参与这样的黑产链条， 要付出怎样的代价？ 近日，上海市静安区人民法院审理了一起涉保险"高返佣"合同诈骗案件。 来源：上海高院 保险从业者牵线搭桥， "熟人"投保人默契配合， 高额"返佣"到手就退保。 案情回顾 图片源自网络 2020年4月，A保险公司与B保险经纪公司签订协议，约定由B保险经纪公司代理销售A保险公司的重疾 险、年金险等产品，并收取相应佣金；若出现保单短期大量退保情形，B保险经纪公司需向A保险公司 支付补偿金。 同年7月，宋某承包B保险经纪公司C市分公司（已于2023年1月注销）业务并自负盈亏，每年向B保险经 纪公司缴纳固定管理费。期间，宋某发现有两款保险产品的佣金或佣金+退保保单现金价值远超首期保 费，短期退保可赚取可观差价。此后，宋某便利用承包经营便利，以"高额返佣""保本付息"等为诱饵， 直接发展熟人投保，还招募仇某、季某等6人担任"经销商"，拓展更多投保人。 宋某等人明知投保人无真实投保意愿、无长期续保能力，却仍诱导多人投保上述保险产品：他们或让投 保人自筹资金，或推荐其办理保单贷款，以此垫付首期保费。待投保一个月至一年内保单生效，B保险 经纪公司收到A保险公司支付的佣金后，宋某按约定向投 ...

新华社济南12月17日电（记者邵鲁文）为车辆张贴个性车衣，购买高额虚假发票，在前车变道时采 取不刹车或故意加速的方式撞上去，造成本人车辆"无责"的假象，以此骗取高额保费……这不是电视剧 中的剧情，而是公安机关破获的真实案例。 经办案民警调查发现，李某某的作案足迹涉及山东省内济南、济宁，及江苏、河北、山西、安徽、 江西、广西等多个省份，累计制造33起同类交通事故。被骗保险公司多达13家，累计诈骗金额487215 元。经过数月深入侦查，充分掌握其活动规律和犯罪证据后，济南市公安局历下区分局专案组民警在李 某某居住地将其抓获归案。目前，李某某因涉嫌保险诈骗罪被依法刑事拘留。 近日，济南市公安局历下区分局破获一起涉案地域广、手法专业的系列保险诈骗案。据济南市公安 局历下区分局经侦大队办案民警介绍，警方此前接到线索，反映有人涉嫌通过故意制造交通事故的方式 诈骗保险金。历下警方立即组织精干力量成立专案组展开调查，并协调全市各大保险公司协查，梳理可 疑理赔案件。经初步调查，李某某进入警方视线，民警仔细检查其理赔记录，发现存在诸多疑点。 警方提醒，"碰瓷"骗保是严重犯罪行为，不仅面临保险诈骗罪的刑责，其故意制造事故的行为还可 ...

"近年来，骑手利用交通事故欺诈骗保的情况屡有发生。"上述检察官表示，外卖骑手工作流动性 强、风险系数高，各大平台普遍采取每日自动扣费的方式为骑手强制投保意外险，初衷是为骑手提供保 障。但现实中，骑手跨平台接单现象普遍，不同平台的保险产品相互独立，理赔审核流程相对简单，且 保险公司之间数据共享不充分，这就给不法分子留下了可乘之机。 "保险诈骗不仅侵犯保险公司的财产权益，更严重扰乱了社会保障体系的正常运行。"上海一家律师 事务所刑事辩护律师对《金融时报》记者解释，根据我国刑法规定，保险诈骗罪是指投保人、被保险人 或者受益人以非法获取保险金为目的，违反保险法规，采用各种方法骗取保险金的行为。进行保险诈骗 活动，数额较大的，处五年以下有期徒刑或者拘役，并处一万元以上十万元以下罚金。他特别提醒，新 业态从业者切莫心存侥幸，故意制造事故、伪造理赔材料等行为是明确的刑事犯罪。广大骑手要树立保 险理赔的正确认识，自觉抵制保险欺诈行为，切勿蓄意骗保，触犯法律底线。 新业态保险风控需要多方协同发力。业内人士表示，针对这起案件暴露的理赔审核漏洞，建议行业 联合搭建跨平台骑手理赔信息共享库，对高频理赔、集中案发地、相似材料等异常情况 ...

