In case of agreement between the parties in a traffic accident, the principle of not being able to claim additional insurance money
Exception of ‘aftereffects’… Payment of insurance money when an accident causal relationship is proven
Claims must be made within 3 years of onset… Change of insurance premium with premium rate applied
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Mr. Lee, an office worker in his 30s, who commutes from Gyeonggi-do to Seoul every day, has recently been struggling with unexpected worries. This is because, three years after the incident that caused a contact accident while on the first road to Seoul as a novice driver, the victim’s side claimed that there was an aftereffect and claimed additional insurance money. Mr. Lee could not erase his unhappy heart. This is because immediately after the accident, while dealing with personal accidents, an agreement was reached with the victim, and the related amount was refunded when renewing auto insurance, and the case was concluded with ‘No insurance processing’. Mr. Lee said he was even suspected of being caught in an insurance scam he had only seen on the news. In response to the insurance company’s answer to wait, Mr. Lee was unable to do this or that, and looked at his bankbook and sighed one after another.
If you are a car driver, you must have experienced being involved in a car accident at least once due to your own or someone else’s mistake. Once a traffic accident occurs, the amount of damage is calculated and an agreement is decided between the parties involved in the accident. In principle, if the victim agrees to an accident-related injury at this stage, additional claims for insurance money cannot be made. This is because the agreement usually contains a waiver clause stating that the indemnity right holder waives all claims for damages and not to bring a lawsuit.
However, there are exceptions where additional insurance claims can be made after an accident even if the parties reach an agreement. This is an insurance claim in the event of an aftereffect. This type of agreement is called a conciliation agreement in civil law. Article 733 of the Civil Act states that ‘a contract of conciliation cannot be canceled on the ground of an error, but cancellation is permitted if there is an error in matters other than the dispute, which is the purpose of reconciliation or the qualifications of the parties to the reconciliation’. However, not many drivers are aware of insurance claims due to after-effects. This is because the aftereffects themselves are not universal cases that occur to all victims in the event of a traffic accident.
If so, what does it mean to be able to claim after-effects and insurance benefits? First, the term “sequelae disability” refers to a condition in which the disease cannot be cured even after receiving treatment for a disease, injury, or industrial accident, or the physical and mental sequelae remain. In other words, exempting the aftermath of disability from the principle of non-claiming insurance means that even if a considerable amount of time has elapsed after a traffic accident, if the victim develops an illness that was not expected at the time of the settlement, the agreement itself is judged to have no effect. In this case, the victim can file an additional claim for insurance by submitting a medical certificate from a doctor proving the causal relationship between the disease and the accident.
In the case of non-life insurance, this is covered by the main contract and various special terms and conditions for damage after injury. In the accident insurance, the degree of aftereffects is determined and the insurance amount is calculated according to the classification of the aftereffects as set forth in the terms and conditions. There is no legal limit on the period when insurance claims can be made for aftereffects. However, since the statute of limitations for insurance claims is three years, the victim must complete the insurance claim within three years from the time of the aftereffects.
The case that allows for additional insurance claims in the event of aftereffects is also a provision proven through precedent. In the Supreme Court’s judgment 97da 423 sentenced on April 11, 1997, “As the subsequent damage is unpredictable given the circumstances at the time of the settlement, it is reasonable to assume that if the parties had anticipated the subsequent damage, it would not have been compromised by the amount of the settlement in terms of social norms. If the damage is serious enough, it cannot be considered that the intention of the party has waived the right to claim compensation for such damage, so it can be claimed again.”
If there were only injuries due to the accident at the time the insurer and the victim reached an agreement, and no obstacles were expected, the settlement amount is considered to be an agreement only for medical expenses, loss of business, and alimony caused by the accident. If there is an aftereffect of the accident after the agreement on the injury, it is concluded that it is a ‘ matter other than a dispute ‘ that is not included in the content of the mutual concession between the two parties at the time of the agreement.
Therefore, even in Mr. Lee’s case, regardless of when the accident occurred and whether there was an agreement, if the victim is suffering from after-effects of the accident, he does not have the right to refuse the insurance claim. When the victim completes an additional claim for insurance, the insurance company will proceed with the compensation process after going through procedures to prove the causality between the accident and the disease, such as confirming the diagnosis of aftereffects and requesting advice from a third-party medical institution. At this time, Mr. Lee gets his insurance money back to avoid the insurance process. Because the meaning of the refund itself has disappeared. Instead, the premium rate that reflects the insured event retrospectively is applied to the premium applied when renewing the insurance contract. In the end, Mr. Lee is paying an additional difference between the two amounts.
An insurance industry official said, “There are various cases of aftereffects such as minor disc disease, brain hemorrhage, spinal cord injury, and cancer metastasis to the brain or spine. “There is a lot of room for insurance claims to be processed within two years,” he said.
The above information is based on a specific case, and may differ from whether the insurance company pays insurance money for actual civil complaints.
Kim Soo-hyun, reporter at Hankyung.com [email protected]