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Notice on the issuance of the "Anti-Insurance Fraud Work Measures"

Golden Rules [2024] No. 10

Financial regulatory bureaus，All insurance group (holding) companies、Insurance company、Professional insurance intermediary agency，Yinbaoxin Company、Insurance Association、Insurance Institute:

The "Anti-Insurance Fraud Working Measures" are now issued to you，Please follow the instructions。

State Financial Supervision and Administration Administration

July 22, 2024

Anti-insurance fraud working methods

　　Chapter 1 General Provisions

Article 1 To prevent and resolve insurance fraud risks，Improve the comprehensive risk management capabilities of the insurance industry，Protecting the legitimate rights and interests of parties involved in insurance activities，Maintain market order，Promote high-quality development of the industry，According to the "Insurance Law of the People's Republic of China", "Criminal Law of the People's Republic of China" and other laws and regulations，Based on the current development status of the industry，Develop these measures。

Article 2 Insurance fraud (hereinafter referred to as fraud) as mentioned in these Measures refers to the act of using insurance contracts to seek illegal benefits，Mainly including intentionally fictitious insurance subjects，Fraud insurance money;Making up insurance accidents that never happened、Making up false causes of accidents or exaggerating the extent of losses，Fraud insurance money;Intentionally causing an insured accident，The act of defrauding insurance money, etc.。

The term insurance fraud risk (hereinafter referred to as fraud risk) as mentioned in these Measures refers to fraudulent activities carried out by fraud perpetrators，The risk of causing economic losses or other damage to the parties involved in insurance activities and the public。

Article 3 The goal of anti-fraud work is to establish “supervision guidance、Organization-based、Industry joint defense、Four-in-one working system of collaboration among all parties，The anti-fraud system and mechanism are basically sound，Effectively curbing the momentum of fraud and illegal crimes，The ability to prevent and resolve fraud risks in the industry has been significantly improved，Consumers’ anti-fraud awareness has increased significantly。

Article 4 Insurance institutions should establish a full-process fraud risk management system，Gradually improve multi-party early warning in advance、Intelligent management and control、Workflow of post-event retrospective management。

Industry organizations should give full play to the role of big data and industry joint defense in combating fraud and crimes in accordance with the division of responsibilities，Strengthen the effective application of anti-fraud intelligent tools，Improving industry fraud risk monitoring、Early Warning、Disposal Process，For regulatory authorities、Provide support for anti-fraud work by public security, judicial organs and insurance institutions。

Article 5 Insurance dafabet live casinoinstitutions and industry organizations should coordinate network security according to the division of responsibilities、Data security and innovative development，Perform safety protection obligations in accordance with the law，Improving the management system，Strengthen network security and data security protection，Guarantee necessary personnel and resource investment，Take cyber security、Data security management and technical measures，Ensure the safe and controllable operation of the anti-fraud information system。

Article 6 Insurance institutions should take the protection of consumer rights and interests as the starting point and foothold of anti-fraud work，Continuously improve the quality and efficiency of insurance services，Guide insurance intermediaries、Third-party outsourcing service provider、Consumers, etc. comply with laws and regulations、Participate in insurance activities honestly and trustworthy，Create a good insurance market order，Effectively protect the legitimate rights and interests of consumers。

　　Chapter 2 Anti-Fraud Supervision and Management

Article 7 The State Administration of Financial Supervision and its dispatched offices shall supervise fraud risk management work in accordance with the law。

Article 8 The State Administration of Financial Supervision and its dispatched agencies should establish an anti-fraud regulatory framework，Improving the anti-fraud supervision system，Strengthen anti-fraud guidance for insurance dafabet live casinoinstitutions and industry organizations，Promotion and public security and judicial organs、Communication, collaboration and information exchange between relevant industry authorities and local government functional departments，Strengthening cross-border cooperation in anti-fraud。

Article 9 The State Administration of Financial Supervision and its dispatched offices shall guide insurance institutions to carry out the following work:

(1) Establish and improve a fraud risk management system;

(2) Preventing and responding to fraud risks;

(3) Participate in anti-fraud industry collaboration;

(4) Carry out anti-fraud publicity and education.

