"Insurance Companies' Rate of Denying Claims After Medical Consultation Approaches 80%"

According to Kim Byung-wook, a member of the Democratic Party of Korea, on the 4th, the non-payment rate through the medical advisory system of insurance companies in the past three years reached up to 79%.

[Asia Economy Reporter Oh Hyung-gil] Concerns have been raised that the medical advisory system used by insurance companies is being exploited to deny insurance payouts.

According to Kim Byung-wook, a member of the Democratic Party of Korea, the non-payment rate through the medical advisory system by insurance companies in the past three years has reached as high as 79%.

Kim argued that the high non-payment rate through the medical advisory system is expected to result in damages to insurance consumers who have life and non-life insurance policies.

The medical advisory system refers to the process where insurance companies seek the opinion of medical specialists regarding the insured’s (consumer’s) illness when deciding whether to pay insurance claims. However, it has been pointed out that insurance companies excessively overuse the medical advisory system and conduct it through commissioned medical advisors, which undermines objectivity and fairness.

Kim stated, "The purpose of the medical advisory system is to obtain the help of medical advisors to ensure objectivity when it is difficult to determine whether the insurance claim filed by the policyholder falls under the conditions for payment according to the policy terms. Contrary to this purpose, insurance companies are applying medical advisory broadly."

He added, "Even if similar injuries occur in the same area, due to differences in treatment methods and the patient’s constitutional heterogeneity, the final assessed aftereffects differ. However, the medical advisors commissioned by the insurance companies evaluate only the provided imaging films and medical records, which raises concerns about fairness and objectivity."

Kim emphasized the urgent need to improve the medical advisory system by refining and strengthening its requirements, enhancing the obligation to explain the consent procedure for medical advisory, establishing a credible medical appraisal system, and disclosing information about medical advisors and advisory institutions.

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