Core Insights - The article highlights a significant insurance fraud case in Jiangsu, where a criminal network exploited employer liability and group accident insurance, resulting in over 270 million yuan in fraudulent claims [1][8]. Group 1: Fraud Mechanisms - Criminals created fake labor dispatch relationships and engaged in repeated insurance claims, utilizing bribery to manipulate third-party appraisers [1][4]. - A small metal processing company with only 15 employees reported suspicious insurance claims, leading to an investigation that uncovered a long-term fraud operation [3][4]. - The fraud ring, led by an insurance agent, established multiple labor dispatch companies to fabricate high-risk employee documentation and secure multiple insurance policies [4][5]. Group 2: Regulatory Failures - The investigation revealed systemic failures in the insurance underwriting, appraisal, and claims processes, allowing the fraud to persist [5][6]. - Insurance companies failed to adequately verify the legitimacy of policyholders and their claims, leading to significant financial losses [5][9]. - The reliance on external appraisers, who were bribed to overlook discrepancies, further compromised the integrity of the claims process [6][10]. Group 3: Industry Implications - The case reflects a broader issue within the insurance industry, where the balance between service efficiency and fraud prevention is misaligned [9][10]. - There is a pressing need for enhanced fraud detection capabilities, including the use of big data to monitor suspicious activities [9][10]. - The article emphasizes the importance of collaboration between insurance companies and law enforcement to effectively combat such fraud schemes [10].

本应是企业用工风险"防护盾"的雇主责任险，正沦为不法分子的"敛财工具"。12月4日，北京商报记者 注意到，日前央视新闻公布了一则跨领域的雇主责任险相关保险诈骗案，不法分子利用保险公司承保审 核、理赔调查等环节的漏洞，采用多种手段进行骗保，使雇主责任险沦为其"摇钱树"。近两年，雇主责 任险成为保险欺诈的"重灾区"，相关不法行为越来越多。对于保险机构和相关部门来说，该如何堵住风 控漏洞、斩断骗保黑灰产业链，才能有效遏制这一犯罪态势的发展？ 理赔成了"摇钱树" 雇主责任险，原本是保障员工权益、化解企业生产风险的一种有益方式。然而，这种专为雇主设立的险 种，却被一些不法分子视为赚钱的工具。 据央视新闻报道，一起发生在江苏的特大保险诈骗案，背后是一条横跨多行业、覆盖9省16市的骗保黑 灰产业链，涉案金额高达2.7亿余元。 近些年，雇主责任险相关保险诈骗屡见报端。甚至可以说，雇主责任险正在偏离初衷，变成一些别有用 心者的"敛财工具"。从各地警方近期披露的案例来看，通过虚假劳务合同、伪造住院病历等手段骗取保 险赔偿，有的已经形成造假产业链。这些行为不仅损害了保险公司的利益，也破坏了保险市场的健康发 展。 业内人士表示，建议 ...

本应是企业用工风险"防护盾"的雇主责任险，正沦为不法分子的"敛财工具"。12月4日，北京商报记者注意到，日前央视新闻公布了一则跨领域的雇主责 任险相关保险诈骗案，不法分子利用保险公司承保审核、理赔调查等环节的漏洞，采用多种手段进行骗保，使雇主责任险沦为其"摇钱树"。近两年，雇主 责任险成为保险欺诈的"重灾区"，相关不法行为越来越多。对于保险机构和相关部门来说，该如何堵住风控漏洞、斩断骗保黑灰产业链，才能有效遏制这 一犯罪态势的发展？ 理赔成了"摇钱树" 缘何雇主责任险会成为不法分子的"敛财法宝"？浙大城市学院副教授林先平表示，雇主责任险出现乱象背后，一是高风险行业事故概率较高，为骗保提供 了可乘之机；二是保险公司在承保和理赔环节的风控机制不完善，对投保主体资质、事故真实性审核不严；三是跨区域作案和团伙化欺诈增加了调查难 度，行业信息共享不足导致"信息孤岛"。 需建立互相协作的反诈机制 近些年，雇主责任险相关保险诈骗屡见报端。甚至可以说，雇主责任险正在偏离初衷，变成一些别有用心者的"敛财工具"。从各地警方近期披露的案例来 看，通过虚假劳务合同、伪造住院病历等手段骗取保险赔偿，有的已经形成造假产业链。这些行为不仅 ...

央广网北京12月4日消息（总台记者管昕 孙莹 王延均）据中央广播电视总台中国之声报道，运费险 是电商平台为了方便消费者退换货推出的便利服务，但有不法分子从运费险中找到商机，通过购买高额 运费险来骗取保费。如此"薅羊毛"已被多次曝光，其中不乏触及刑事犯罪的案例。近期，"退货赚运费 险"的教程再度在社交平台悄然传播。 有教程宣称，"11元赔付，5.8元寄出，就能'赚'到差价。"这类教程的核心逻辑是消费者在退货时选 择"自行寄回"方式，通过特定快递平台以较低价格寄出退货包裹，从而获取差价。看似"小赚一笔"的诱 惑背后，暗藏哪些法律风险？ 记者在社交平台搜索发现，有博主发视频教网友打运费险的主意薅羊毛。 该博主表示："咱们用自己的买家号去自己的店铺下单，下单之后，店铺不需要发货，只需要空单 号走过来，回去也弄个空单号，也就几毛钱，一来一回，也就是一块钱左右的成本。一块钱运费险赔个 七八块钱……" 业内人士姜楠告诉记者，从目前司法案例来看，涉及运费险的骗保已呈现作案团伙化甚至形成黑色 产业链的特点。 姜楠说："有的是串联多个平台，手法可能比较传统，就是利用真人刷单的形式去做骗保。现在更 多的其实是倒卖大量平台账号、设备 ...

