. 1. 45),,,. (N ICB), (CAIF),, (IRC : Insurance Research Cou ncil), III(In surance Inform ation Institu te), CAIF, Connin g & Com p any. Conning - 1996 Conning frau d Survey 46) - (IRC). Conning s Survey 1996 2 250 (property-casualty comp anies) 250 - (life-health companies).. 47) (violent crime), (economic crim e) 45) 1996 Conning F raud S urvey. Conning Insurance Research & Publications, Insurance F raud- The Quiet Catastrop he 1996. 46) < 3>. Con nin g' s Su rvey. 47) Con nin g & Com p any, Insuran ce Fraud- The Quiet Catastrophe, p.31. - 34 -
(social crim e)... (intensity).... 48). < 2> (as sault ) (m urder ) (rape) (robbery ) (ar son ) (burglary ) (em bezzlem ent ) (forgery ) (Fra ud), (theft ) (Loitering ) (w eapons ) : Con nin g & Com p any, p.18. 48) M others A gain st Dru nk Drivers(MADD)", "Don 't Be a Litter Bu g". Connin g & Com p any, p.17. - 35 -
,,,.., (p adding)..... Conning's Survey. < 3> / Sem i-. 1) - 36 -
. 80%, 4 3. - 52%. < 1>. 2) 74%, - 64%.. FBI Uniform Crim e Report 1989 290,000 1985 251,000 15.5%. 1990 1994 5-37 -
18.2%., 49) Conning s Survey ( 71%, - 88%) 3. 50) < 1> < 2> < 3>. < 2>? 49),. 50) Con nin g In su r ance Research & Pu blication s, Insurance Fraud- The Quiet Catastrophe 1996. p.7 8. - 38 -
.,.,. Conning. < 3> 3? - 39 -
. IRC 28%(1995) 40%(1997) (deductible) (claim pedding, ), 24%(1995) 36%(1997).,. 51) CAIF 1997 60%, 3 1. 52)., 25% 250, 1994 15. < 4> (1994) 24,074,261 6,018,565 $1,504,641,300 : ISO, A.M. Best, Connin g & Com p any. 51) Connin g & Com p an y, p.25 ; In su rance Inform ation In stitu te, Insurance Issues update, 1999.1. 52) III, p.11. - 40 -
32%, (withholding information), 53), 20%. < 5> 21.,. 32 % 32 % 28 % 23 % 21% 21% 20% 14 % 12 % 11% 9 % 8 % 6% 5 % : In su ran ce Research Cou ncil, Con nin g & Com p any, p.27,. 53) IRS 1992 630. - 41 -
,,. < 6> 18-24 25-29 30-34 35-44 45-54 55-64 65+ 31% (withholding information) (ded u ctible) 26% 22 % 25 % 16% 25 % 21% 19 % 18 % 12 % 32 % 29 % 28 % 26% 20% 34 % 30% 26% 23 % 19 % 29 % 24 % 18 % 22 % 15 % 29 % 24 % 22 % 24 % 12 % 32 % 24 % 17% 26% 14 % 20% 16% 13 % 14 % 11% 20% 17% 16% 13 % 9 % : In su ran ce Research Cou ncil, Con nin g & Com p any, p.28,. 1997 CAIF 31%, 22%, ( ) 26%. 54),, (44 ) 55). 54) In su r an ce Inform ation In stitu te, p.11. 55) 39. Insurance Information Institute, p.3. - 42 -
. (de d uc tible) 3. (deductible) 56),,. 57). Conning 43%, 29%. 83%, 88%.. 56)..,,, 1999, p.1. 57),. - 43 -
< 4>. < 5>? - 44 -
. 3 ( ) 58). - 40%. < 6>. 58) (extern al frau d) (, ). (intern al frau d),. - 45 -
< 7>. 83% - 92%. -. - 70%, 28%.. 33% (major to m oderate problem), 21%. - 46 -
-. < 8>? < 9>? - 47 -
