Simplified Claims Process Expanded to Pharmacies... Insurance System Changes Next Year

Change Group Insurance 'Non-Work-Related Accident Death' Beneficiary to Employee
Increase Limits for Gas Accident and Children's Playground Liability Insurance

Next year, various insurance systems will be improved in the insurance industry to protect consumer rights, support vulnerable groups, and activate insurance fraud reporting.

According to the Life Insurance and Non-life Insurance Associations on the 30th, from January 1 next year, a reward system for reporting prohibited acts such as insurance fraud mediation, solicitation, and advertising will be implemented. With the enforcement of the amended "Special Act on the Prevention of Insurance Fraud" in August, not only insurance fraud acts but also mediation, inducement, solicitation, and advertising of insurance fraud are subject to punishment. Accordingly, the operating standards for the insurance crime reporting reward system were recently revised to provide a basis for paying a reward (1 million KRW) for reporting acts such as insurance fraud mediation and solicitation, and it will be implemented from next year.

From January 1 next year, the beneficiary of insurance in group insurance contracts will be changed from the "company" to the "worker" (legal heir) in the event of "death due to non-work-related accidents." Group insurance, which is subscribed to by groups or companies with five or more people, is insurance to cover workers' death, sequelae, and actual medical expenses. Until now, there have been frequent disputes over insurance payments because the beneficiary was often designated as the company or employer rather than the worker. The financial authorities improved the system reflecting the Supreme Court precedent that recognizes the insurance money for non-work-related accidents as belonging to the worker, even if the beneficiary of the death insurance money in group insurance contracts is designated as the "group or the representative of the group."

An image depicting ChatGPT illustrating the use case of the elderly family assistance system when purchasing insurance. Provided by ChatGPT

The convenience of Happy Call for consumers is also expected to be completed by the first quarter of next year. Happy Call is an explanation procedure in which the insurer confirms and supplements whether full sales have been made, such as fulfilling the obligation to provide thorough explanations and delivering documents at the insurance contract stage. For elderly people aged 65 or older, a family assistance system will be introduced. Previously, elderly people could not receive Happy Calls through electronic methods such as mobile phones. However, from now on, by designating a family member as an assistant, Happy Calls via mobile will be possible. In addition, when conducting Happy Calls for foreigners, interpretation and translation services will be provided in major foreign languages to ensure smooth communication.

From April next year, the means of identity verification for proxy insurance claims will be diversified. Previously, when making proxy insurance claims, a certificate of seal impression or a certificate confirming the fact of the claimant's signature had to be issued. However, from now on, convenience will be improved so that identity verification can also be done through electronic authentication methods such as financial certificates.

From May 15, the compensation limit for gas accident liability insurance will be increased. Gas accident liability insurance is mandatory insurance to compensate for damage to others' life, body, or property caused by gas accidents such as high-pressure gas or city gas. The compensation limit will increase from the existing 80 million KRW to up to 150 million KRW in case of death or sequelae. For injuries, it is expected to increase from 15 million KRW to up to 30 million KRW.

From June 18, the compensation limit for children's playground liability insurance will also be raised. This insurance is mandatory insurance to compensate for damage to others' life, body, or property caused while using playground equipment at places with children's playground facilities. In case of death or injury accidents occurring at places where playground equipment is installed, such as daycare centers, the compensation limit will be raised so that victims can receive sufficient compensation. The compensation limit for death and sequelae will increase from 80 million KRW to 100 million KRW, for injury from 15 million KRW to 20 million KRW, and for property damage from 2 million KRW to 2.5 million KRW. In addition, the scope of facilities subject to mandatory insurance will be expanded. Previously, there were 20 types of facilities such as daycare centers, kindergartens, and child welfare facilities, but four types of facilities including science museums, arboretums and gardens, public sewage treatment facilities, and amusement parks will be added.

On October 25, the second phase of the electronic claim system for indemnity medical insurance will be implemented. The electronic claim system for indemnity insurance allows subscribers to claim insurance benefits directly through the Silseun24 application or website without issuing paper documents related to medical expenses. From October 25 last year, the first phase was implemented first in hospital-level medical institutions (with 30 or more beds, etc.). From the second phase, it will be expanded to clinics and pharmacies.