"Why Is Only Half of the Cancer Insurance Payout Received?"

FSS Major Complaints and Dispute Cases in Q4 Last Year
Be Careful About the Payment Period for Car Repair Replacement Vehicle Fees

About a year ago, office worker Mr. A, who had purchased cancer insurance, recently received a cancer diagnosis and filed a claim. The insurance company paid only 50% of the insured amount, citing that the cancer diagnosis was confirmed within two years from the insurance contract date. Mr. A filed a complaint with the financial authorities, claiming it was unfair, but there was nothing that could be done. This was because the insurance policy stated, "If the cause for payment occurs within two years from the contract date, 50% of the insurance benefit will be paid."

The Financial Supervisory Service disclosed major complaints and dispute cases that occurred in the fourth quarter of last year on the 20th.

When repairing a vehicle damaged in a car accident, the rental car fee is paid within the "usual repair period." The usual repair period is calculated by the Korea Insurance Development Institute based on past rental car payment periods and work hours. Even if there is an estimated repair period provided by the service center, the usual repair period recognized under the automobile insurance policy applies, so caution is needed.

If you agree to the electronic document notification service when signing an insurance contract, documents such as payment notices (demands) may be sent electronically instead of by registered mail. Even if you did not receive registered mail and the insurance contract was canceled due to non-payment of premiums, you may not be able to seek relief.

In the case of the "Personal Liability Coverage Endorsement," it is important to understand the scope of coverage. One complainant filed a claim under personal liability insurance for a student’s fracture accident that occurred at the Taekwondo academy he operated but was denied. This was because the accident occurred after regular classes ended, but he had the duty to manage and protect the students at the Taekwondo academy. Liability arising during the performance of duties can be compensated through duty-related liability insurance. The personal liability coverage endorsement does not cover liability arising during the performance of duties.

It is also important to understand whether infectious diseases are recognized under accident insurance policies. One complainant was bitten by an encephalitis mosquito, leading to the Japanese encephalitis virus entering the body, resulting in encephalitis and a long hospitalization, after which he filed a claim for accident hospitalization insurance benefits but was denied. According to policies and precedents, an accident is defined as a sudden and accidental external event that damages the integrity of the body or causes impairment of physiological functions. Even if being bitten by a mosquito is considered a sudden and accidental external event, the entry of the Japanese encephalitis virus into the body is mostly asymptomatic and naturally heals without special treatment, so it is difficult to consider it as bodily harm. Furthermore, in cases where the virus progresses to encephalitis, intrinsic factors such as age, gender, and constitution may have played a role, making it difficult to recognize it as an external event.