Circular of the China Insurance Regulatory Commission on Issuing the Guidelines on Anti-Insurance Fraud
Circular of the China Insurance Regulatory Commission on Issuing the Guidelines on Anti-Insurance Fraud
Circular of the China Insurance Regulatory Commission on Issuing the Guidelines on Anti-Insurance Fraud
Bao Jian Fa [2018] No.24
February 11, 2018
All bureaus of the China Insurance Regulatory Commission, China Insurance Information Technology Management Co., Ltd., Insurance Association of China, Insurance Society of China, and all insurance group (holding) companies, insurance companies, and professional insurance agencies:
With a view to protecting the legitimate rights and interests of insurance consumers, effectively preventing and eliminating insurance fraud risks and promoting a healthy and sustainable development of the insurance industry and the construction of social credibility system, the China Insurance Regulatory Commission has formulated the Guidelines on Anti-Insurance Fraud, and they are hereby issued for your effective implementation based on the actual status.
Guidelines on Anti-Insurance Fraud
Chapter I General Provisions
Article 1 To enhance the comprehensive risk management ability of the insurance industry, and prevent and resolve the risks of insurance fraud, these Guidelines are formulated in accordance with the laws and regulations including the Insurance Law of the People's Republic of China and the Criminal Law of the People's Republic of China.
Article 2 For the purpose of these Guidelines, the term "insurance institution" refers to any insurance group (holding) company, insurance company and its branches approved by the China Insurance Regulatory Commission (hereafter referred to as "CIRC") and its local offices (hereinafter referred to as "local offices"). Professional insurance intermediaries, reinsurance companies and other agencies with anti-insurance fraud functions shall refer to the Guidelines while conducting anti-fraud related work.
Article 3 Insurance fraud (hereinafter referred to as "fraud") refers to the act of illegally obtaining profits in the name of insurance or through the use of insurance contracts, including fraud in relation to insurance benefits, illegal insurance business operation and insurance contracts. Unless otherwise specified, for the purpose of these Guidelines, fraud refers only to fraudulent acts related to insurance benefits, mainly including the acts of obtaining insurance benefits by way of deliberately making up the subject matter of insurance, making up any insured accident that has never occurred, fabricating false causes for any insured accident or exaggerating the amount of losses, deliberately causing any insured accident, and any other act of obtaining insurance benefits by cheating.
For the purpose of these Guidelines, the "risk of insurance fraud" (hereinafter referred to as the "fraud risk") refers to the risk of fraudulent activities by fraudsters to cause economic losses or other losses to the insurance industry, insurance consumers and the public.
Article 4 The anti-fraud work aims at protecting the legal rights and interests of insurance consumers, maintaining the market order and promoting the healthy development of the insurance industry.
Article 5 The CIRC and its local offices shall supervise the fraud risk management of insurance institutions according to laws.
Chapter II Fraud Risk Management of Insurance Institutions
Article 6 An insurance institution shall take the primary responsibility for fraud risk management, including establishing and improving the fraud risk management system and mechanism, standardizing operational procedures, properly handling fraud risks and fulfilling reporting obligations.
Article 7 An insurance institution shall have an insurance fraud risk management system with the following basic elements:
1. The effective supervision and management of the board of directors, the board of supervisors and the management;
2. Institutional mechanisms that are appropriate to the nature, scale and risk characteristics of the business;
3. Fraud risk management organizational structure and process setting;
4. Division of responsibilities and authority, and the assessment and accountability mechanisms;
5. Fraudulent risk identification, measurement, assessment, monitoring and resolving procedures;
6. Internal control and supervision mechanism;
7. Fraud risk management information system;
8. Reporting and crisis management mechanism.
Section 1 Institutional System and Organizational Structure
Article 8 An insurance institution shall formulate a fraud risk management system to clarify the roles, responsibilities and reporting paths of the board of directors and its special committees, board of supervisors (supervisors), management team and relevant departments in the management of fraud risks, standardize operational procedures, perform strict appraisal, and implement accountability system.
Article 9 The board of directors of an insurance institution shall assume the ultimate responsibility for the management of fraud risks. The main duties of the board of directors include:
1. Work out the strategic plan and overall policy for fraud risk management;
2. Review and approve the basic system for fraud risk management;
3. Supervise the effectiveness of the implementation of fraud risk management system;
4. Deliberate the report on fraud risk management submitted by the management team or the risk management committee;
5. Adjust and improve the fraud risk management policies according to internal audit results, and supervise the correction made by the management team;
6. Deliberate other major issues involving fraud risk management;
7. Take other responsibilities as prescribed by laws and regulations.
The board of directors may authorize its risk management committee to perform some of its responsibilities of fraud risk management in accordance with the Articles of Association and Rules of Procedure of the Board of Directors.
