[사진 제공 = 연합뉴스]There is a high level of dissatisfaction among insurers as insurance companies are making the insurance payment review too strict. They say, ‘Welcome to you’ when signing up for insurance, but when you actually need to pay insurance, your attitude changes.
It is pointed out that the overuse of ‘on-site investigations’ is a problem, although it is possible to prevent damage to good insurers only when the insurance premium calculation and payment review are accurately performed.
The on-site investigation aims to thoroughly examine whether insurance claims are paid, including the possibility of insurance fraud, from the insurer’s point of view, but at the same time, it is also used as a means of refusal or underpayment of insurance benefits.
According to the latest ‘Financial Dispute Mediation Receipts’ announced by the Financial Supervisory Service on the 3rd, the number of cases in the insurance sector is increasing from 28,118 cases in 2018, 29,622 cases in 2019, and 32,130 cases in 2020.
Looking at the status of treatment by type, insurance claim calculation and payment accounted for the largest share with 12,190 cases (2018), 14,498 cases (2019), and 14,961 cases (2020) during the period. This is literally the current status of processing, and it is unknown whether the insurance claim calculation and payment were handled in the insured’s favor, or whether the FSS accepted the insurance company’s claim.
Last year’s statistics on the status of financial dispute mediation receipts have not yet been released, but it is likely that the number of financial dispute mediation submissions increased further as the insurance sector accounted for 64,056 cases of financial complaints and consultations last year, up from 62,701 cases in the previous year.
Financial dispute mediation is a procedure in which the Financial Supervisory Service induces an agreement between the parties regarding disputes raised by financial consumers to financial companies such as insurance companies.
Disputes over the payment of insurance claims have spread to lawsuits. According to the announcement of the Life Insurance Association, there were 1,395 lawsuits (excluding duplicate or repeated applications) from 23 life insurance companies during the first quarter of this year (January to March). The average is 60.6 cases per life insurance company. During the same period from January to March last year, 24 life insurance companies disclosed a total of 1,498 cases. The average is 62.4 cases.
As insurance companies have strengthened the review of insurance payments related to cataract surgery, complaints from insurance consumers claiming to have suffered damage are increasing rapidly, so insurance claims are expected to increase.
The proportion of insurance companies that do not pay insurance at all or only partially pay for medical advice is also high. As of the second half of last year, 22 life insurers had an average of 26.2%, and some payment rates were 32.3%. This is similar to 26.2% and 31.3% in the first half of the previous year. In the meantime, it has been pointed out that insurance companies have been misusing the results of medical advice as a standard for reducing insurance premiums or refusing payments. The insurance industry is operating a medical advisory system that confirms the findings of disease, etc. only with data, rather than directly examining the patient in case of an insurance claim dispute.
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