"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 Points - Many delivery riders are facing challenges with accident insurance claims, highlighting issues in the insurance process and the complexity of policy terms [1][2][3] - The insurance policies, often automatically activated upon order acceptance, are criticized for their lack of clarity and high thresholds for claims [1][5][11] Group 1: Insurance Claim Challenges - A recent court ruling in Zhengzhou mandated an insurance company to pay 600,000 yuan after it initially denied a claim based on the rider's pre-existing health condition, emphasizing the insurer's failure to fulfill its disclosure obligations [1][3] - Another case involved a rider whose claim was denied due to driving an unlicensed vehicle, but the court ruled in favor of the rider, indicating that the insurer had a responsibility to understand the nature of the rider's work [2][3] - The complexity of insurance terms, including special clauses and exemptions, has led to numerous disputes, with courts often siding with riders when insurers fail to provide adequate notice of these terms [3][4][11] Group 2: Insurance Policy Structure - The typical cost for rider accident insurance ranges from 2.5 to 4 yuan per day, with many riders unaware of the automatic deduction and the associated terms [5][7] - The insurance application process is streamlined but lacks sufficient emphasis on critical policy details, leading to confusion among riders regarding their coverage [5][6] - Legal experts stress that insurance companies must clearly communicate exemption clauses and ensure that riders are aware of their rights and obligations under the policy [7][8] Group 3: Industry Implications - The proliferation of complex insurance terms has given rise to a gray market for claims assistance, where agents exploit riders' lack of understanding of the policies [9][10] - The government is exploring new models for worker protection, such as extending "new occupational injury" insurance to delivery riders, which could complement existing commercial accident insurance [10][11] - Industry stakeholders are urged to collaborate to improve the clarity of insurance products, enhance the claims process, and ensure that platforms fulfill their responsibilities in informing riders about their coverage [11][12]