general rule
Article 1 These Guidelines are formulated in accordance with the Insurance Law of People's Republic of China (PRC), the Criminal Law of People's Republic of China (PRC) and other laws and regulations in order to enhance the overall risk management capability of the insurance industry and prevent and resolve the risks of insurance fraud.
Article 2 Insurance institutions mentioned in these Guidelines refer to insurance group (holding) companies, insurance companies and their branches established with the approval of China Insurance Regulatory Commission (hereinafter referred to as China Insurance Regulatory Commission) and its dispatched offices (hereinafter referred to as dispatched offices). Insurance professional intermediaries, reinsurance companies and other institutions with anti-insurance fraud functions shall carry out anti-fraud related work with reference to these Guidelines.
Article 3 Insurance fraud (hereinafter referred to as fraud) refers to the act of seeking illegal benefits under the guise of insurance or using insurance contracts, mainly including insurance premium fraud, illegal insurance business fraud and insurance contract fraud. Unless otherwise specified, the fraud mentioned in these Guidelines only refers to insurance fraud, mainly including deliberately fabricating the subject matter of insurance to defraud insurance money; Fabricating an insurance accident that has never happened, fabricating a false cause of the accident or exaggerating the degree of loss to defraud insurance money; Deliberately causing an insurance accident and defrauding insurance money, etc.
The insurance fraud risk mentioned in these Guidelines (hereinafter referred to as fraud risk) refers to the risk that fraudsters engage in fraudulent activities and cause economic losses or other losses to the insurance industry, insurance consumers and the public.
Article 4 Anti-fraud work aims at protecting the legitimate rights and interests of insurance consumers, maintaining the order of the insurance market and promoting the healthy development of the insurance industry.
Article 5 The China Insurance Regulatory Commission and its dispatched offices shall supervise the fraud risk management of insurance institutions according to law.
Article 47 of Chapter 4 of the Guidelines aims to establish the insurance fraud risk management norms and anti-fraud technical standards, and further prevent and resolve the insurance fraud risks. Focus on the following aspects:
First, it is clear that insurance institutions bear the main responsibility for fraud risk management. Insurance institutions are required to establish and improve the fraud risk system and organizational structure, clarify the roles, responsibilities and reporting paths of the board of directors and its special committees, the board of supervisors (supervisors), management and relevant departments in fraud risk management, standardize operational procedures, improve basic data and information systems, strictly implement the assessment and accountability system, properly handle fraud risks and fulfill reporting obligations.
II. Clarify the responsibilities of the CIRC and its dispatched offices. It is clear that China CIRC and its dispatched offices shall supervise the fraud risk management of insurance institutions according to law, and play the role of planning, coordination, guidance and supervision in anti-insurance fraud. China CIRC and its dispatched offices are required to regularly check and evaluate the soundness and effectiveness of the fraud risk management system of insurance institutions, and continuously supervise the fraud risk management of insurance institutions through regulatory rating, risk warning, notification and interviews.
The third is to clarify the responsibilities of each unit in the anti-fraud cooperation mechanism. It is clear that the CIRC and its dispatched offices should improve the departmental and regional cooperation mechanisms to combat and punish insurance fraud, and build a framework system for cross-border and cross-regional exchanges and cooperation. Insurance institutions, insurance industry organizations and China Baoxin are required. Under the guidance of the CIRC and its dispatched offices, we should carry out in-depth industry cooperation, build a mechanism for data sharing and fraud risk information exchange, deepen theoretical research, academic exchanges and international exchanges, jointly carry out industry actions, and strengthen cooperation in risk management.