预防发现和纠正保险欺诈的指引_Guidance_paper_on_preveting_detecting_and_remedying_fraud_in_insurance1838.pdfVIP

Guidance Paper No. 12 INTERNATIONAL ASSOCIATION OF INSURANCE SUPERVISORS GUIDANCE PAPER ON PREVENTING, DETECTING AND REMEDYING FRAUD IN INSURANCE OCTOBER 2006 This document was prepared by the Insurance Fraud Subcommittee in consultation with IAIS Members and Observers. This publication is available on the IAIS website (). © International Association of Insurance Supervisors 2006. All rights reserved. Brief excerpts may be reproduced or translated provided the source is stated. Guidance paper on preventing, detecting and remedying fraud in insurance Contents 1. Introduction4 2. Fraud risk in insurance7 2.1. Fraud triangle7 2.2. Profiles of insurance fraudsters8 2.3 Fraud risk management by insurers8 3. Internal fraud10 3.1. Internal fraud risk 10 3.2. Internal fraud prevention11 3.3. Internal fraud detection 12 4. Policyholder fraud and claims fraud13 4.1. Policyholder fraud and claims fraud risk 13 4.2. Policyholder fraud and claims fraud prevention14 4.3. Policyholder fraud and claims fraud detection 15 5. Intermediary fraud16 5.1 Intermediary fraud risk 16 5.2 Intermediary fraud prevention and detection18 6. Supporting organisational measures and procedures19 6.1 Training of boards of directors, management and staff19 6.2 Reporting suspicions of fraud20 6.3 Information exchange between insurers and other financial institutions20 7. Role of the supervisor 21 7.1 General 21 7.2 Supervision of anti-fraud measures and fraud risk management22 7.3 Cooperation and information exchange23 Appendix A – IAIS Insurance core principle on fraud25 Appendix B