독일 법제를 통해 본, 보험사기 방지에 관한 연구

In South Korea, there is a deep recognition of the distinctiveness of insurance fraud, which differs from general fraud, as well as the social harm it causes. In response, the Special Act on the Prevention of Insurance Fraud was enacted in 2016, aiming to combat insurance fraud with a strong approach. However, in 2022, the amount of detected insurance fraud reached a record high of KRW 1.818 trillion, indicating that insurance fraud is becoming increasingly sophisticated and evolving into organized crime. 94.6% of the total detected amount is related to excessive (false) hospitalization and medical expenses. The fact that there is a concentration of soft fraud, where claims exaggerate the actual damages when seeking insurance benefits, in the field of property insurance highlights the need to pay attention to legislative and judicial measures in order to prevent insurance fraud. This paper primarily focuses on analyzing Germany’s insurance fraud prevention legislation, which has had a significant impact on the development of insurance laws in countries like South Korea and Japan. The main objective is to address the vulnerabilities in the establishment and implementation stages of insurance contracts that can lead to insurance fraud incentives. Specifically, the occurrence of insurance fraud will be divided into the following stages: 1) the stage of insurance contract conclusion, 2) the stage of insurance accident occurrence, and 3) the stage of insurance accident notification and claim filing. By comparing the regulations and systems of Germany’s criminal law, special laws, insurance laws, civil laws, etc., the paper will assess the applicability to our legal system.