보험사기 예방 및 근절을 위한 IAIS ICP 21에 관한 연구: 보험업 감독규정에 근거한 경영실태평가제도의 비교를 중심으로

This study aimed to determine if fraud risk management and supervision by South Korean competent institutions was reasonable, focusing on principal items related to insurance fraud prevention status with risk assessment and application system based on the regulations on supervision of insurance business in South Korea as well as the recommendations by IAIS about prevention and eradication of insurance fraud. As for awareness of fraud risk, IAIS and South Korean competent authorities have the following characteristics: ICPs concerning IAIS insurance fraud prevention and eradication regard every working behavior of insurers as a potential fraud risk and recommend finding association with other ICPs. Instead of regarding a fraud risk as a single risk, they consider fraud risks of authorization and permission by insurers and regard it as a potential risk for insurance business in general. So they require fraud risk management in every stage of supervision of insurance business. They consider insurance solicitors as those causing insurance fraud and recommend reinforcing internal control for them and applying the criteria for insurance fraud prevention to insurers and insurance solicitors equally. Compared with IAIS, South Korean authorities increase post-management and reinforce relevant assessment and supervision, taking repetitive insurance frauds into account. The general recommendations of IAIS are limited to the 'system for sharing information about frauds' by the competent authorities for the level of post-management with the aim of recommending work performance by the authorities to prevent fraud risks. In contrast, South Korean competent authorities regard post-management related to insurance fraud as risk management in consideration of the continuous characteristics of insurance contract and require specific work performance.