900次航班延误理赔300万，究竟是“赚”还是“骗”

📅 2020-06-17 📂 Zhiming Hot Comments Zhiming Hot Comments 🏷️ #Criminal Law of the People's Republic of China #保险诈骗罪 #航班延误理赔

Compiled from: Sina.com, China Economic Net

[2] Case Review
Li previously worked in the aviation service industry and was familiar with flight delay information and insurance claim procedures. Before purchasing a flight, she would analyze the flight and weather conditions, and use the identity information and bank cards of relatives and friends to buy multiple flight delay insurances. If she learned that the flight might not be delayed, she would cancel the ticket before takeoff to minimize losses. Once a flight was delayed, Li would begin to file claims with the insurance company.

From 2015 to the present, Li has fabricated itineraries by purchasing tickets, obtaining over 3 million yuan in compensation from nearly 900 delayed flights.

Currently, Li has been placed under criminal coercive measures by the police on suspicion of insurance fraud, and the case is under further investigation.

Opinion 1: The crime of insurance fraud is established.
"Criminal Law of the People's Republic of China"
Article 198: Crime of Insurance Fraud
Whoever engages in insurance fraud under any of the following circumstances, if the amount is relatively large, shall be sentenced to fixed-term imprisonment of not more than five years or criminal detention, and shall also be fined not less than 10,000 yuan but not more than 100,000 yuan; if the amount is huge or there are other serious circumstances, the sentence shall be fixed-term imprisonment of not less than five years but not more than ten years, and a fine of not less than 20,000 yuan but not more than 200,000 yuan; if the amount is especially huge or there are other especially serious circumstances, the sentence shall be fixed-term imprisonment of not less than ten years, and a fine of not less than 20,000 yuan but not more than 200,000 yuan or confiscation of property: (1) The policyholder intentionally fabricates the subject matter of insurance to defraud insurance money; (2) The policyholder, insured, or beneficiary fabricates false causes for an insured incident or exaggerates the extent of loss to defraud insurance money; (3) The policyholder, insured, or beneficiary fabricates an insured incident that never occurred to defraud insurance money; (4) The policyholder or insured intentionally causes property loss from an insured incident to defraud insurance money; (5) The policyholder or beneficiary intentionally causes the death, disability, or illness of the insured to defraud insurance money.

Based on the currently available information, Li first leveraged his familiarity with aviation services and procedures to analyze flight delays, identifying flights with higher delay rates. He then used the ID information of friends and relatives to purchase multiple flight tickets and delay insurance. Finally, if the flight was not delayed, Li would cancel the tickets; if the flight was delayed, he would proceed with claims, thereby obtaining compensation.

After media reports, many netizens and professionals believe that although Li does not meet the five conditions for insurance fraud as described above, his actions do constitute the elements of fraud. That is, subjectively, Li had the intent to unlawfully possess the insurance company's flight delay claim funds. Objectively, he carried out the standard procedural behavior of fraud, specifically fabricating the deceptive act that he and his relatives were about to take flights. This deceptive behavior led the insurance company to mistakenly believe that Li had experienced a genuine flight delay. This mistaken belief caused the insurance company to make a payout, Li obtained the insurance money, and the insurance company suffered a loss.

View Two: Not Guilty
Another view is that Li is not guilty. First, Li did not fabricate facts about flight delays, including inventing weather conditions, flight situations, or forging relevant flight delay documentation, which would have led the insurance company into a mistaken belief and caused them to pay out. Second, even though the identity information Li used to purchase tickets was not entirely his own, it was all real information. Third, the insurance company's flight delay insurance did not stipulate that the policyholder and the beneficiary must be the same person. In summary, Li's actions do not constitute insurance fraud.

The author believes

First, Li used real identity information to purchase tickets and flight delay insurance, and paid the full consideration. This transaction and insurance purchase were entirely legal. The insurance company does not screen customer information; it only checks during claims whether the customer purchased a ticket for the delayed flight. As for the customer's identity information and whether the customer actually boarded the flight, these are not within the insurance company's review scope.

Second, flight information and weather information are public. Whether a flight is delayed depends not only on weather but also on many other factors, which Li cannot control. Since 2015, Li has filed nearly 900 claims for flight delay insurance. Apart from his analytical ability, there is also an element of luck. Li has encountered many instances where flights were not delayed. So why, when flights are not delayed, does the money Li pays become profit for the airlines and insurance companies? In fact, the essence of insurance companies is for commercial purposes. Customers legitimately purchase insurance, and if a flight is delayed, a claim is paid—this is perfectly normal. It cannot be considered insurance fraud simply because a particular customer has filed too many claims.

But the key issue is that, according to the notice issued by the Nanjing police on June 12, "Li fabricated materials proving flight delays and fabricated the fact of flight delays." The crime of insurance fraud refers to the act of illegally obtaining insurance money for the purpose of illegal gain, violating insurance regulations, and using methods such as fabricating insurance subjects, insurance accidents, or creating insurance accidents to defraud insurance companies of a relatively large amount of money. From this perspective, Li's actions constitute insurance fraud.

Finally, insurance companies need to plug loopholes and standardize operations. From the perspective of industry-standard operations, many insurance companies still have many loopholes in their business processes. Due to the frequent occurrence of such incidents, insurance companies have gradually begun to pay attention to the claims process for delay insurance. This type of case serves as a lesson and a wake-up call for insurance companies. In fact, the more important focus is on how to regulate the normal operations of the insurance industry, better fill these loopholes, ensure compliance, and prevent such incidents from happening again in the long run.

900次航班延误理赔300万，究竟是“赚”还是“骗”

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