuratorate and Civil Administrative Procuratorate issued procuratorial recommendations to the relevant authorities, urging them to carry out special inspections. , self-examination and self-correction of illegal and non-compliance problems existing in the industry have been adopted.
At the same time, the Pudong New Area Procuratorate held a symposium with some law firms and injury appraisal agencies, suggesting that law firms and injury appraisal agencies strengthen professional ethics education, establish and improve internal professional management systems, and actively accept social supervision.