Fraud insurance

Abstract

To solve the problem that as for fraud insurance, since an expected accident occurrence rate and a damage scale are extremely large, if an insurance fee is prevented from being less than a brake-even point, the insurance fee is extremely high and is difficult to be distributed in the market, and if a user can join insurance with a reasonable insurance fee without imposing a large burden on a household budget, excessively large payment of an insurance fee and no profit inhibit product development of fraud insurance, spreading / establishment to people, reduction in fraud crimes, and achievement of a society living in comfort.SOLUTION: When a contractor of fraud insurance pays some money to somewhere, and he slightly feels doubt of fraud, before paying the money, a notified insurance company examines a content so that notification of the insurance company is used as a payment condition of insurance money, and prevention of fraud damage is promoted by determination of possibility of fraud, result notification related to application of the insurance money, and an advice of warning.SELECTED DRAWING: Figure 1

Description

[Technical Field]

[0001] The present invention relates to fraud insurance, a business field in the non-life insurance industry, aimed at providing relief to victims of fraud and preventing fraudulent crimes. [Background technology]

[0002] The insurance industry plays a major role in supporting a society where everyone can live with peace of mind. Life is full of many different risks, and modern people have progressed from the days when it was common for those who encountered a sudden, unforeseen disaster to never recover and meet a tragic end. Today, we enjoy the benefit of being able to cover life's risks with insurance. From natural disasters, crime, unforeseen accidents, illness, hospitalization, surgery, work-related injuries, unemployment, nursing care, education expenses, retirement, death, survivor benefits, fire, car accidents, theft, negligence compensation, travel, and even pet illnesses, the wonderful system of insurance has improved the quality of life and built a sophisticated, civilized society. There are two areas of serious life risks that are not covered by insurance: kidnapping and fraud. Of these, kidnapping is prohibited, at least in Japan, on the grounds that if ransoms were paid with insurance, it would lead to a society that encourages confinement and kidnapping for profit. This is an entirely justifiable decision. However, with regard to fraud, even if the loss amount is paid with insurance, it cannot be considered a contributing factor to the crime, just like theft insurance. This is because the determination of fraud crimes is not whether or not one can raise funds, but whether or not one is deceived. However, currently (in the first quarter of the 21st century), there are no insurance products on the market that compensate victims who suffer financial losses as a result of fraud crimes for the money they lose. In Japan, during the long economic downturn following the collapse of the bubble economy, the number of fraud crimes has skyrocketed, becoming a social problem. Starting with "It's me fraud," the name has evolved to "bank transfer fraud" and then "special fraud." Based on the management philosophy that "maintaining the status quo is regression (arrest)," fraud organizations have always put into practice the foresight to anticipate the times, the planning ability to develop innovative methods, and PDS (Protection Data System) of honing know-how through repeated trial and error, and the entire fraud industry has evolved into a growth industry. Methods have become more diverse and sophisticated, including theatrical scams that take advantage of timely topics that attract a lot of social attention, use the names of city hall, police, tax offices, large corporations, etc., and stage fictitious stories with characters such as victims, police officers, and lawyers.Currently, not only the elderly but also generations that are not normally susceptible to deception are prone to being deceived by scams that use social media as the main tool, such as fictitious billing scams for large amounts of winnings, refund payment fees, and browsing site usage fees, investment scams involving cryptocurrencies, FX, and asset management, romance scams that manipulate people's psychological feelings through romantic feelings, and scams offering to write graduation thesis for them. [Prior art documents] [Patent documents]

[0003] [Patent Document 1] Summary of the Invention [Problem to be solved by the invention]

[0004] This had the following drawbacks: In a typical business's P / L (profit and loss statement), raw material procurement and manufacturing costs or product purchasing costs are listed as cost of sales, and the difference between these and sales is gross profit. In contrast, in the insurance business, sales (insurance premium income) are generated initially, followed by sporadic cost of sales (insurance payment), which is recognized when income and expenses for a certain period are confirmed. For example, in the case of marine insurance, cost of sales becomes zero when the ship safely arrives at its destination port, and the profit margin on sales is 100%. However, if there is a reinsurance premium, this becomes cost of sales, and the amount after deducting this becomes gross profit. For automobile insurance and fire insurance, insurance payments are set based on variable costs such as the expected accident rate and scale of damage, and then gross profit is added to calculate premiums, which are adjusted periodically based on the number of policyholders. If fraudulent insurance were designed, the expected accident rate and scale of damage would be so large that, unless it were to fall below the break-even point, the premiums would be too high and it would be difficult to distribute in the market. On the other hand, if fraudulent insurance were sold at a premium that was affordable for the average household and would not strain their income and expenditures, that division would be in the red, dragging down the automobile insurance and fire insurance divisions, which are performing well, and becoming a burden on the entire company. This is the main reason why fraudulent insurance cannot exist.

