The amount of traffic accident claims is significantly high?Big data collisions out of the "Human Human Scroke" series of fraudulent cases

Through the contrast of the big data collision, the case handler discovered the association in the insurance fraud case of "Human Human Scroke", and rides the insurance fraud gang members. The prosecution of the Pudong New District Procuratorate in Shanghai, more than 70 defendants were convicted for crime of committing insurance fraud. On June 28 this year, a series of false litigation civil supervision cases were transferred to the court by the Pudong New District Procuratorate, and the subsequent procuratorial suggestions for the series of cases were also served together. At present, related cases are being processed further.

An abnormal data attracts the attention of the prosecutor

"Some insurance companies reported the case, saying that some traffic accident wounded may have falsification in the process of personal damage claims to deceive more insurance claims. Due to the complexity of the case and many personnel involved, we involved in the investigation in advance." Luo Zei, a prosecutor of the Procuratorate of Pudong New District. In the early investigation stage, an abnormal data attracted the attention of the prosecutor: after comparing the claims amount and disability rate of the city's traffic accidents with similar data in other provinces and cities, the results were found significantly high. "It's not a little higher, but a few times higher. We think it's abnormal." Luo Zei said.

Through further sorting out the case, the prosecutor found other clues: the same method of making the crime is to obtain higher compensation through the "high" disability level. However, so many wounded people who have no intersection with each other, why do they take the same way in the same way?

With this question, the case handler decided to "collide" the truth with big data. They use civil judgment and injury appraisal opinions involving the dispute over the traffic accident responsibility dispute, establishing a digital model, and after a collision comparison and related analysis. Most of the companies have raised objections to injury identification.

"Litigation agents and injury appraisers are the two key factors we have discovered." After that, the case -handling personnel conducted big data retrieval, screening and contrast to civil judgments involving these two factors, and found more suspected insurance fraud. The traffic accident liability dispute cases were re -arranged one by one.

As a result, more than 70 members of the "Human injury scalpel" gang who consisting of more than 70 members, dozens of crimes, and more than 7 million yuan of fraud have surfaced.

Start civil litigation supervision

Send a retrial procuratorial suggestion

Due to the large number of links and complex procedures for traffic accident claims, a special group appeared in the society -traffic accident claims intermediary, also known as "human hurt scalpel". They are familiar with the claims process and settle their claims for the injured and collect service fees.

In order to obtain more compensation, some "human injuries" and a few injuries appraisers and individual lawsuit agents conspire, and the injured appraiser will issue an appraisal opinion that does not match the actual disability level of the injured person, and then the litigation agent shall be based on the identification. Opinions, by mentioning the means of civil lawsuits, deceive insurance companies pay more than their payable compensation.

When the prosecutor of the Criminal Procuratorate of the Pudong New District Procuratorate reviewed this series of insurance fraud cases, he timely transfer the clues of false lawsuits to the civil administrative procuratorial department in a timely manner, and shared the evidence materials for the first time, which greatly improved the case handling efficiency. The prosecutor of the civil administrative procuratorial department launched the supervision of civil litigation in accordance with the law, retrieved the original dossier materials and related criminal file materials, listened to the opinions of the parties, and organized two centralized public hearings. Through review and confirmation, the disability level of the injured identification of the injury identification in the original trial is inconsistent with the actual situation after re -identification, which is enough to confirm that the civil case involved in this series of insurance fraud belongs to a false lawsuit.

"They exaggerated the disability of the wounded, which led the court to accept these false injury appraisal opinions, and made a high recognition of the disabled compensation, misunderstanding, and nursing fees." In this regard, the Pudong New District Procuratorate by the Procuratorate by the case by the case one by one case Send a retrial prosecution proposal to the court.

Tracing governance to promote the standardized rectification of the industry

In fact, as early as November 2021, the Ministry of Justice and the China Banking Regulatory Commission jointly issued a joint notice to make clear requirements for the judicial appraisal of insurance claims, emphasizing that judicial appraisal agencies and judicial appraisers must not have false appraisal opinions and seek improper interests, etc. In violation of laws and regulations, the insurance institutions and parties are advocated to commission the appraisal, and encourage insurance institutions should send officers to the scene to witness under the conditions of conditions permit; requiring judicial administrative agencies at all levels and bank insurance regulatory authorities at the same level to build a joint law enforcement mechanism to severely crack down on the parties , "Human Human Cattle", "Judicial Cattle" colluded with illegal acts such as insurance fraud and other violations of laws and regulations.

In response to the supervision vulnerabilities found during the "Human injury scalpel" insurance fraud case, the criminal procuratorial department and civil administrative procuratorial department of the Pudong New District Procuratorate issued a prosecution proposal to the relevant competent authorities, and urged relevant competent authorities to carry out special inspections Self -inspection and self -correction of illegal and violations in the industry have been adopted.

At the same time, the Pudong New District Procuratorate held a symposium with some law firms and injury appraisal agencies, suggesting that law firms and injury appraisal agencies were advised to strengthen professional ethics education, establish and improve internal occupational management systems, and take the initiative to accept social supervision. (Prosecutor's Daily Children's Painting)

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