Article 10 The State Administration of Financial Supervision and its dispatched offices shall regularly inspect and evaluate the soundness and effectiveness of the fraud risk management system of insurance institutions，Mainly include:

(1) Implementation of anti-fraud regulatory provisions;

(2) Development of internal fraud risk management system;

(3) Establishment of fraud risk management organizational structure and personnel performance;

(4) Completeness of fraud risk management process、Operationability and operation;

(5) Construction and operation of fraud risk management information system;

(6) Anti-fraud cooperation;

(7) Fraud risks and case handling;

(8) Anti-fraud training and publicity and education;

(9) Network Security、Data security and personal information protection。

Article 11 The State Administration of Financial Supervision and its dispatched offices pass the regulatory evaluation、Risk Warning、Notification、Conduct continuous supervision of fraud risk management of insurance institutions through interviews and other methods。Insurance institutions violate the provisions of these Measures，causing adverse consequences，The State Administration of Financial Supervision and its dispatched agencies shall take regulatory measures or impose administrative penalties in accordance with the Insurance Law of the People's Republic of China and other laws and regulations。

Article 12 The State Administration of Financial Supervision guides bancassurance companies、Insurance Association、Industry organizations such as the Insurance Institute carry out in-depth industry cooperation，Build a mechanism for data sharing and fraud risk information exchange within and outside the industry，Strengthen risk management collaboration，Joint industry action to combat fraud，Organize anti-fraud publicity and education，Deepen theoretical research and academic exchanges，Collaboratively promote anti-fraud work。

The offices dispatched by the State Administration of Financial Supervision should guide local insurance industry associations、Insurance institutions and their branches should improve anti-fraud organizations based on actual conditions，An anti-fraud center can be established or jointly established with the public security organs、Anti-Fraud Office, etc.。

　　Chapter 3 Fraud Risk Management of Insurance Institutions

Article 13 Insurance institutions shall bear the main responsibility for fraud risk management，Establish and improve fraud risk management systems and mechanisms，Standardized operating procedures，Improve information system，Properly handle fraud risks，Strengthen industry collaboration，Carry out anti-fraud communication training、Publicity and Education，Perform reporting obligations。

Article 14 The fraud risk management system of insurance institutions shall include the following basic elements:

(1) Board of Directors、Board of Supervisors (Supervisors) or professional committees that perform the duties of the Board of Supervisors、Effective supervision and management by management;

(2) And business nature、Institutional mechanism suitable for scale and risk characteristics;

(3) Fraud risk management organizational structure and process settings;

(4) Division of responsibilities, authority and assessment and accountability mechanism;

(5) Fraud risk identification、Measurement、Evaluation、Monitoring and Disposal Procedures;

(6) Internal control and supervision mechanism;

(7) Fraud risk management information system;

(8) Anti-fraud training and talent team building;

(9) Anti-fraud publicity and education;

(10) Participation and cooperation in the anti-fraud collaboration mechanism;

(11) Building a culture of honesty, trustworthiness and compliance.

Article 15 Insurance institutions should comprehensively consider business development、Regularly evaluate the effectiveness of the fraud risk management system based on factors such as technological updates and market changes，And judge relevant strategies based on the evaluation results、Do the systems and procedures need to be updated and revised。

Insurance institutions shall submit the effectiveness evaluation report of the fraud risk management system for the previous year to the State Administration of Financial Supervision or its dispatched office in the first quarter of each year。Provincial branches of insurance institutions submit fraud risk management system effectiveness evaluation reports in accordance with the requirements of local agencies。

Article 16 Insurance institutions should develop a fraud risk management system，Clear Board of Directors、Board of Supervisors (Supervisors) or professional committees that perform the duties of the Board dafabet casino mobile appof Supervisors、Management、The role of the fraud risk management leader and anti-fraud function in fraud risk management、Responsibilities and reporting paths，Standardized operating procedures，Strict assessment、Accountability system execution。

Article 17 Insurance institutions should reasonably determine fraud risk control points for various business activities and management activities，Clear the review departments and approval authority for matters related to fraud risk management，Execute standardized and unified business processes and management processes，Cover fraud risk management and control to all key business units，Strengthen the verification of risk information on the underwriting and claims sides，Improve the quality and efficiency of claims。

Insurance institutions should strengthen integrity education and compliance culture construction，Improving the personnel selection and on-the-job performance inspection mechanism，Strengthen employee behavior management，Carry out investigation of abnormal behaviors of employees，Strictly guard against insider fraud。

Insurance institutions should carefully select insurance intermediary business partners or business-related outsourcing service providers，Strengthen anti-fraud supervision。

Article 18 Insurance institutions should establish a fraud risk identification mechanism，Assess the fraud risks faced by key business units and the likelihood and degree of harm，Choose appropriate risk management strategies and tools，Control the development trend of events、Compensation for asset losses，Properly resolve risks。

