Document Type : Original Research Paper
Authors
1 Department of Law, Faculty of Law and Political Science, University of Tehran, Iran
2 Department of Law, Faculty of Literature & Human Science, University of Zabol, Zabol, Iran
Abstract
BACKGROUND AND OBJECTIVES: The extent of fraudulent use of insurance benefits is one of the basic problems of social and commercial insurances, which causes huge damage to policyholders, insured persons and society To combat this abnormality, our legislator criminalized Article 97 of the Social Security Law and Article 61 of the Third Party Insurance Law, approved in 2016, as an independent crime and imposed two punishments, imprisonment and a fine. In American law, at the federal level, fraudulent use is prosecuted under general headings such as fraud, however, some forms of fraudulent use are considered an independent crime in Article 1033, Chapter 18 of the Criminal Code. Following the latter approach, all states have criminalized all forms of fraudulently obtaining benefits as a specific offense.
METHODS: The method which is used in this research is analytical and descriptive, which explains and inferred legal materials with the methods of legal and interpretive reasoning.
FINDINGS: The research carried out is showing that there are many ambiguities in terms of the constituent elements of crime and punishment. In both penal systems, the mentoined crime is amongst the intentional crimes whose physical behavior constitutes a positive material act, with the difference that some states have exceptionally accepted the omission of the act in workers' insurance. Also, in both models, the fact that the operation is fraudulent is a condition that must precede the collection of funds and its cause; However, unlike fraud, there is no need for negligence on the part of the organization or the insurer. In terms of the element of result, American law does not consider the realization of loss or the acquisition of benefits as a condition, but in Iranian law, the crime under Article 61 is a restricted crime and the benefit of the perpetrator is a condition. However, Among the opinions, regarding the absoluteness or binding nature of the crimes under Article 97, the legal principles and interpretation, in favor of the accused, are more compatible with the theory of obligation. The penal policy of our legislator is dual and ramshackle, and legislatively, it has chosen a strict form in the third party insurance law, this duality is the product of two agents of time and different modality of insurances. In the American system, the aforementioned crimes are punishable, but with the approval of Article 15 of the Law on Reduction of Imprisonment in 2019, they are subjected to the general provisions of Article 122 and are not punished. From the point of view of formal rules of crime, fraudulent use is subject to the passage of time due to its penal nature. The crime under Article 97 is a forgivable crime and depends on the organization's complaint, but the fraudulent acquisition of third-party insurance becomes unforgivable, which is in line with the general principle of crimes.
CONCLUSION: Examining different dimensions of the issue shows that the existing penal policy is far from the ideal situation and cannot achieve the goals of the legislator. On the other hand, unlike the United States, this policy will be unilateral and to the detriment of the insured, and it will not cover the criminal behavior that companies use to defraud the insured from legal benefits. In order to fix these disadvantages, it is necessary to amend the mentioned articles and determine the punishments according to the severity and importance of the crime. In this article, the fraudulent use of insurance benefits was investigated in the light of the Iranian and American criminal systems, with a view to the approval of new laws, including the revised penal law of 2019.
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