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id="newscontent"> <h2 class="newscontent"> <div><p>虛假增員、虛增保費、虛列費用套取資金……此前，多名保險公司員工實名舉報領(lǐng)導(dǎo)造假并登上微博熱搜。與此同時，通過惡意投訴實現(xiàn)“退保理財”、“退舊換新”、收取高額手續(xù)費牟利的“代理退保”產(chǎn)業(yè)鏈也在持續(xù)擾亂保險市場，侵害保險公司和消費者權(quán)益。</p> <p>針對保險業(yè)種種亂象，監(jiān)管部門已通過罰單和專項治理持續(xù)加大監(jiān)管力度。同時，專家表示，保險公司要摒棄對保費收入規(guī)模的“偶像崇拜”，同時要增強(qiáng)市場參與者的敬畏之心。“看得見”的短期終究不可持續(xù)，“看不見的”長期才重要。</p> <p><strong>行業(yè)造假行為屢禁不止</strong></p> <p>“其實看了舉報之后，說實話，這些現(xiàn)象在保險行業(yè)一直存在，可能外行人看起來覺得觸目驚心，其實很多都是行業(yè)‘心知肚明’的事情。”一位從業(yè)多年的壽險業(yè)務(wù)員對《經(jīng)濟(jì)參考報》記者表示，長險短做、虛假賠付、虛假憑證、虛假增員等，確實比較常見，特別是在大力推廣的開門紅銷售季中。</p> <p>該業(yè)務(wù)員表示，保險銷售有較大業(yè)績壓力和增員壓力，“要么當(dāng)個人代理賣保險沖業(yè)績，然后拿獎勵升職位，要么自己不賣保險，拉人頭組成自己的一個小團(tuán)隊，然后把他們掛到你的名字下面，督促他們賣，‘保費論英雄’嘛，選拔晉升也都要看業(yè)績，所以很多人會為了賺取績效傭金、謀求晉升鋌而走險”。</p> <p>業(yè)內(nèi)人士指出，一直以來，保險公司在業(yè)務(wù)經(jīng)營中都存在“五虛”問題，即虛列費用、虛假承保、虛假退保、虛假理賠和虛掛保費。而這主要和壽險績效考核體系以及粗放的管理模式有關(guān)。一方面，過去兩年代理人數(shù)量下降以及新單負(fù)增長壓力下，壽險公司對于增員和增收的需求更加迫切，保費指標(biāo)、增員指標(biāo)、繼續(xù)率等KPI層層下壓；另一方面，為了推動業(yè)績提升，壽險公司投入了大量資源在增員、增收上。壓力和誘惑之下，如果沒有長效機(jī)制并配以規(guī)范的內(nèi)部治理和嚴(yán)格的合規(guī)文化，很容易使銷售前端行為走形，從而出現(xiàn)違規(guī)問題。</p> <p>在湖南大學(xué)風(fēng)險管理與保險精算研究所所長張琳看來，虛列費用、虛假承保、虛假增員等并不是新出現(xiàn)的問題。</p> <p>中央財經(jīng)大學(xué)中國精算研究院精算科技實驗室主任陳輝對記者表示，這些問題之所以屢禁不止，說明保險公司的產(chǎn)品設(shè)計和內(nèi)控制度設(shè)計存在套利空間，長險短做、虛假增員都是利用了設(shè)計漏洞進(jìn)行“無風(fēng)險套利”，而虛列費用是因為內(nèi)部控制問題。</p> <p><strong>“代理退保”產(chǎn)業(yè)鏈擾亂市場</strong></p> <p>除了險企內(nèi)部的造假，“代理退保”也成為擾亂保險市場、損害保險公司和消費者利益的重災(zāi)區(qū)。值得注意的是，當(dāng)前“代理退保”已形成通過惡意投訴實現(xiàn)“退保理財”、“退舊換新”、收取高額手續(xù)費牟利的一條產(chǎn)業(yè)鏈，并正從傳統(tǒng)壽險、健康險等人身保險產(chǎn)品，延伸到車險領(lǐng)域。</p> <p>“代理退保”組織及人員模仿直銷模式，通過加盟代理、中介合作、招收學(xué)員等形式，廣泛發(fā)展下線代理，并開展所謂的“保單維權(quán)說明會”“專業(yè)培訓(xùn)會”，形成線下逐層獲益、線上網(wǎng)課收費的獲利模式。</p> <p>在這一過程中，“代理退保”組織通常先阻斷保險公司與客戶聯(lián)系，并嘗試與客戶簽訂所謂的“代理維權(quán)協(xié)議”，收取高昂定金甚至以身份證件、保單、銀行卡作為抵押，從而捆綁客戶。再教唆客戶通過編造投訴理由、設(shè)計圈套、鬧訪等形式，引導(dǎo)被訴人或保險公司其他人員做出不利的陳述，并利用電話錄音、微信截屏、拍照等方法“釣魚”取證。在取證過后，惡意投訴組織隨即向監(jiān)管部門投訴，對保險公司施壓，進(jìn)而完成退保。一旦退保成功，惡意投訴組織向客戶收取全額保費20%至60%不等的手續(xù)費。</p> <p>一位基層保險機(jī)構(gòu)人士對記者表示，保險公司處理每一單投訴的時間成本、人力成本都很高，很多時候險企是無精力去分辨的，因此為了安撫消費者，也為了應(yīng)對監(jiān)管考核，險企只能按照消費者的需求退保。</p> <p>而這一退保黑產(chǎn)業(yè)鏈還在延伸。中國銀保信此前曾下發(fā)《關(guān)于疑似新購車輛“集中退保騙傭”欺詐風(fēng)險的提示函》，其中指出，2020年5月至7月間，多家經(jīng)營車險業(yè)務(wù)保險公司在承保“以租代購”公司的新車保險業(yè)務(wù)中，不同程度遭遇因大量集中退保導(dǎo)致大額傭金損失的疑似保險欺詐行為。