"If Death Occurs Immediately After Maturity Due to an Accident During the Insurance Period, Insurance Benefits Must Be Paid"

Korea Consumer Agency Consumer Dispute Mediation Committee Mediation Decision

[Asia Economy Reporter Lim Chun-han] # Mr. A, in his 60s, subscribed to a one-year maturity product called 'Farmer Safety Insurance' from an insurance company on March 7, 2019, and paid the insurance premium for one year. On March 3 of the following year, while repairing a goat barn, he fell from the roof and received intensive care in the hospital's intensive care unit due to traumatic brain hemorrhage, eventually passing away on March 30. The bereaved family claimed insurance benefits such as survivor benefits and funeral expenses, but the insurance company refused, stating that according to the insurance policy Mr. A subscribed to, both the accident and death must occur during the insurance period to pay the insurance benefits.

A dispute mediation decision has been made that insurance benefits can be received even if death occurs immediately after the insurance maturity date due to an accident that happened during the insurance period.

On the 24th, the Korea Consumer Agency's Consumer Dispute Mediation Committee announced that it made a mediation decision that insurance benefits must be paid even if death occurs immediately after maturity while receiving intensive care due to an accident that occurred during the insurance period.

The Dispute Mediation Committee explained that the insurance benefit payment requirements stipulated in the insurance policy (death due to agricultural work safety accident during the insurance period) should be interpreted fairly and reasonably based on the purpose and intent of the policy and the principle of good faith, considering the average customer's understanding.

Once an accident occurs during the insurance period, it is fair and reasonable based on the average understanding to interpret that death after maturity does not affect the payment of insurance benefits. Furthermore, it is difficult to clearly interpret, as the insurance company claims, that both the accident and death must occur during the insurance period. In cases where the meaning of the policy is not clear, it should be interpreted in favor of the customer according to the 'principle of interpreting ambiguities against the drafter' under relevant laws. The Supreme Court's ruling on October 9, 2008, which stated that insurance benefits must be paid even if the diagnosis of sequelae caused by an accident during the insurance period is confirmed after the insurance period, was also taken into consideration.

The Consumer Agency stated, "Considering that Mr. A's death has a direct causal relationship with the accident and occurred in close temporal proximity, it was decided that paying the insurance benefits is reasonable."