Article 10 The management team of an insurance institution shall assume the responsibility of implementing fraud risk management.
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Bao Jian Fa [2018] No.24
February 11, 2018
All bureaus of the China Insurance Regulatory Commission, China Insurance Information Technology Management Co., Ltd., Insurance Association of China, Insurance Society of China, and all insurance group (holding) companies, insurance companies, and professional insurance agencies:
With a view to protecting the legitimate rights and interests of insurance consumers, effectively preventing and eliminating insurance fraud risks and promoting a healthy and sustainable development of the insurance industry and the construction of social credibility system, the China Insurance Regulatory Commission has formulated the Guidelines on Anti-Insurance Fraud, and they are hereby issued for your effective implementation based on the actual status.
Guidelines on Anti-Insurance Fraud
Chapter I General Provisions
Article 1 To enhance the comprehensive risk management ability of the insurance industry, and prevent and resolve the risks of insurance fraud, these Guidelines are formulated in accordance with the laws and regulations including the Insurance Law of the People's Republic of China and the Criminal Law of the People's Republic of China.
Article 2 For the purpose of these Guidelines, the term "insurance institution" refers to any insurance group (holding) company, insurance company and its branches approved by the China Insurance Regulatory Commission (hereafter referred to as "CIRC") and its local offices (hereinafter referred to as "local offices"). Professional insurance intermediaries, reinsurance companies and other agencies with anti-insurance fraud functions shall refer to the Guidelines while conducting anti-fraud related work.
Article 3 Insurance fraud (hereinafter referred to as "fraud") refers to the act of illegally obtaining profits in the name of insurance or through the use of insurance contracts, including fraud in relation to insurance benefits, illegal insurance business operation and insurance contracts. Unless otherwise specified, for the purpose of these Guidelines, fraud refers only to fraudulent acts related to insurance benefits, mainly including the acts of obtaining insurance benefits by way of deliberately making up the subject matter of insurance, making up any insured accident that has never occurred, fabricating false causes for any insured accident or exaggerating the amount of losses, deliberately causing any insured accident, and any other act of obtaining insurance benefits by cheating.
For the purpose of these Guidelines, the "risk of insurance fraud" (hereinafter referred to as the "fraud risk") refers to the risk of fraudulent activities by fraudsters to cause economic losses or other losses to the insurance industry, insurance consumers and the public.
Article 4 The anti-fraud work aims at protecting the legal rights and interests of insurance consumers, maintaining the market order and promoting the healthy development of the insurance industry.
Article 5 The CIRC and its local offices shall supervise the fraud risk management of insurance institutions according to laws.
Chapter II Fraud Risk Management of Insurance Institutions
Article 6 An insurance institution shall take the primary responsibility for fraud risk management, including establishing and improving the fraud risk management system and mechanism, standardizing operational procedures, properly handling fraud risks and fulfilling reporting obligations.
Article 7 An insurance institution shall have an insurance fraud risk management system with the following basic elements:
1. The effective supervision and management of the board of directors, the board of supervisors and the management;
2. Institutional mechanisms that are appropriate to the nature, scale and risk characteristics of the business;
3. Fraud risk management organizational structure and process setting;
4. Division of responsibilities and authority, and the assessment and accountability mechanisms;
5. Fraudulent risk identification, measurement, assessment, monitoring and resolving procedures;
6. Internal control and supervision mechanism;
7. Fraud risk management information system;
8. Reporting and crisis management mechanism.
Section 1 Institutional System and Organizational Structure
Article 8 An insurance institution shall formulate a fraud risk management system to clarify the roles, responsibilities and reporting paths of the board of directors and its special committees, board of supervisors (supervisors), management team and relevant departments in the management of fraud risks, standardize operational procedures, perform strict appraisal, and implement accountability system.
Article 9 The board of directors of an insurance institution shall assume the ultimate responsibility for the management of fraud risks. The main duties of the board of directors include:
1. Work out the strategic plan and overall policy for fraud risk management;
2. Review and approve the basic system for fraud risk management;
3. Supervise the effectiveness of the implementation of fraud risk management system;
4. Deliberate the report on fraud risk management submitted by the management team or the risk management committee;
5. Adjust and improve the fraud risk management policies according to internal audit results, and supervise the correction made by the management team;
6. Deliberate other major issues involving fraud risk management;
7. Take other responsibilities as prescribed by laws and regulations.
The board of directors may authorize its risk management committee to perform some of its responsibilities of fraud risk management in accordance with the Articles of Association and Rules of Procedure of the Board of Directors.
Article 10 The management team of an insurance institution shall assume the responsibility of implementing fraud risk management.
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