[0005] Fraud, like fire, car accidents, and theft, is one of the major financial risks in life. Insurance, which creates a society where people can live safely against the risk of fraud, is not contrary to public order and morals or social justice. On the contrary, it promotes public welfare and increases the happiness of the people, so it is a system that should exist someday in any civilized nation. Therefore, the objective of the present invention is to provide fraud insurance that can be purchased at an affordable premium that does not strain the household income and expenditure of a standard household and that is profitable for the insurance company. The present invention has been made to eliminate the above-mentioned drawbacks. [Means for solving the problem]

[0006] Whether it is life insurance or non-life insurance, those who wish to enter into a contract must disclose to the insurance company the information necessary for the insurance contract (decision-making materials). The insurance company will review the information disclosed and decide whether or not to enter into the contract. This obligation to disclose can solve the problem. Generally, if it is discovered that facts were not disclosed or false information was provided when signing an insurance contract, this constitutes a breach of the duty to disclose, and the insurance company is exempt from liability even if a reason for payment of insurance claims arises. In other words, the contract does not require the insurance company to pay claims. Fraud insurance requires insurance companies to notify policyholders in advance if they have been the victim of fraud and suffered financial losses, and makes it a condition of claiming insurance benefits that the policyholder receive advice from the insurance company regarding that notification.

[0007] Simply put, if a policyholder suspects even the slightest bit of fraud when making a payment somewhere and wants to receive compensation under the fraud insurance, the policyholder must notify the insurance company before making the payment. Upon receiving the notification from the policyholder, the insurance company will evaluate the content of the notification, determine the likelihood of fraud, and provide warning advice. The insurance company then assigns the policyholder a notification acceptance number. This number is required when filing a claim, but even if filled out, if the claim is determined to be fraudulent, the insurance will not cover the claim. Policyholders are free to notify the insurance company if they suspect fraud but find it too much hassle or the amount is small. In that case, they will not be covered even if they suffer fraud. Furthermore, even if they notify the insurance company and the insurance company determines that there is a possibility of fraud, they are free to ignore the suspicion and pay the money. In that case, they will not be covered even if they suffer fraud. This allows the insurance company to conduct a preliminary review before fraud occurs, and they are exempt from the obligation to pay claims in cases determined to be fraudulent. On the other hand, for cases that are determined not to be fraudulent, no insurance claims will be filed, so either way, the cost of sales will be zero and all insurance premium income will become gross profit. The only time a cost of sales will be incurred is in the case of an irregularity (misjudgment). However, operating profits are deducted from sales and administrative expenses, such as the costs of receiving, confirming, and reviewing notifications, the cost of maintaining and managing the call center, staff labor costs, advertising, attracting customers, sales, contracts, maintenance, administration, and so on. These are not particularly different from traditional insurance products, so there is no particular problem. Whether it's a fire, a car accident, or theft, they come suddenly and unexpectedly, leaving no room for avoidance and leaving the policyholder with no option but to respond passively. However, with fraud, there is room to consider whether or not to pay the money, and the policyholder can actively exercise their right to choose and make a decision of their own volition. Normally, one would not think of consulting a third party because they fear that the situation they are about to pay money into may be a scam. If they are wise enough to think this way, they can avoid the danger themselves without consulting anyone in the first place. However, even if they are not wise, they have taken out insurance that covers the full amount of the loss in the event of a scam, so they will always be motivated to fulfill their duty to disclose in order to secure their right to receive insurance money. This is the same behavioral psychology as when a car insurance policyholder is involved in a personal injury accident and always fulfills their duty to provide first aid in order to secure their right to receive insurance money. In cases where an insurance company has determined that there was no fraud but it turns out that there was fraud, the insurance company will pay the claim. In cases where an insurance company has determined that there is a high possibility of fraud, but it turns out that there was no fraud, as a general rule, lost profits will not be compensated. The present invention has the above structure. [Effects of the Invention]

