"Insurance Payment Criteria and Policy Verification Required"
The Financial Supervisory Service (FSS) will continuously disclose information on consumer complaints and disputes related to finance, ranging from insurance to used car purchases.
On the 27th, the FSS announced that as part of its business innovation roadmap (FSS.), it disclosed 20 major complaint and dispute cases from the second half of last year along with 5 resolution standards. Most of these were related to insurance. Among the disclosed complaint and dispute cases, 65% (13 cases) were in the insurance sector, overwhelmingly more than banking and specialized credit finance (4 cases) and financial investment (3 cases). Additionally, 80% (4 cases) of the dispute resolution standards introduced by the FSS were related to insurance.
The top complaint and dispute case highlighted was the refusal to pay insurance benefits for chemoport insertion surgery. This is because chemoport insertion surgery, which involves implanting a device inside the body to administer medication and exposing the drug inlet connected to the device outside the skin, is explicitly excluded from the definition of "surgery" in insurance policy terms. Therefore, it was explained that there is a need to distinguish between general surgeries and surgeries covered under insurance policies.
There was also a case involving a used car collateral loan issued by a capital company. The dispute arose because the capital company negligently evaluated the collateral despite the vehicle having an accident history, resulting in excessive loan execution. However, since the loan amount was within the limit and the borrower confirmed the sale price, loan amount, and vehicle inspection through a happy call, the loan was executed, and the FSS did not accept the complaint. Ultimately, consumers need to carefully verify the appropriate market price.
It was also emphasized not to forget that in the case of comprehensive car insurance claims, the insurance payout is calculated based on the vehicle's value at the time of the accident, not the value at the time of contract. It was explained that this should be confirmed through the Korea Insurance Development Institute’s vehicle standard value inquiry.
The FSS also disclosed various major dispute resolution standards. For disease insurance payout standards, insurance contracts with policy terms applied before April 1, 2020, determine insurance benefits based on the Korean Standard Classification of Diseases (KCD) at the time of subscription or diagnosis. Insurance contracts concluded after April 1, 2020, determine disease applicability solely based on the KCD at the time of diagnosis. Furthermore, it was emphasized that indemnity insurance covering criminal settlement costs arising from accidents while driving a car determines coverage eligibility based on whether the unique working equipment of construction machinery (such as the front forks of a forklift) was used.
An FSS official stated, "We will continue to provide useful information quarterly that can help prevent consumer damage by preemptively blocking potential complaints and disputes, and assist consumers and financial companies in resolving disputes should they arise."
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