[Column] Simplifying the Stalled 12-Year Process of Filing 실손보험 Claims

[Image source=Yonhap News]

[Asia Economy Reporter Ki Ha-young] Policyholders of indemnity insurance face numerous inconveniences when claiming insurance benefits. Under the current system, they must visit hospitals in person to obtain various supporting documents required for the claim. The documents to be submitted to insurance companies vary as well. This process also incurs various issuance fees. Many policyholders give up on claiming indemnity insurance benefits if the amount to be received is small.

A solution to this issue is the simplification of indemnity medical insurance claims. Insurance companies and financial authorities advocate for its introduction to enhance consumer convenience, but related legislation has been stalled for 12 years. The medical industry strongly opposes it, citing concerns over medical information leakage and misuse.

There were high expectations that discussions on simplifying indemnity insurance claims would gain momentum in the 21st National Assembly, as the Assembly recognized the necessity. However, this month, the National Assembly's Legislation and Judiciary Committee did not include the amendment to the Insurance Business Act, which contains measures to simplify indemnity insurance claims, on its agenda. The strong resistance from the medical community remains a significant obstacle.

Currently, five related bills proposed by lawmakers Jeon Jae-su, Ko Yong-jin, Kim Byung-wook, Jung Cheong-rae (all from the Democratic Party), and Yoon Chang-hyun (People Power Party) are pending in the National Assembly. All five bills mandate that when an insurance contract holder requests the transmission of documents necessary for an insurance claim, medical institutions must comply unless there is a justifiable reason not to.

According to a survey conducted last month by civic groups Green Consumer Network, Consumers Together, and Financial Consumers Federation targeting 1,000 people, 47.2% of respondents had given up on claiming indemnity medical insurance within the past two years. Reasons for giving up (multiple responses allowed) included ▲the medical expense was small (51.3%), ▲no time to visit the hospital to collect documents (46.6%), and ▲it was bothersome to send supporting documents (23.5%).

While this issue has been at a standstill for 12 years, the burden has been passed on to 39 million indemnity insurance policyholders. The collective selfishness of the medical community has delayed progress every year, disregarding the convenience of policyholders. Moreover, in an era where contactless services have expanded due to COVID-19, requiring the submission of paper documents is a step backward. Even now, policyholders frustrated by the complicated process may be giving up on claiming their insurance benefits. Nothing is more important than the rights and convenience of insurance consumers.