Paid ‘metastatic cancer’ insurance money… Frequent user disputes due to processing of specific insurance money, not general insurance money

There is often conflict between consumers and insurance companies as they pay for ‘metastatic cancer’, secondary cancer, on a ‘specific cancer’ basis, which is a smaller amount than general cancer.

In the case of metastatic cancer, insurance companies are in a position to pay special cancer insurance premiums in accordance with the terms and conditions, but most consumers claim that they were not given an explanation at the time of signing up, arguing that the planner was at fault

Judgments are divided within the courts on the issue of metastatic cancer. The district court ruled that it was not important to explain, while the Supreme Court ruled that if the designer’s explanation was insufficient, the payment should be made on the basis of general cancer.

Lee (daughter), who lives in Suwon, Gyeonggi-do, also clashed with the company over cancer insurance after signing up for AIA Life cancer insurance in June 2020. Mr Lee was diagnosed with colon cancer and rectal and liver metastases recently and requested a general cancer diagnosis, but it was deemed to be paid as a specific cancer diagnosis benefit.

If you look at the insurance coverage that Mr. Lee for it, the general cancer diagnosis benefit is paid from at least 15 million earned to 30 million depending on the date of the contract. Specific cancer diagnosis benefits range from 3 million won to 6 million won.

Mr Lee appealed for injustice, saying, “I don’t understand that liver metastasis is also a cancer, but it is not considered a general cancer. I was not informed that the colon was classified as a specific cancer at the time of joining , and I was only told the contents of the contract in a book.”

An AIA Life official said, “In the case of ‘(no) one-stop 100-year-old cancer insurance Ⅲ (renewal)’ to which the informant has subscribed, insurance money is paid based on primary cancer.” Paid accordingly. to the standard divided according to each cancer, and the diagnosis fee for colorectal cancer related to a specific cancer is paid at a level of 20% of the diagnosis fee for general cancer.”

All cancer insurance policies generally specify that for secondary cancer such as metastatic cancer, insurance is paid based on the first cancer.

In the case of secondary cancer (C77-C80), a ‘classification clause based on primary cancer’ was added to the cancer insurance terms and conditions by revising the terms and conditions in 2011. It was classified as gastric cancer.

Distribution is possible under the terms and conditions, but conflicts over insurance claims continue due to insufficient explanations by lawyers before subscription.

In the judgment of the Supreme Act on the payment of secondary cancer insurance money (2014da229917, judgment 229924) and the mediation of a dispute between the Consumer Dispute Mediation Committee (2020) and the Financial Dispute Mediation Committee (2019), “If the lawyer’s explanation of the terms and conditions are insufficient, it’s better to pay the general cancer insurance money. That’s right,” he said, raising the consumer’s hand.

However, there are precedents that have given strength to insurers. According to the ruling of the Gwangju District Court (2018 Gaso 78627), ‘It seems that the provision of payment of insurance money based on the primary site has placed the concept of various cancers subject to payment, such as cancer diagnosis fees, in the contract insurance deemed that The phrases for the distribution of basic cancer standards are not important information that must be explained, so I saw that it would not affect the payment of insurance money even if they were not told.

An insurance industry official said, “Currently, insurance companies pay special cancer insurance money in the case of metastatic cancer according to the terms and conditions. There are many disputes because it is difficult to prove it in practice,” he said.

[소비자가만드는신문=이예린 기자]

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