보험사기 전담기구 설치에 관한 소고: 특별사법경찰제도 도입방안을 포함하여

Insurance fraud is an anti-social crime that exploits structural vulnerabilities in the insurance system and shifts costs onto the insurance pool as a whole; a prevention-oriented approach alone is insufficient to secure adequate deterrence. In Korea, although the enactment of the Insurance Fraud Prevention Act in 2016 and the 2024 amendments have substantially addressed certain institutional gaps, the absence of a permanent control tower equipped with standing and specialized response capabilities remains a structural limitation in light of the steadily growing scale of insurance fraud and its increasing sophistication and organization. The current response framework disperses functions among the Financial Supervisory Service (FSS), investigative authorities, insurance associations, and individual insurers, thereby constraining the collection, sharing, and utilization of information, delaying coordination between administrative inquiries and criminal investigations, and resulting in weak effective authority. Against this backdrop, this article focuses on strengthening insurancefraud detection capacity. With reference to the response systems of major jurisdictions such as the United States, the United Kingdom, France, and Germany, it examines the need to establish within the FSS a permanent body dedicated to comprehensively handling insurance-fraud matters, including policy development, education and public outreach, risk-signal detection and data analytics, the prompt referral of cases and investigative support, and related legal and institutional reforms. In particular, while insurance-fraud cases often hinge on rapid evidence preservation and expert analysis at the initial stage, investigative authorities in practice tend to prioritize resource allocation toward violent and other serious crimes, making it difficult to build and sustain specialized investigative capacity for insurance fraud on a continuous basis. Accordingly, the proposed dedicated body should be designed to ensure expertise and speed beyond the scope of a simple administrative fact-finding function, and, as a measure to enhance its effectiveness, this article proposes linkage with a special judicial police (SJP) system. At the same time, granting investigative functions to FSS personnel may raise concerns about abuse of authority. It is therefore essential to put in place safeguards that secure due process and protect fundamental rights, including organizational separation between supervisory/examination functions and investigative functions, strict limitation of the scope of duties, mandatory compliance with investigative guidelines and job training, control mechanisms including prosecutorial direction and supervision, internal audits, and an oversight framework involving external experts. Ultimately, insurance-fraud enforcement can achieve stronger deterrence only by moving beyond the limitations of one-off crackdowns or ad hoc, non-permanent organizations and by establishing an integrated governance framework in which a permanent specialized body endowed with meaningful authority and accountability coordinates and links prevention, detection, and punishment.