First Trial: Guilty → Second Trial: Not Guilty → Supreme Court Overturns
"Even If Explanation Duty Is Lacking, False Acts Are Deception"
Deliberate Omission of Emergency Medical Chart
Supreme Court Sides with the Insurance Company
A case in which a mother omitted the word "electric kickboard" from an insurance claim and instead wrote "injured from a fall"-after learning that accidents involving electric kickboards are not covered by children's indemnity insurance, and subsequently received 2,740,845 won in hospital expenses-has reached the Supreme Court.
The insurance company viewed this as a violation of the Special Act on Prevention of Insurance Fraud and filed a criminal complaint against the insurance agents involved. The Supreme Court determined their actions constituted "deception."
According to the legal community on November 3, the Supreme Court's Third Division (Presiding Justice Noh Kyungphil) overturned the appellate court's acquittal of two insurance agents and the mother of the child who was injured in the electric kickboard accident.
This case began in 2021 when a child suffered a fracture after falling off an electric kickboard on the road. The child's mother had enrolled in Meritz Fire & Marine Insurance's children's indemnity medical insurance in May 2019. The policy clearly stated that "if a motorcycle is continuously used, this must be reported to the insurer, and accidental injuries caused by motorcycles are not covered."
On December 28, 2021, the mother and the insurance agents wrote "injured from a fall" as the cause of injury and submitted documents to the insurer that excluded the part of the emergency medical chart indicating "electric kickboard accident." As a result, they received a total of 2,740,845 won, including 766,381 won for hospitalization due to injury, 384,464 won for non-reimbursable injections, and 1,590,000 won for surgery.
The first trial found the insurance agents guilty, stating that the agents and the client had conspired to manipulate the accident details and receive insurance payouts, fully aware that electric kickboard accidents were excluded from coverage.
The appellate court reached a different conclusion. The judges determined that the insurer's explanation of the policy terms was insufficient. They noted, "The insurer only explained that 'accidents while driving a motorcycle' were not covered, and there is no evidence that the insurer informed the policyholder that accidents while riding an electric kickboard were also excluded." Therefore, the court found it difficult to conclude that the policyholder had deceived the insurer.
The Supreme Court overturned this decision. The judges stated, "The policy in question requires the insured to notify the company if they continue to use a motorcycle or a motorized bicycle, and explicitly excludes injuries occurring while driving from coverage." They further explained, "The defendants' actions-falsifying the cause of the accident and omitting relevant medical chart information-constitute deception that cannot be accepted by social standards and fall under the fraudulent act of deception." The court also clarified, "Even if the insurer failed to fulfill its duty to explain, this alone does not affect whether deception occurred."
© The Asia Business Daily(www.asiae.co.kr). All rights reserved.
