Tongyang Life Insurance was sanctioned by the financial authorities after unfairly reducing the insurance money of 46 subscribers who were diagnosed with colorectal intramucosal cancer and claimed treatment from June 2013 to March 2015. According to the terms and conditions, a total of 760 million won should be paid for cancer treatment, but it became a problem that only 100 million won was paid for cancer treatment in situ. Cases in which insurance companies do not properly pay insurance money have been repeated recently. DB ( DB ) Insurance, Meritz Fire & Marine Insurance, and Samsung Fire & Marine Insurance were also sanctioned for unfair payment of insurance money this year . It is pointed out that this problem is repeated due to the level of weak punishment, such as small-scale fines.
On the 12th, <The Hankyoreh> looked at the details of sanctions by the Financial Supervisory Service for the past 10 years (2014-June 2023). From 2001 to 2020, the total amount of insurance money that these insurance companies did not or did not give to subscribers reached 170 billion won.
Samsung Life Insurance has the largest unpaid balance. From January 2011 to September 2019, a total of 2019 insurance contracts were subject to sanctions for not unfairly paying 57.879 billion won. A typical example is the case of non-payment of suicide insurance. According to the terms and conditions, insurance money must be paid even if a subscriber commits suicide, but suicide is a reason for exemption from payment. In addition, a subscriber suffering from cancer was treated at a nursing hospital and received a sanction from the Financial Supervisory Service last year after refusing the claim for insurance money on the grounds that it is not a direct treatment for cancer. Hanwha Life Insurance has the largest number of unpaid insurance contracts. In 5049 insurance contracts, 14.082 billion won of insurance money was not properly paid.
The method used by insurance companies to reduce the amount of insurance money is similar. It is a way of reducing the death benefit due to past medical history unrelated to the accident, or reducing the insurance money for not notifying the insurance company안전놀이터 in advance of a job change unrelated to the accident. Sometimes, the special contract insurance money is arbitrarily omitted at the time of payment, or the compensation manager lowers the insurance money payment rate without any grounds.
The problem is that insurance companies are repeating the practice of unfair payment of insurance money. There are many cases where an insurance company that has been sanctioned by the authorities is sanctioned again. This has nothing to do with the fact that the level of punishment is weak.
A total of 170 billion won in insurance money unfairly paid by the 27 insurers subject to sanctions was only 10.469 billion won in fines. It is about 6.2% of the amount of wrongful payment. This is because the penalty is determined based on the premium income received from the policyholder for a year, not the unfair gains from not paying the insurance money properly, resulting in an underestimation problem. Insurance usually covers more than the premium.
Insurance companies are paying insurance money and delayed interest to subscribers only when the financial authorities start to take sanctions. From the point of view of insurance companies, if they are caught by the authorities, they can pay the insurance money, late interest, and a small penalty. It can take years for policyholders to get their insurance money back, and compensation for damages is rarely made. The level of punishment is not strong, so there is little incentive to improve the current form.
Won Hee-jeong, head of the damage insurance inspection bureau at the Financial Supervisory Service, said, “Although the FSC has the authority to order the return of unjust enrichment, in reality, most insurance companies will return the insurance money on their own.” I know that there are few of them,” he said.
The financial authorities recognized the problem and started to strengthen the punishment. An amendment to the Insurance Business Act is being pursued to change the standard for calculating fines from premium income to unjust gains. After the legislative announcement in February, the bill has been submitted to the National Assembly’s Political Affairs Committee.
Kim Seong-joo, CEO of the Cancer Patients Rights Council, said, “If we consider even subscribers who pass over without reporting to the Financial Supervisory Service, the scale of unfair profits by insurance companies will be much larger.” have to,” he said.