보험사기의 억제에 관한 법적 고찰

Abstract

【Abstract】

A Study on the Legal Control to the Insurance Fraud

Kim, Hyun-Woo Advisor : Prof. Kim, Jae-Hyeong, Ph.D. Department of Law, Graduate School of Chosun University

Nowadays people live in a wide variety of risks. Insurance is the system that was created as a precaution to minimize a sudden financial loss that can occur due to all kinds of risks such as accidents or diseases. Despite so useful insurance, insurance crime is increasingly exploiting the insurance system. John D. Long listed the following several factors about the reason why insurance crime is growing rapidly: changes in the economic system, long-term inflation, population issues, resources issues, pollution problems, medical and scientific advances, shortening of working hours, and enhanced interest in health and leisure. As harmful consequences of soaring insurance crime are getting serious, countries around the world are making efforts to devise a hedge against insurance crime and Korea is also not an exception. For these reasons, this thesis aims to examine representative laws which are related to insurance fraud, to investigate problems of each related laws further, and to suggest solutions to the problems. To find solutions, the laws which are related to insurance fraud were examined as follows. First, this study examined the improvement in the civil law provisions. Second, including introduction of the famous principle of utmost good faith in terms of commercial law, revision of the commercial law provisions was reviewed in detail. Also, the problems and improvement for each of the regulations were carefully examined. Third, this study examined revision process of insurance law and arrangement of legislative regulation for the revision process. Fourth, this study examined a recent serious problem of bogus patients on Guarantee of Automobile Accident Compensation Act. The problems and improvement in provisions of the act were examined, too. Fifth, with respect to criminal law this study examined the need of regulating insurance fraud as a crime and the application of insurance fraud to Act on the Aggravated Punishment, etc. of Specific Economic Crimes. There are also institutional countermeasures besides regulation of related laws. It is being promoted to legislate private investigation system, detective system, which is famous in the USA. In recent years Special Investigation Unit, SIU, was installed to strengthen authority and position of insurance companies. Special Investigation Unit strengthens cooperation with relevant agencies and devotes all its energy into preventing insurance fraud. However, the public awareness of serious insurance fraud is in need of change and it is more important than the above legislative and institutional regulation. Therefore, it is necessary to examine and make good use of systems of advanced countries to change the public awareness of insurance fraud. For example, in the UK, Australia, the USA and Canada, governments produce public advertisements for TV and newspapers at national level to explain that insurance fraud eventually causes damage to all citizens as well as a large number of innocent policyholders. In addition, the governments conduct a certain amount of education about insurance fraud to those who are related to insurance fraud when they acquire or renew a driver's license. The government also enroll promotional expressions for the prevention of insurance fraud on health insurance notice of payment and add some education about insurance fraud in construction basic safety education area by the industrial accident compensation insurance. With public relations and a detailed approach, the governments have led changes in public awareness of insurance fraud. Recently Korean government has made various efforts at national level but it should not stop at this much. The government will have to lead changes in public awareness of insurance fraud more actively.