Injury Insurance Fraud:the Research Based On Information Asymmetric Theory

Injury insurance is a kind of social insurance system; it was implemented by the force of the national law which entitle the insured or his dependent the right to get compensation from the injury insurance fund when the insured encounter with death or disability (whether temporary or permanent) due to accident or occupational diseases in their works. The injury insurance fund is actually the premiums. The injury insurance performs a good job in maintaining the legitimate right of the workers, the normal production of the companies and the stable of the society. However, because of the frequent injury insurance fraud, the effectiveness of the injury insurance is seriously affected.In this paper, we investigate the injury insurance fraud, the moral hazard and adverse selection in injury insurance due to information asymmetric; the fraud behaviors of suppliers, demanders and the third party are also analyzed. We can get the conclusion that the fraud is derived from the moral hazard and adverse selection since the information asymmetric between the insured and the insurers. Then, we discuss the further effects of the information asymmetric to the injury insurance by some real fraud cases in injury insurance.At the end, based on the theory and cases analysis, we bring up suggestions from two points. From the point of information asymmetric, we bring up some anti-fraud macro measures, such as the establishment of the related laws and regulations, the maturity of the injury insurance information report system, and the healthiness of integrity system. From the view of controlling moral hazard and adverse selection, we bring up some anti-fraud micro measures like to broaden the cover of the injury insurance, enforce the inner control of the related departments, perfect the underwriting system and medical management policies, determine the appropriate premium, and construct the information share platform.