보험사기방지특별법에 관한 논의와 개선 방향

As an importance of the insurance is recognized, the insurance becomes a very meaningful system for stabilizing an economic life in order to disperse risks of societies and individuals.The major adverse effect of the insurance due to a speculative characteristic of an insurance contract is an insurance crime problem such as signing an insurance contract for the purpose of receiving insurance money from the beginning, or deliberately injuring an insured person after a life insurance contract is concluded. An incident based on moral risk is contrary to the essential nature of the insurance, because it lacks the chance factor of an insurance incident. Although there are some opinions that a new addition of an insurance fraud clause and a provision of an additional punishment in the Special Act on Insurance Fraud Prevention are not different from the existing legislation and thus, the effectiveness of the new legislation is doubtful, the new legislation has been estimated to be successful to some extent to make prevention of insurance frauds to be a social issue before and after its enforcement. Even though it is expected that an examinee involved in an insurance fraud will suffer from not a little damage, the existing Act on Insurance Fraud Prevention does not provide sufficient institutional strategies needed to minimize or relieve it. Therefore, it is also required to provide an institutional strategy to minimize damages given to a policy-holder being suspected of being involved in an insurance fraud, in an investigation process about the insurance fraud. Considering the reality that there is not sufficient professional investigational agencies and personnels capable of investigating insurance fraud crimes in comparison with complexity of such insurance fraud crimes, if an investigation team which can conduct an objective investigation rather than a biased investigation by an insurance company about insurance frauds is formed, such investigation will be progressed relatively quickly and fairly, and inconvenience of many goodwill policy-holders will be minimized. In doing so, under the reality that there is not sufficient professional investigational agencies and personnels capable of investigating insurance fraud crimes in comparison with complexity of such insurance fraud crimes, an objective investigation may be conducted relatively quickly and fairly rather than a biased investigation by an insurance company about insurance frauds, and inconvenience of many goodwill policy-holders may be minimized. Therefore, it is thought that a provision of establishing a special investigation unit should be newly added into said Special Act. If the Special Act on Insurance Fraud Prevention stipulates a symbolical provision on protection of patients damaged by being suspected of being involved in insurance frauds, but the Presidential decree stipulates related cases in detail, an insurance company is allowed to refuse to pay Insurance money on the ground of an insurance incident investigation and accordingly, will be given justification for refusing to pay the insurance money, and thus, the basis for refusing to pay the insurance money are highly likely to infringe the interests of policy-holders, contrary to expectation. In addition, the Special Act does not stipulates an explicit rule on civil legal relationships, such as the effect of insurance contracts, the expiration of insurance money claims and the like in the case of insurance frauds, and also, where it is recognized to be necessary to examine whether hospitalization of an insured person (insurant) is adequate, there are insufficient institutional strategies to guarantee objectivity and fairness in the adequacy examination of hospitalization by the Health Insurance Review and Assessment Service. Legislative supplementation is needed in many of these parts. It is necessary to have an active discussion for deriving actual and effective criminal policy measures against insurance frauds through advanced prevention for efficiently eradicating insurance frauds and structural improvement effort of an insurance system but not severe punishment focused on coercive criminal punishment. This is because, even if a new insurance fraud penality is created to strengthen crackdown on and even additionally punish insurance frauds, such efforts will not be paid off unless the social system causing insurance frauds is improved.