보험사기방지특별법은 보험사기의 증가현상으로 인한 보험금의 누수를 방지함으로써 건전한 보험거래질서를 확립하고 보험사기를 사전에 예방하도록함으로써 사회적 손실을 경감시키려는 취지로 2016. 3. 29. 제정되어 2016. 9.
30. 시행되었다.
그러나 보험사기방지특별법이 시행된 이후에도 보험사기범죄 및 피해금액은 계속하여 증가하고 있다. 증가의 주요 원인으로는 허위입원⋅보험사고내용조작 등의 허위⋅과다사고 유형이 증가하였기 때문이다.
보험금의 산정에 기여하는 관련 직무 종사자로서는 의료종사자, 손해사정사, 보험설계사, 정비사 등 다양한 전문직종이 있다. 그중에서도 보험금의 결정에 기초가 되는 손해액의 산정을 함에 있어 결정적 역할을 담당하는 직종은의료종사자라 할 것이다.
보험사기방지특별법은 제3조에서 다른 법률과의 관계에 대하여 ‘보험사기행위의 조사⋅방지 및 보험사기행위자의 처벌에 관하여는 다른 법률에 우선하여이 법을 적용한다’고 규정함으로써 형법 제347조의 사기죄에 우선하여 적용되며 양형도 높게 규정하고 있다.
그럼에도 의료법은 여전히 보험사기범죄에 대하여 형법을 적용하고 있으므로 그에 따르는 벌칙인 행정처분에는 실질적인 제재의 효과가 없다 할 것이므로 보험사기방지특별법이 우선 적용되는 효력이 실효성이 없게 되는 결과가된다.
이 논문에서는 보험사기범죄의 피해금액이 증가하는 주요 원인 및 문제점을 검토하여 보험사기방지특별법이 실효성을 거둘 수 있는 개선방향을 제시해보고자 한다.
The Special Act on Prevention of Insurance Fraud was enacted on March 29,2016 and implemented on September 30, 2016 in order to prevent insurance fraud inadvance and reduce social loss by avoiding leakage of insurance amount due to theincrease in insurance fraud and establishing sound insurance trading order. However, even after the enactment of the Special Act on Prevention of InsuranceFraud, the amount of insurance fraud crime and damage amount continues toincrease. The main reason for that increase is that false or excessive claimedaccidents such as fraudulent hospitalization and manipulation of insurance accidentshave increased. There are various kinds of professional workers such as medical care workers, lossadjusters, insurance planners, mechanics and others who contribute to the calculationof insurance amount covered. Among them, it is the medical care workers that playa decisive role in calculating the amount of damage that will be the basis for thedetermination of insurance amount. The Special Act on Prevention of Insurance Fraud shall be applied in preferenceto the fraud crime stipulated in Article 347 of the Criminal Law and the punishmentsentence also stipulates higher standards than that of the Criminal Law. That is whyArticle 3 of the Special Act on Prevention of Insurance Fraud provides that withregard to investigations or prevention of insurance fraud or punishment of personswho commit insurance fraud, this Act shall apply in preference to other Acts. Nevertheless, such priority of application for the Special Act on the Prevention ofInsurance Fraud becomes invalid because the Medical Law still applies the CriminalLaw against the insurance fraud crime, so there is no effect of the actual sanctionsrelating to the relevant administrative penalties. In this thesis, I would like to present the direction of improvement to have theeffectiveness of the Special Act on the Prevention of Insurance Fraud by reviewingthe major causes and issues for increasing damages of insurance fraud crimes.
The Special Act on Prevention of Insurance Fraud was enacted on March 29,2016 and implemented on September 30, 2016 in order to prevent insurance fraud inadvance and reduce social loss by avoiding leakage of insurance amount due to theincrease in insurance fraud and establishing sound insurance trading order. However, even after the enactment of the Special Act on Prevention of InsuranceFraud, the amount of insurance fraud crime and damage amount continues toincrease. The main reason for that increase is that false or excessive claimedaccidents such as fraudulent hospitalization and manipulation of insurance accidentshave increased. There are various kinds of professional workers such as medical care workers, lossadjusters, insurance planners, mechanics and others who contribute to the calculationof insurance amount covered. Among them, it is the medical care workers that playa decisive role in calculating the amount of damage that will be the basis for thedetermination of insurance amount. The Special Act on Prevention of Insurance Fraud shall be applied in preferenceto the fraud crime stipulated in Article 347 of the Criminal Law and the punishmentsentence also stipulates higher standards than that of the Criminal Law. That is whyArticle 3 of the Special Act on Prevention of Insurance Fraud provides that withregard to investigations or prevention of insurance fraud or punishment of personswho commit insurance fraud, this Act shall apply in preference to other Acts. Nevertheless, such priority of application for the Special Act on the Prevention ofInsurance Fraud becomes invalid because the Medical Law still applies the CriminalLaw against the insurance fraud crime, so there is no effect of the actual sanctionsrelating to the relevant administrative penalties. In this thesis, I would like to present the direction of improvement to have theeffectiveness of the Special Act on the Prevention of Insurance Fraud by reviewingthe major causes and issues for increasing damages of insurance fraud crimes.
