Supreme Court: Death Before Long-Term Care Grade Assessment Is Not Eligible for Insurance Payment

Court: "Judgment on the deceased... Difficult to consider legally effective"

If a person's health condition qualifies them for long-term care benefits, but the insured dies before the long-term care grade is determined after signing an insurance contract that pays benefits, the Supreme Court has ruled that the insurance payout cannot be made.

The Supreme Court's First Division (Presiding Justice Oh Kyung-mi) announced on the 1st that it overturned the second trial ruling, which had ruled against the insurer in a lawsuit filed by the insurer against the bereaved family of the deceased Mr. A, and sent the case back to the Ulsan District Court.

Mr. A had subscribed to an insurance product that pays benefits if he receives a long-term care grade between 1 and 3, and had been paying premiums since 2014. The insurance policy included a clause stating that "if the insured dies during the insurance period, the contract is terminated."

While battling cancer, Mr. A applied for long-term care recognition on June 1, 2017, and on June 8 of the same month, the National Health Insurance Service's inspection team visited the hospital to conduct an on-site inspection. However, Mr. A died that evening on the day the inspection was conducted. Subsequently, on June 21, the National Health Insurance Service assigned Mr. A a long-term care grade 1.

The bereaved family of Mr. A claimed insurance benefits from the insurer after the National Health Insurance Service's long-term care grade determination, and when the insurer refused payment, they filed a lawsuit. The first and second trials ruled in favor of the bereaved family. The courts stated, "It is sufficient that the facts causing the grade determination, namely the health condition requiring long-term care, are confirmed; it cannot be viewed differently just because the grade determination date is after death."

However, the Supreme Court's judgment differed. The Supreme Court concluded that if the insurance contract was terminated before the long-term care grade was determined, there was no basis for paying insurance benefits.

The court stated, "Since long-term care benefits are inherently premised on the survival of the insured, it is impossible to determine a long-term care grade after the applicant's death. Even if the grade determination committee was unaware of the death and assigned a long-term care grade, it is difficult to consider the grade determination for a deceased person as legally effective. Therefore, the occurrence of the insurance payout condition stipulated in the insurance policy cannot be recognized simply because the long-term care grade determination was made after the insured's death."

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