Core Points - The article discusses a major insurance fraud case in Jiangsu, where a criminal network exploited employer liability and group accident insurance, resulting in over 270 million yuan in fraudulent claims [1][16] - The case involved multiple provinces and cities, highlighting a widespread issue within the insurance industry [16] Group 1: Fraud Mechanism - The main perpetrators used fake labor dispatch documents to secure multiple insurance policies for the same employees, inflating claims [7][14] - They manipulated injury reports and collaborated with various parties, including insurance company employees and medical institutions, to facilitate the fraud [12][18] - The fraudsters employed bribery to bypass investigations, making it difficult for insurance companies to detect the fraudulent activities [10][18] Group 2: Investigation and Legal Action - The fraud was uncovered after a local insurance company reported suspicious claims, leading to a police investigation that revealed significant irregularities [3][16] - A total of 27 suspects were arrested, and various forged documents were seized during a coordinated crackdown [16][20] - The case has been recognized as part of a larger trend of similar frauds across multiple provinces, indicating systemic issues within the insurance sector [16][18] Group 3: Industry Implications - The case underscores vulnerabilities in the insurance industry, particularly regarding regulatory oversight and the potential for exploitation by knowledgeable individuals [18][20] - It highlights the need for improved internal controls and employee training within insurance companies to prevent such fraudulent schemes [20]

Core Viewpoint - The article discusses the emergence of tutorials on social media that promote exploiting shipping insurance for profit, highlighting the potential legal risks and industry crises associated with such practices [1][3][4]. Group 1: Shipping Insurance and Its Purpose - Shipping insurance was developed to address disputes over return shipping costs in online shopping, becoming an essential service for e-commerce platforms and logistics [3][4]. - The original intent of shipping insurance is to compensate buyers or sellers for shipping losses incurred during legitimate returns [4][5]. Group 2: Exploitation of Shipping Insurance - Recent tutorials have surfaced that instruct consumers on how to profit from shipping insurance by choosing to return items via cheaper third-party shipping services [3][4]. - The calculation for potential profit involves comparing the insurance payout to the actual shipping cost, with examples showing how small differences can accumulate to significant amounts [3][5]. Group 3: Legal and Ethical Implications - Legal experts warn that intentionally returning items for profit violates the principles of good faith and could lead to civil lawsuits for unjust enrichment [4][5]. - The rise of fraudulent claims related to shipping insurance has been noted, with law enforcement highlighting a case where an individual fraudulently claimed shipping insurance over 30,000 times, resulting in illegal profits exceeding 200,000 yuan [5][6]. Group 4: Impact on the Insurance Industry - The cumulative effect of these fraudulent activities could lead to increased operational costs for insurance companies, potentially resulting in higher premiums for consumers and businesses [6][7]. - The increase in fraudulent claims may force some businesses to discontinue shipping insurance services, negatively impacting honest consumers [7][8]. Group 5: Regulatory Responses and Future Directions - Insurance companies are implementing protective measures, such as real-time monitoring of unusual claims and requiring specific shipping methods to prevent exploitation [8][9]. - E-commerce platforms are also utilizing big data analytics to monitor and identify abnormal return behaviors, although challenges remain in balancing consumer experience with fraud prevention [9][10]. - Future reforms may include more precise risk assessments for insurance premiums and enhanced data sharing between platforms and insurers to combat fraudulent activities [10][11].

Core Viewpoint - A ride-hailing driver was involved in 42 traffic accidents within six months, leading to the discovery of a large-scale insurance fraud scheme involving multiple parties, including the driver and auto repair shop operators [1][5]. Group 1: Incident Overview - The traffic management team in Cixi, Zhejiang Province, identified over 30 vehicles with high accident frequency, all linked to the same auto repair shop [1]. - The driver, Li, had an unusually high number of claims, prompting further investigation into the insurance payouts, which were all directed to the same repair shop [1][3]. Group 2: Fraud Mechanism - The investigation revealed that the accidents often occurred in secluded areas during peak hours, with vehicles following each other closely before the incidents, suggesting intentional collision [3][5]. - The auto repair shop owner, He, and his partner, Zhang, colluded with clients to create accidents for insurance claims, forming a complete fraud chain [5][9]. Group 3: Recruitment and Execution - He initially used repair shop vehicles to stage accidents but later expanded the scheme by recruiting clients to participate in the fraud, promising them financial benefits [9][11]. - The fraud ring executed over 140 staged accidents from August 2024 to October 2025, resulting in over 1.2 million yuan in fraudulent claims [17][18]. Group 4: Legal Consequences - The police arrested 23 individuals involved in the scheme, highlighting the serious legal repercussions for those attempting to exploit insurance systems [17][18].