Article 19 Insurance institutions should establish a fraud risk management information system or embed existing information systems with relevant functions，Make good connections between internal standards for business element data and industry standards，Ensure the authenticity of data related to fraud risk management、Complete、Accurate、Specification。

Insurance institutions should process and use consumers’ personal information and industry data in accordance with the law，Ensure data security and completeness。

Article 20 Insurance institutions should incorporate anti-fraud publicity and education into daily consumer education and concentrated education activities，Establish diversified anti-fraud publicity and education channels，Via official website、Mobile Internet Application、Carry out anti-fraud propaganda in business premises，Raise consumer awareness about fraud，Enhance consumers’ awareness and ability to prevent fraud。

Article 21 If an insurance institution discovers fraud clues that may involve other insurance institutions，Should report to the bancassurance company or the local insurance industry association and anti-fraud organization to verify and combine the fraud clues。

Insurance institutions should establish and improve the fraud clues assistance investigation mechanism，Actively cooperate with industry organizations to carry out clue merging、Risk Check、Case handling and other work。

Insurance institutions should establish incentive mechanisms，Yes, report、Investigation、Reward and commend units and personnel with outstanding achievements in combating fraud and crimes。

Article 22 Insurance institutions carry out agricultural insurance、First (set) major technical equipment insurance、The first batch of key new materials to apply insurance and other types of insurance provided by the financial department with insurance premium subsidies，Fraud risk should be assessed separately and on an ongoing basis，And reasonably formulate fraud risk management measures based on the results。

Insurance institutions should strengthen supervision of institutions that assist in handling business，False claims are not allowed、Dummy expenses、False surrender or withholding、Misappropriation of insurance funds、Misappropriate operating funds and other methods to offset the insurance premiums payable by policyholders or insurance premium subsidies provided by the finance department。No misappropriation by any unit or individual、Intercepted、Occupying the insurance money that the insurance institution should compensate the insured。

Article 23 The insurance institution receives the policy holder、After the insured or beneficiary’s request for claim settlement or insurance payment，Should be handled in a timely manner in accordance with laws, regulations and contract agreements，Without conclusive evidence or clues，Do not use suspected fraud as an excuse to delay claims、Unreasonable refusal to compensate。

　　Chapter 4 Anti-Fraud Industry Cooperation

Article 24 The Insurance Association shall play the role of industry self-discipline and coordination and promotion under the guidance of the State Administration of Financial Supervision，Assume the following responsibilities:

(1) Establish an anti-fraud joint meeting system，Convene regular joint meetings to coordinate and promote anti-fraud work in the industry;

(2) Establish an anti-fraud professional talent pool，Organize anti-fraud communication training;

dafabet online sports betting app(3) Organize and carry out special anti-fraud education and public welfare activities;

(4) Strengthening cooperation with other industries、Exchange and cooperation with self-regulatory organizations or international anti-fraud organizations;

(5) Organize and carry out anti-fraud research;

(6) A written report to the State Administration of Financial Supervision on the anti-fraud work of the previous year in the first quarter of each year;

(7) Other anti-fraud work that should be undertaken.

Article 25 Banking, insurance, credit companies, etc. shall give full play to the advantages of centralized management of big data platforms under the guidance of the State Administration of Financial Supervision and its dispatched offices，Explore the establishment of a multi-insurance industry anti-fraud information platform、Infrastructure such as anti-fraud intelligence center，Monitor and analyze industry fraud risks，Centralized screening of data suspected of fraud，Release discovered fraud clues to local insurance industry associations and anti-fraud organizations、Insurance agency for verification。Suspected of committing a crime，Report the case to the public security agency in a timely manner。

Office dispatched by the State Administration of Financial Supervision、Local insurance industry associations and anti-fraud organizations can refer to the above model to organize big data anti-fraud work within their jurisdictions。

Article 26 Local insurance industry associations and anti-fraud organizations shall be under the guidance of the dispatched offices of the State Administration of Financial Supervision，Adhering to "Service、Communication、Coordination、Self-discipline” work policy，Assume the following responsibilities:

(1) Establish an anti-fraud cooperation mechanism within the jurisdiction;

(2) Issue fraud risk warning within the jurisdiction、Alert，Exploring the establishment of a fraud risk indicator system within the jurisdiction;

(3) Organize and coordinate insurance institutions within the jurisdiction to cooperate with bancassurance companies, etc. to conduct fraud clue verification、Serial and parallel work，Perfect case investigation、Transfer and filing、Relevant mechanisms such as evidence retrieval;

(4) Explore the establishment of a local anti-fraud information platform，Provide information and data support for fraud risk analysis and early warning within the jurisdiction，Investigating regional fraud clue organizations、Research and Judgment，Cooperate with the public security organs in crackdowns;

(5) Strengthen anti-fraud cooperation and coordination with other competent departments or self-regulatory organizations，Enhancing data and information sharing，Facilitate anti-fraud work;

(6) Organize and carry out special anti-fraud education and public welfare activities within the jurisdiction;

(7) Establishing an anti-fraud professional talent pool and case database within the jurisdiction，Organize anti-fraud communication training;

(8) A written report on the anti-fraud work of the previous year to the local dispatched office in the first quarter of each year;

(9) Other anti-fraud work that should be undertaken.

