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Mr. A's child was diagnosed with developmental delay due to a brain disorder and received language and neurodevelopmental intervention therapy. During this process, the child was diagnosed with a permanent impairment related to speech function. Mr. A filed a claim for disability insurance benefits under a children's insurance policy, but the insurer refused to pay. The insurer argued that since the child could pronounce some consonants among the four types of speech sounds-bilabial, alveolar, palatal, and laryngeal-it was difficult to consider the impairment as "permanent."

However, the Financial Supervisory Service determined that if even some consonants within a speech sound category cannot be pronounced, it can be regarded as an inability to pronounce that speech sound. For example, if the child cannot pronounce 'm' and 'b' but can pronounce 'p' among the bilabial sounds, this should be interpreted as an inability to pronounce bilabial sounds. Taking into account the fact that Mr. A's child was diagnosed with a disability after a long period of treatment and the results of various tests, the Financial Supervisory Service concluded that a permanent impairment existed and ordered the insurer to pay the insurance benefits.

The Financial Supervisory Service disclosed cases of complaints related to insurance claim payments, claims, and premium surcharges. Getty Images

On January 14, the Financial Supervisory Service released major cases and decisions related to insurance claim payments, claims, and premium surcharges that occurred in the third quarter of last year.

Mr. B suffered a fall accident while using a golf practice facility within an apartment complex and claimed accident insurance benefits from the liability insurer. The apartment residents' representative council, as the policyholder, had purchased facility owner and operator liability insurance and additionally subscribed to a special rider for on-premises medical expenses. This rider covers medical expenses within a set limit for third parties injured in accidents inside the facility, even if there is no defect in the facility itself. However, the insurer argued that since there was no defect in the facility during the accident, the residents' representative council had no liability, and thus the insurance payment could not be made. Mr. B filed a dispute with the Financial Supervisory Service, claiming the insurer's refusal was unfair, and the Financial Supervisory Service ruled in favor of Mr. B.

Facility owner and operator liability insurance covers the liability borne by the insured. If the insured has no legal liability, compensation may not be paid to the victim. However, the on-premises medical expenses rider allows the victim to claim actual medical expenses from the insurer if an accident within the facility is confirmed, even if the insured (the residents' representative council) is not legally liable.

Mr. C purchased automobile insurance and added a rider allowing his spouse to drive the vehicle. This rider allows not only the car owner but also the spouse and family members to drive the insured vehicle. While driving Mr. C's car, his spouse was involved in an accident. Afterwards, Mr. C was notified by the insurer of a premium surcharge. Mr. C filed a dispute with the Financial Supervisory Service, claiming it was unfair to apply the premium surcharge to himself, the insured, rather than to the spouse who actually caused the accident.

The Financial Supervisory Service did not accept Mr. C's claim. Automobile insurance evaluates accidents and calculates premium discounts or surcharges based on the insured, not the actual driver. Therefore, the insurer's handling of the premium surcharge on Mr. C, the insured, even though the spouse caused the accident, was not considered unfair.

Mr. D, whose father was both the insured and the beneficiary of the insurance claim, filed a claim for diagnosis insurance benefits on behalf of his father, who had lost consciousness due to acute stroke. The insurer refused to pay, stating that only the father, as the beneficiary, could file the claim. Mr. D then filed a dispute with the Financial Supervisory Service.

The Financial Supervisory Service concluded that, under civil law, unless one is an authorized agent or a legal guardian, it is not possible to perform legal acts such as filing an insurance claim on behalf of another person. Even if Mr. D is an immediate family member of the insured, he cannot file the claim unless he has been delegated the right to exercise the claim or has been appointed as a legal guardian. However, if the "designated proxy claimant system" is used, the spouse or children of the insured can file claims on behalf of the insured in cases where the insured is unable to do so due to a serious illness or other reasons.