A comparison between investigating insurance frauds and criminal investigations of frauds

Zavarovalniške goljufije so v današnji družbi precej pogost pojav. Pojavljajo se pri vseh vrstah zavarovanj, največ goljufij pa je moč zaznati pri avtomobilskih zavarovanjih. V naši kulturi se zavarovalniških goljufij zavestno še vedno ne dojema kot kaznivo dejanje, zato je pomembno, da se javnost čim bolje osvešča o tej tematiki. Za uspešno omejevanje zavarovalniških goljufij je potrebno vzpostaviti učinkovit sistem odkrivanja, preiskovanja in dokazovanja, tako znotraj preiskovalnih oddelkov zavarovalnic, kot tudi v policiji. V diplomski nalogi nas je predvsem zanimalo, katere so glavne podobnosti in razlike med preiskovalnimi metodami zavarovalniških goljufij, ki jih uporabljajo v policiji in znotraj preiskovalnih oddelkov zavarovalnic in na kakšen način ter kako pogosti preiskovalci med seboj sodelujejo. Zanimalo nas je tudi, kako med seboj sodelujejo zavarovalnice ter ali to vpliva na bolj uspešno preiskanost. S tem namenom smo opravili osebni intervju z dvema strokovnima sodelavcema za analizo prevar iz Službe za preprečevanje, odkrivanje in raziskovanje prevar (SPORP) na Zavarovalnici Triglav d.d. in dobili bolj praktičen vpogled v njihov metode in način preiskovanja. Ugotovili smo, da so si preiskovalne metode zavarovalnic in policije večinoma podobne, glavno razliko pa predstavlja predvsem uporaba prikritih preiskovalnih ukrepov in odvzem prostosti, za kar je pooblaščena samo policija. Večino zavarovalniških goljufij se razišče znotraj zavarovalnic samih, policija pa preiskuje predvsem goljufije, katere izvršujejo organizirane kriminalne združbe. Sodelovanje med Zavarovalnico Triglav d.d. in policijo pa se je v zadnjih letih bolj okrepilo in bo za uspešno preiskanost potrebno tudi v prihodnje.Insurance fraud is quite common in today\u27s society. They occur in all types of insurance, but most frauds can be detected in automobile insurance. In our culture, insurance fraud is still not perceived as a criminal offense, therefore it is important that the public is better informed about this topic. In order to effectively limit insurance fraud, an effective detection, investigation and proofing system should be established, both within the investigative departments of insurance companies and also in the police. In this thesis, we were mainly interested in similarities and differences between the investigative methods of insurance frauds used by the police and the investigative departments of insurance companies. We also wanted to find out in what way and how often the investigators cooperate with each other. We were interested in how the insurance companies cooperate with each other and whether this affects more successful research. For this purpose, we conducted a personal interview with two fraud examiners from the Department for Fraud Prevention, Detection and Investigation (SPORP) at Triglav Insurance Company, to get a more practical insight into their work and methods of investigation. We found out that the investigative methods are mostly similar. The main difference are covert operations and arrest, that can be only done by the police. The majority of insurance frauds are being investigated within the insurance companies themselves, and the police is more focused on insurance frauds that are committed by organized criminal groups. Cooperation between Triglav Insurance Company and the police has improved in recent years and it will be important for the successful investigation in the future. With the answers that we obtained, we could define the cooperation between insurance companies and the police more precisely, and provide some guidelines for the future