Article 27 Bancassurance Company、Local insurance industry associations and anti-fraud organizations、Insurance institutions and others should strictly abide by personal information protection laws and regulations，Strengthening the full life cycle management of personal information，Create information collection、Storage、Use、Processing、Transmission、Provided、Deletion and other institutional mechanisms，Clear the purpose of information use and information processing rights and responsibilities，Strictly control the scope and authority of information use。Not authorized by the information subject or permitted by laws and regulations，No organization shall write in writing、Open to the public orally or in other forms、Provide personal information。

Article 28 Bancassurance Company、Local insurance industry associations and anti-fraud organizations、Insurance institutions and others should regularly build anti-fraud information systems、Design of fraud indicators and monitoring model、Fraud case investigation、Carry out exchanges and cooperation in sharing typical cases。

　　Chapter 5 Collaboration of All Parties in Anti-Fraud

Article 29 The State Administration of Financial Supervision and its dispatched offices shall establish and improve the coordination with the public security organs、People’s Procuratorate、The connection mechanism between anti-fraud administrative law enforcement and criminal justice between the people’s courts，Under unified law applicable、Information Sharing、Information Sharing、Information release、Case transfer、Investigation and Evidence Collection、Case Discussion、Strengthen cooperation in judicial suggestions and other aspects。

Article 30 The State Administration of Financial Supervision and its dispatched agencies discover that fraud and illegal facts are suspected of committing a crime，Suspected criminal cases should be transferred in accordance with the relevant regulations of administrative law enforcement agencies，Transfer case clues to the public security organs in a timely manner，And send a copy of the case transfer letter to the People’s Procuratorate at the same level。Suspected of crimes committed by public officials，Prompt transfer to the disciplinary dafabet online betting websiteinspection and supervision agency。

The State Administration of Financial Supervision and its dispatched agencies should strengthen cooperation with the public security agencies、People’s Procuratorate Law Enforcement Linkage，For key areas、New type、Major fraud case，Carry out joint attack or supervision。

Article 31 The State Administration of Financial Supervision and its dispatched agencies should establish and improve market supervision、Judicial Administration、Collaboration mechanism of medical security and other departments，In information sharing、Notice of consultation、Lead transfer、Exchange and mutual training、Strengthen cooperation in joint law enforcement and other aspects。

Article 32 The State Administration of Financial Supervision and its dispatched agencies should strengthen coordination and interaction with local government functional departments，Promote the establishment of a normalized anti-fraud communication mechanism，Timely notification of important regulatory information、Key risk clues and major special actions，Strengthen information sharing and law enforcement collaboration。

Article 33 The State Administration of Financial Supervision and its dispatched agencies should strengthen cross-border cooperation in anti-fraud，Establish and improve a framework system for cross-border exchanges and cooperation，Guide industry organizations to strengthen communication and liaison with overseas anti-fraud organizations，Entrusted cross-border investigation、Information Inquiry Notice、Carry out anti-fraud cooperation in exchanges and visits。

　　Chapter 6 Supplementary Provisions

Article 34 Insurance institutions as referred to in these Measures，refers to the insurance company approved by the State Administration of Financial Supervision and its dispatched offices、Mutual insurance organizations and their branches。Insurance Group (Holding) Company、Reinsurance company、Professional insurance intermediaries and other institutions with anti-fraud functions shall carry out anti-fraud related work with reference to these measures based on their own operating realities and risk characteristics。

Article 35 The effectiveness evaluation methods and indicators of the fraud risk management system of insurance institutions shall be separately stipulated。

Article 36 The State Administration of Financial Supervision is responsible for the interpretation of these Measures、Revised。

Article 37 These Measures will come into effect on August 1, 2024，"Notice of the China Insurance Regulatory Commission on Issuing the "Anti-Insurance Fraud Guidelines"" (Insurance Regulatory Commission [2018] No. 24) is repealed at the same time。

Source: State Financial Supervision and Administration