Preventing Tricks for Car Insurance Claims on Private Clinic and Premium Hospital Room Admissions

Exception Rules for Traffic Accident Patients Using Higher-Level Hospital Rooms
Existing 'All Medical Institutions' Reduced to 'Hospitals or Higher'

The Ministry of Land, Infrastructure and Transport announced on the 9th that it will implement an improvement plan for the "Automobile Insurance Medical Fee Standards" starting November 14, which reduces the exception allowing traffic accident patients to use higher-grade hospital rooms from all medical institutions to only hospital-level or higher medical institutions, in order to prevent leakage of automobile insurance payments.

For inpatient treatment of traffic accident patients, the use of general hospital rooms is the principle. Until now, exceptions have been made to allow the use of higher-grade rooms in cases of ① treatment purposes (e.g., infectious diseases) and ② unavoidable cases where no general rooms are available (within 7 days), with inpatient fees fully covered by automobile insurance regardless of room grade.

The inpatient room fees are approximately 30,000 to 400,000 KRW per day for higher-grade rooms and about 30,000 to 40,000 KRW for general rooms.

However, recently, the exception rule applied in small-scale clinic-level institutions without general rooms has been exploited, with a significant increase in cases where higher-grade rooms are predominantly installed and high room fees are charged, raising the need for improvement.

The payment scale for higher-grade room inpatient fees has steadily increased from 1.5 billion KRW in 2016 to 11 billion KRW in 2020, and 34.3 billion KRW last year (2021).

The revised plan maintains the current rule for ① treatment purposes but limits ② unavoidable cases due to lack of general rooms to hospital-level institutions only, excluding clinic-level institutions. This reflects the intent under the Medical Service Act to operate facilities and personnel differently between hospital-level (inpatient) and clinic-level (outpatient) based on treatment purposes.

Park Ji-hong, Director of Automobile Policy at the Ministry of Land, Infrastructure and Transport, stated, "We expect that this improvement measure will help prevent moral hazard by medical institutions that operate expensive higher-grade rooms for automobile insurance patients and excessively claim insurance payments, thereby contributing to the prevention of insurance payment leakage."