[0008] 1 If a fraudster or group of fraudsters makes a financial claim against an insurance policyholder under some pretext in an attempt to defraud them of money, the policyholder will notify the insurance company of the details of the claim, and the policyholder will be able to receive confirmation and judgment-based advice from a specialized institution before making any payment. 2 Insurance companies can provide risk avoidance advice based on notifications from policyholders before an event requiring payment of insurance claims occurs, which means that insurance claims payments drop dramatically and the majority of premium income becomes gross profit. As a result, fraudulent insurance becomes a cash cow rather than an unprofitable sector. 3. Insurance companies can provide risk avoidance advice based on notifications from policyholders before an event requiring payment of insurance claims occurs, which dramatically reduces insurance claims payments and allows the majority of premium income to become gross profit. As a result, they can develop products with affordable premiums that do not strain the household budget of a typical household. 4. It will help to alleviate the fear that in the future, as people age and their thinking and judgment abilities decline, they may become victims of fraud and lose their assets; even if they do not age, they may fall prey to new types of fraudulent schemes and lose their assets; and the fear that an era will come when the advances in the fraud industry will outpace their own knowledge of how to counter them. 5 Fraud insurance is expected to have the effect of promoting opportunities for advance consultation before fraud damage occurs, so the more fraud insurance becomes widespread and established in society, the more dramatically the incidence of fraud crimes will decrease. [Brief explanation of the drawings]

[0009] [Figure 1] 1 is an explanatory diagram of the present invention (Example 1). [Figure 2] 1 is an explanatory diagram of the present invention (Example 2). DETAILED DESCRIPTION OF THE INVENTION

[0010] Hereinafter, an embodiment of the present invention will be described. Generally, individuals who encounter cases that they suspect may be frauds can consult with family, friends, acquaintances, government agencies, consumer affairs centers, financial institutions, the police, etc. However, because this is not an obligation, people do not proactively seek advice, and when multiple payments of money accumulate over a long period of time, they begin to feel suspicious and finally decide to seek advice, but by that time the damage has already spread and it is too late. In the first place, if one has the rationality to act wisely enough to consider consulting a third party and getting their opinion, they will be able to detect fraud in the early stages without relying on anyone. The causes of fraud victims are carelessness on the part of the victim, preconceived notions (biases), and differences in IQ between the victim and the other party. Intelligence is like air pressure; even if the same number is used, it is a relative evaluation in which it is treated as high if the other party has a low IQ and low if the other party has a high IQ. For example, a fraudster with an IQ of 120 can fool an average person with an IQ of 110, but will be fooled by a black market fraudster (a fraudster who targets other fraudsters) with an IQ of 130. Therefore, as a condition for receiving insurance payments when an ordinary person loses property due to fraud, an obligation to notify the insurance company of suspected fraud cases before payment is made is imposed on each case. Although notification is not mandatory, if the loss amount is not covered in cases where notification is not made, the behavioral psychology of complying with the notification obligation will come into play. Once notification is made, the insurance company or an institution commissioned by the insurance company can confirm and judge the case and provide professional advice to the policyholder regarding whether or not there is suspicion of fraud. 1 Notification will be made on an individual case basis. 2 Notification methods include: (1) entering the notification form from the policyholder screen on the insurance company's website and sending it; (2) calling the call center and answering the operator's questions; (3) filling out the designated form and sending it by mail; (4) other methods. 3 The contents of the notice shall include the contract holder's name (name, address, date of birth, customer number, security number, etc.), the other party's information, (1) the other party's name or title, (2) address and contact information, (3) the amount claimed, (4) the reason for the claim, (5) the date of contact, (6) communication medium, (7) a summary of the case, and (8) other details. 4 The insurance company will ask questions if necessary and will record and store the information disclosed. 5. When signing a contract, insurance companies obtain consent for the use of the customer's personal information and then conduct various checks and investigations. They verify the authenticity of the names, addresses, and contact details of the parties provided by the customer by checking with relevant parties and databases. They also check the entire process for any suspicious points, inconsistencies, or typical patterns of fraud, and make a comprehensive assessment of the possibility of fraud. 6 The insurance company will issue a notification acceptance notice to the policyholder by electronic communication or mail, which will include a notification number or case number. This will be completed when claiming insurance benefits as proof of prior notification. 7 The notification of receipt of notification will include a "judgment" as to whether the content of the notification is fraudulent or not, an "evaluation" as to the possibility of fraud, a "result" as to whether insurance payment is applicable or not, and advice and warnings regarding the content of the notification, including explanations. 8 The work of assessing and evaluating the content of the subscriber's notification will be carried out by human or AI staff. 9 In cases where an insurance company has determined that a fraud was not committed, but in fact it was, the insurance company will be eligible for payment of insurance claims. In cases where an insurance company determines that a claim is fraudulent but in fact it is not, resulting in lost opportunities and lost profits, the amount of coverage will depend on the evaluation score, but as a general rule, the insurance company will not provide coverage. The present invention is carried out as described above. [Industrial Applicability]