. (S IUs ). 3 1, 3 1, 3 1. 59) (Special Investigative Units, SIUs).. IRC SIU 1983 21% 1992 62%. 1996 Conning 250 75% SIU. - SIU. - SIU 48% 68%. 60) SIUs 75% 1993. SIUs, (International Association of Sp ecial Investigative Units, IASIU) 61) 1992 820 1996 2,989 265%. IASIU 125 475 280% 59) Con nin g & Com p any, p p.9 10. 60) 1995 ICA (In tern ation al Claim A ssociation) 68 % SIU, Connin g 48 %. ICA Conn in g. 61) 95 %. - 48 -
. SIUs. SIUs. SIUs. 9. SIUs. 62) Conning 75%, - 48% SIUs. SIUs. < 7> S IU Fu ll-tim e < > 16 8-1995 $1,365,500 $956,900 1991-95 1986-90 1980-85 1980 52 % 33 % 12 % 3 % 76% 8% 8% 8% 43 % 32 % 16% 3 % 6% 40% 40% 0% 10% 10% 43 % 30% 62). SIUs. - 49 -
SIUs 10, 9 3. 78% 44%. SIUs 10 2 3... 63). 1,200. (health care) 950, (property-casu alty) 200 - (life-disability) 50. (health care), ( ) (w orkers' compensation),,,. Conning, -.. 63) Con nin g & Com p any, p.7 8. - 50 -
< 8> / PPO* H MO s**/ POS*** 1 2 3 4 5 6 7 8 3 1 5 4 2 6 7 8-2 +1-2 0 +3 0 0 0 ) * PPO (p referred p rovider organization s) : ** H MO (health m ainten ance organization s) : *** POS(p oint-of service p lan ) : IRC 1978 1989 64), (padded claim) 79%, 66%, 64%, 62%, 53%.. 64) 1978, 1981, 1983, 1989 4. - 51 -
2... 64) ( ). / 700. 1999 6 14 7 2 504 ( : 72%). 12 ( ) 8 200. 5,. 1999 6 25 7 2 153 ( : 77%).,,,..,. 64),,. ( ) ( ), ( 99 ). - 52 -
< 9> (%) 29 162 32.1 39 212 42.1 49 87 17.3 50 43 8.5 504 100.0 280 55.6 224 44.4 504 100.0 217 43.1 57 11.3 70 13.9 (, ) 160 31.7 504 100.0 27 17.6 43 28.1 13 8.5 ( ) 28 18.3 24 15.7 ( ) 18 11.8 153 100.0 : 5 ( ) (,,, ), ( ),... 62.7%, 78.4%. - 53 -
. ( ) 80.2% 85.0%. ( : ) 82.1%, 69.9%., 3 (, ). ( ). - 54 -
< 10> - 55 -
. 1). 35.9%, 15%. 1996 Conning 80%, - 52%,.. < 11> ( ) - 56 -
2).., 67.1% 57.2%. 72%, 26%, 64%, 36%. < 12> - 57 -
2.,. 3). (TV,, ). 26.0% 53.4%. 53.4%, 47.4%. < 13> - 58 -
. 1) 61.7%, 19.2%, 13.7%,. 33%. CAIF 1997 31%, 22%, ( ) 26%. 65) 2) ( ). (32.4%) (47.7%). CCAIF (1996) 43% 47%.,. 65) In su r an ce Inform ation In stitu te, Insurance Issues Update, 1999. 1. - 59 -
< 14>, 87%, 74%, 66%. 23%, 16%.... - 60 -
< 15> `, 71.5% 13.9%. CCAIF (1996)? 78%.. 1). - 61 -
.., 84.1%, (8.9%) (3.8) (12.7%). < 16> ( ) - 62 -
13.1% 50.3%, 24.8%.? 6.7%. 2),,,.. 74.6% 21.6%. 48.4%, 32.0% 80.4%. 3 (,, ) 3.0%. - 63 -
< 17>. 1).. 27.7%, ( 20.1%, 12.3%), - 64 -
(11.9%).,. (8.3%), (8.2%), (6.4%).. < 18> < > * : - 65 -
, 5, (78.3%), (76.5%), (75.0%), (69.3%), (66.4%).. 3 (,,, ),. < 19> < > * : - 66 -
2), 77%. 13%, 8%, 2%. 1997 CAIF 63%, 15%, 7%, 3%, 2%. < 20> - 67 -
3) (de ductib le) (deductible). 46.4%. IRC 22%(1993), 28%(1995), 40%(1997), Conning 43%, 29%. < 2 1> - 68 -
4) 82.9% 6.6%. < 22>. 1) /.., 57.2%, 12.5%. 2) 3-69 -
. 48.0% 15.8%. 67.8% 9.2%..,,.. 62.3% 6.6%. < 23> - 70 -
3.,,,,.,...,.. (padding) - 71 -
... - 72 -