Convicted Insurance Fraud... Even After Lawsuits, Not All Unjust Enrichment Can Be Recovered (Comprehensive)

No Choice Despite Reckless Litigation Stigma
727 Unjust Enrichment Recovery Lawsuits in First Half
Full Win Rate Only 86~96%
Urgent Need for Institutional Measures for Recovery

[Asia Economy Reporter Oh Hyung-gil] Even when found guilty of insurance fraud, the unjust gains earned through fraud are not fully returned. Despite the stigma of aggressively filing lawsuits against consumers, insurance companies have no choice but to pursue unjust enrichment recovery lawsuits. Although the scale of insurance fraud detection has been increasing every year, there are calls for institutional measures to be established for recovery after detection.

According to the insurance industry on the 13th, the number of insurance fraud unjust enrichment recovery lawsuits sentenced in the first half of this year totaled 727 cases, including 81 life insurance cases and 646 non-life insurance cases. Among them, the average full win rate for life insurers was 86.3%, while non-life insurers recorded 96.2%.

Among life insurers, ABL Life had a 50% full win rate, winning 1 out of 2 lawsuits fully and losing 1. Dongyang Life also recorded a 50% full win rate, with 1 full win and 1 partial win/loss out of 2 cases. Heungkuk Life (80%) and Fubon Hyundai Life (85.7%) also showed low full win rates.

Among major companies, Hanwha Life recorded 6 full wins, 1 partial win/loss, and 3 losses out of 10 lawsuits. Samsung Life won 14 out of 15 lawsuits fully and had 1 partial win/loss. Kyobo Life had 9 full wins and 1 partial win/loss out of 10 cases. Shinhan Life, NH Nonghyup Life, LINA Life, AIA Life, Orange Life (before merger), DB Life, and MetLife Life each achieved a 100% full win rate.

Since automobile insurance and indemnity medical insurance are mainly exploited for insurance fraud, non-life insurers have a relatively high number of lawsuits but also a high full win rate. Hyundai Marine & Fire Insurance won all 165 lawsuits in the first half of the year, while Samsung Fire & Marine Insurance recorded 156 full wins out of 160 cases, achieving a 97.5% full win rate.

On the other hand, Hana Insurance won only 3 out of 4 cases fully, resulting in a 75% full win rate. Hanwha General Insurance (92.8%), AXA General Insurance (96.5%), Meritz Fire & Marine Insurance (97.5%), and DB Insurance (99.1%) also did not win all their lawsuits fully.

Insurance companies file unjust enrichment recovery lawsuits when a guilty verdict for insurance fraud is confirmed to reclaim the insurance payments made due to fraud. Although criminal trials conclude with a guilty verdict for insurance fraud, civil trials must be conducted to recover the insurance money defrauded by the accused.

This is because the current 'Special Act on the Prevention of Insurance Fraud' does not include provisions for recovering defrauded insurance payments. A revision bill that would require insurance companies to recover fraud amounts upon a confirmed fraud conviction has been pending in the National Assembly for years.

Insurance companies express difficulties, saying they have no choice but to file lawsuits. Even when lawsuits are filed, there are many cases where the accused hide assets during the litigation process, limiting recovery. Additionally, courts sometimes side with medical institutions during trials, considering that actual medical services were provided, resulting in failure to recover insurance payments.

An insurance industry official said, "There are often different standards of judgment between criminal convictions for insurance fraud and civil trials for recovering insurance payments. While legal judgments can naturally differ, it is a very regrettable aspect."

Meanwhile, in the future, the number of insurance fraud unjust enrichment recovery lawsuits will be counted separately from insurance claim and payment lawsuits. Until now, these cases were combined and disclosed together, but due to criticism that this made it difficult to convey the degree or seriousness of insurance fraud, it was decided to disclose the number of lawsuits separately.

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