[0011] Because fraud prevention is a highly public interest activity, rather than being handled solely by a specific non-life insurance company, it should be positioned as a socially important issue and tackled by both the public and private sectors. Therefore, it would be desirable to establish a public interest incorporated association, the Fraud Prevention Center (tentative name), and inject public funds to promote the eradication of fraud. 1 All non-life insurance companies will share the center's database to improve operational efficiency. 2 It will be an organization that spans ministries and agencies, including the National Police Agency, the Consumer Affairs Agency, the Ministry of Finance, the Ministry of Economy, Trade and Industry, and financial institutions. The board of directors is composed of former government officials, academics, and other experts. 3. As fraud methods become more diverse and sophisticated, more data will need to be collected, analyzed, and analysed, so we will actively utilize AI. 4. We actively utilize professionals who are well-versed in fraud methods to educate and train staff who communicate directly with customers through conversation and electronic communication. Specifically, inmates with advanced knowledge, experience, and ability in fraud crimes will be employed as general managers and instructors after their release. Furthermore, inmates with intermediate to beginner levels will be employed as staff. All positions will be full-time employees with no set employment period. 5. In order to develop staff and improve their skills, we will create a qualification for fraud assessors (pseudonym) and introduce a certification system. 6. In order to encourage the public to provide information on new types of fraud, a system will be introduced in which rewards will be paid to the discoverer (not limited to one person, but to the top discoverers). 7. Information about new types of fraud will be immediately made public through public advertising organizations and other means, so that the public will be made aware of the tactics of fraudsters before the damage spreads.

[0012] A common trait among leaders and executives of fraud organizations is that due to the economic failures of the times or the nation—such as the collapse of the bubble economy, structural recession, financial crisis, revision of the temporary worker dispatch law, restructuring, the employment ice age, the Lehman shock, and social inequality—talented individuals who should have been thriving in positions suited to their intellectual talents became working poor, engaged in harsh labor for low wages, and ultimately decided to become fraudsters. Therefore, fraud insurance is a symptomatic treatment, not a cause-and-effect treatment. While fraud insurance certainly will not eradicate fraud, it will likely dramatically reduce it. However, unless the root cause is addressed, social discontent will only give rise to new forms of crime. These crimes are even more cunning and malicious than fraud, exploiting human psychology in ways that make them difficult for police to control. At least at this point, there is no effective solution. To create a better society in the 22nd century, the Fraud and Crime Prevention Center must eventually change its name, become a central player in preventing new types of crime, and promote social awareness and institutional reform.

Claims

1. This is a type of non-life insurance product contracted between a non-life insurance company and a customer, which covers the amount of loss when the policyholder falls victim to fraud and suffers property damage.When the policyholder pays money somewhere and has even the slightest suspicion that it is fraud, and intends to claim insurance benefits if it is fraud, the policyholder is obligated to notify the insurance company of the details of the case before paying the money.The insurance company will examine the details of the notification and determine whether it is fraud or not, and notify the policyholder.If it determines that there is a high probability of fraud, it will provide advice and warnings, and also have the function of setting conditions under which insurance payments will not apply.Fraud insurance is characterized by this.

2. Fraud insurance as claimed in claim 1, characterized in that it has the function of introducing a qualification examination system such as a fraud assessor (tentative name) in order to ensure that personnel who will confirm, analyze and evaluate notified cases and determine whether or not they are fraudulent have the minimum necessary knowledge and ability.

3. Fraud insurance as claimed in claims 1 and 2, characterized in that it calls for active submission of information in order to gather information on the increasingly diverse and sophisticated fraud methods circulating in the market, and introduces a system in which, if a new type of fraud is identified, a reward is given to the discoverer(s) of the fraud method, and also has a function of disclosing the new fraud method in a medium such as a public advertising corporation immediately after its discovery, thereby disrupting the operations of fraudulent organizations and reducing the number of insurance claims.

4. Fraud insurance according to claims 1 to 3, characterized in that it comprises a cloud server CPU, multiple information memory devices, a database recording past fraud crime patterns by type, a generative AI (artificial intelligence) equipped with the functions of searching, matching and analyzing individual information entered as text or voice, and a function of determining the likelihood of fraud using various application software including language models, learning programs and inductive and deductive cognitive software, and having human or robot staff carry out the work via a CIG network consisting of multiple terminals installed at user support centers (non-life insurance companies, etc.) and an IP-VPN formed on the Internet.

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