Research On Fraud Control Of Work Injury Insurance

Industrial injury insurance is an important part of social insurance, and it is the policy insurance of the state compulsory execution. The implementation of industrial injury insurance, safeguard the legal rights and interests of workers. It make the workers have no worries, and provide compensation for the treatment of industrial injury to workers injured. The burden of the employer for the workers’ compensation is shared, and the normal operation of the employer is ensured. However, with the popularization of industrial injury insurance, the fraud insurance fraud also increases greatly. Which is more common to defy the law are "exploit an advantage" in payment link and the shortage of the punishment system, which are serious threats to the effective operation of the industrial injury insurance system.Based on a large amount of data, this paper applies risk management theory to study the relationship between the industrial injury insurance fraud and the fraud control. Think as a fraud control means,the current industrial injury insurance system and the policy loopholes, especially in the payment link control is not rigorous, and antifraud efforts in the insurance fraud punish link is shortage. In the case of concrete research, this paper first carries on the statistic of the industrial injury insurance fraud in PD District in Shanghai in recent years through risk identification and risk assessment. Escaping the payment of industrial injury insurance and industrial injury accident occurred after the potentially fraudulent are two relative frequency industrial injury insurance fraud; Then, respectively, detailed analysis of the current industrial injury insurance payment system and policy and insurance frace punishment system and policy, The combination of examples, the problem and the improvement of the countermeasures are demonstrated and discussed.The main conclusions of this paper are as follows: First, nip in the bud of source control and remedial measures of the post control should two main aspects of industrial injury insurance fraud control. Secondly, as a source of control means of the industrial injury insurance fraud, the main problem of the current industrial injury insurance system and policy is due to system vulnerabilities or lack of supervision and other reasons cannot do "full, on time, in full " payment. Make up the main countermeasures of these problems lies in fully exploit social insurance agencies with relevant departments to data sharing, strict inspection of after the event insurance unit, after the insured the disposable industrail injury insurance treatment by the unit commitment. Thirdly, as injury insurance fraud after the control means, the main shortcomings of current industrial injury insurance fraud punishment system and policy is punishment executive power is low, the implementation is not in place; The main countermeasure is to improve the legislation of social insurance fraud, strengthen the law enforcement, enrich the form of punishment, strengthen the work injury insurance fraud punishment system and policy propaganda.