"Insurance Expert Medical Advisory Body Should Reduce Insurance Payment Disputes"

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[Asia Economy Reporter Oh Hyung-gil] There has been a call for the establishment of medical advisory procedures or compensation advisory bodies through regulatory authorities to reduce disputes over insurance claim payments between insurers and customers.

Baek Young-hwa, a research fellow at the Korea Insurance Research Institute (KIRI), suggested in a report titled "Considerations for Strengthening Regulations Related to Medical Advisory" published on the 9th in the 'KIRI Insurance Law Review' that "In the long term, it is necessary to establish objective and professional advisory bodies or advisory procedures related to insurance that require medical judgment."

When insurers review whether to pay insurance claims, they consult medical institutions if medical experts' judgment is needed. However, there have been ongoing criticisms that such medical consultations are abused as a means to deny insurance payments.

In response, regulatory authorities have mandated insurers to provide explanations to consumers regarding medical consultations and have improved related systems to disclose the status of medical consultations.

Additionally, although the Insurance Association plans to conduct joint medical consultations with medical societies focusing on dispute cases, it has been pointed out that the objectivity and fairness cannot be completely free from controversy since the consultations are conducted through the Insurance Association, an industry interest group.

Ultimately, to minimize consumer disputes, it is proposed that regulatory authorities intervene to enhance objectivity.

However, the report pointed out that strengthening regulations related to medical consultations should not actually suppress legitimate medical consultations and insurance claim review activities.

This content was produced with the assistance of AI translation services.