Problematika preiskovanja zavarovalniških goljufij pri telesnih poškodbah v prometnih nesrečah z minimalnim trkom

magistrsko delo

Nika Berce (Avtor), Bojan Dobovšek (Mentor)

Povzetek

Zavarovalniške goljufije so ena izmed pogostejših oblik gospodarskega kriminala in se pojavljajo na vseh področjih zavarovanj. Družba do njih ni tako kritična kot do ostalih oblik gospodarskega kriminala, saj večinoma še vedno prevladuje mišljenje, da so zavarovalniške goljufije »kaznivo dejanje brez žrtve«. Temu pa v resnici ni tako, saj se zaradi izplačil goljufom vsako leto višajo zavarovalne premije, zato smo žrtve zavarovalniških goljufij vsi zavarovanci. Zavarovalniške goljufije se najpogosteje pojavljajo pri avtomobilskih zavarovanjih zaradi pogostosti teh zavarovanj in veliko različnih možnosti izvršitve. Posebej problematično pa je ugotavljanje in dokazovanje nastanka telesnih poškodb v prometnih nesrečah z minimalnim trkom. Kljub temu, da pri tovrstnih prometnih nesrečah nastane minimalna materialna škoda, so možne tudi telesne poškodbe, najpogostejše so to poškodbe vratne hrbtenice. Postavljanje diagnoze pogosto temelji zgolj na opisu bolečin oškodovanca, saj rentgenska diagnostika poškodb mišičja ne pokaže. Ravno zato se pogosto poraja sum o resničnosti poškodb, ki naj bi nastale pri minimalnih trkih. Pri ugotavljanju nastanka telesnih poškodb pri minimalnih trkih sodeluje več strokovnjakov, tako pravne kot tudi prometne in medicinske stroke. Njihova strokovna mnenja so ključna pri ugotavljanju, ali je do telesnih poškodb res prišlo, ali pa gre za zavarovalniško goljufijo. V magistrskem delu smo se osredotočili na samo problematiko preiskovanja in dokazovanja telesnih poškodb pri minimalnih trkih. Zanimalo nas je, kako obsežna je ta problematika v Sloveniji in kako jo rešujemo. S tem namenom smo opravili tri osebne intervjuje, in sicer z višjim strokovnim sodelavcem za analizo prevar iz Zavarovalnice Triglav, d. d., s specialistko za pravne zadeve škod iz Zavarovalnice Triglav, d. d., in izvedencem medicinske stroke. Pregledali pa smo tudi prakse iz tujine in preverili, kako se s tovrstno problematiko spopadajo v šestih evropskih državah.

Ključne besede

magistrska dela;zavarovalniške goljufije;telesne poškodbe;minimalni trk;

Podatki

Jezik:	Slovenski jezik
Leto izida:	2020
Tipologija:	2.09 - Magistrsko delo
Organizacija:	UM FVV - Fakulteta za varnostne vede
Založnik:	[N. Berce]
UDK:	343.37:656.1.08(043.2)
COBISS:	3861994
Št. ogledov:	749
Št. prenosov:	111
Ocena:	0 (0 glasov)
Metapodatki:

Ostali podatki

Sekundarni jezik:	Angleški jezik
Sekundarni naslov:	Issues of insurance fraud investigations of bodily injuries caused in minor car accidents
Sekundarni povzetek:	Insurance fraud is one of the most common types of economic crime that occurs in all areas of insurance. The public is not as critical to them as to other forms of economic crime, as it is mostly thought that insurance fraud is a “victimless crime.” Although this is not the case. Since insurance premiums increase every year due to fraudulent compensations, therefore, we are all victims of insurance fraud. Most commonly, insurance fraud is reported in motor insurance due to the frequency of such insurance and many different ways of committing such fraud. Especially problematic is identification and proving of the occurrence of bodily injury caused in road accidents with minimal collision. Despite the fact that such road accidents mostly result in minimal material damage, injuries are also possible. The most common are injuries of cervical spine or whiplash injuries. Diagnosis is often only based on the description of pain of the injured person, as X-ray diagnostics do not show muscle injuries. This is why the suspicion of the reality of injuries that are caused in minimal collisions is often raised. In the assessment of the occurrence of bodily injuries caused in minimal collisions, several experts, such as legal, traffic and medical professionals are involved. Their expert opinions are crucial in determining whether bodily injuries actually occurred or whether it was an insurance fraud. In this thesis, we focused on the problem of proving and investigating bodily injuries caused in minimal collisions. We were interested in how extensive this issue is in Slovenia and how we are solving it. Moreover, we conducted three personal interviews with a fraud examiner from Triglav Insurance Company, with a specialist in legal claims from Triglav Insurance Company and a medical expert. We also examined practices from abroad to see how these issues are being dealt with in six other European countries.
Sekundarne ključne besede:	Insurance Fraud;Bodily Injuries;Minimal Collision;
Vrsta dela (COBISS):	Magistrsko delo/naloga
Komentar na gradivo:	Univ. v Mariboru, Fak. za varnostne vede, Ljubljana
Strani:	VI, 59 str.
ID:	11462169