此類行為在同業(yè)中持續(xù)出現(xiàn)，多個案例形態(tài)具有較大共性，個別公司傭金損失千萬元以上，疑似已經(jīng)形成“集中退保騙傭黑產(chǎn)”。</p> <p>監(jiān)管部門也已在嚴(yán)厲打擊該類違法行為。廣東、廣西、四川、河南、湖北等多地監(jiān)管部門此前陸續(xù)發(fā)布防范“代理退保”騙局的風(fēng)險提示。銀保監(jiān)會也曾向人身險公司下發(fā)了相關(guān)函件，試圖摸底“代理退保”產(chǎn)業(yè)鏈，并制定專項治理方案。</p> <p>業(yè)內(nèi)人士表示，“代理退保”不法團(tuán)伙可能涉嫌違反《中華人民共和國刑法》《中華人民共和國廣告法》。而參與“代理退保”的消費者也會受到影響。</p> <p>法學(xué)博士、北京安杰律師事務(wù)所合伙人詹昊指出，在參與“代理退保”過程中，消費者除了面臨失去正常保險保障、資金信用受損、個人信息泄露等風(fēng)險外，還可能因編造理由、偽造證據(jù)、提供虛假信息等非法行為，構(gòu)成欺詐，從而面臨較大的法律風(fēng)險。</p> <p>慧擇奇點研究院首席研究員馬瀟表示，退?？赡軐?dǎo)致消費者再投保時，會因為身體或年齡原因提高保費或不能正常承保。此外，目前保險行業(yè)內(nèi)也在探討構(gòu)建行業(yè)的大數(shù)據(jù)平臺，對風(fēng)險客戶進(jìn)行識別，如果因保險欺詐或惡意退保被記錄，未來很有可能因誠信原因?qū)υ俅瓮侗．a(chǎn)生不利影響。</p> <p><strong>監(jiān)管治亂象高壓不減</strong></p> <p>據(jù)銀保監(jiān)會公布的數(shù)據(jù)顯示，2020年，我國保險業(yè)保費收入4.5萬億元，同比增長6.1%，截至2020年末，保險公司總資產(chǎn)23.3萬億元。</p> <p>張琳表示，從體量上來講，我國已經(jīng)是保險大國，但從質(zhì)量上來說，無論是保險深度、保險密度，還是保險市場的業(yè)務(wù)結(jié)構(gòu)、市場環(huán)境，仍有很長的路要走。</p> <p>對于保險業(yè)種種亂象，監(jiān)管部門通過罰單和摸底調(diào)查持續(xù)加大對保險機(jī)構(gòu)監(jiān)管。據(jù)普華永道的統(tǒng)計，2020年，銀保監(jiān)會及其派出機(jī)構(gòu)對保險領(lǐng)域共開出1705張監(jiān)管處罰罰單，其中，43家壽險公司共收到470張罰單，罰款金額合計5734.5萬元。編制虛假報告、報表、文件、資料；欺騙投保人；給予投保人保險合同以外的利益，是壽險公司前三大違法違規(guī)事由。</p> <p>4月8日，銀保監(jiān)會下發(fā)《關(guān)于深入開展人身保險市場亂象治理專項工作的通知》開篇直指此次亂象整治的重點：圍繞銷售行為、人員管理、數(shù)據(jù)真實性、內(nèi)部控制等方面，對人身保險市場存在的典型問題和重點風(fēng)險進(jìn)行一次專項治理。從以上四方面整治內(nèi)容來看，銷售誤導(dǎo)、虛增人力、財務(wù)數(shù)據(jù)造假等均為人身險市場長期存在之頑疾，并屢次出現(xiàn)在監(jiān)管內(nèi)容中。</p> <p>馬瀟表示，保險業(yè)經(jīng)營者要改變思維，保險不是賺快錢的生意，而是秉持長期的經(jīng)營思維，不為短期業(yè)績采取激進(jìn)政策。此外，保險公司應(yīng)進(jìn)一步加強(qiáng)內(nèi)控監(jiān)督，通過技術(shù)手段進(jìn)行管理，實現(xiàn)管理的數(shù)字化。</p> <p>清華大學(xué)五道口金融學(xué)院中國保險與養(yǎng)老金研究中心研究總監(jiān)朱俊生也表示，保險公司要摒棄對保費收入規(guī)模的“偶像崇拜”，同時要增強(qiáng)市場參與者的敬畏之心。“看得見”的短期終究不可持續(xù)，“看不見的”長期才重要。（經(jīng)濟(jì)參考報記者向家瑩）</p></div> </h2> </div> <div id="q5ajsmy2y" class="space10"> </div> <div id="q5ajsmy2y" class="newscontent"> <div id="q5ajsmy2y" class="xgyd"> 相關(guān)閱讀： </div> <div id="q5ajsmy2y" class="newslist"> <div> <ul class="kxcotent"> <li><a href="/xfjs/2024-11/12/246014.html" title="APP自動續(xù)費陷阱多消費者警惕繳納“記憶稅”">APP自動續(xù)費陷阱多消費者警惕繳納“記憶稅”</a><span>（2024-11-12）</span></li> <li><a href="/xfjs/2024-10/23/245597.html" 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