Insurance Company Loses Second Trial Against Thyroid Surgery Doctor Lawsuit... Court Rules "Not Excessive Treatment"

An appeal court ruled against an insurance company in a 270 million won damages lawsuit filed against a doctor, claiming unnecessary procedures were performed to generate profit.

According to the legal community on the 31st, the Seoul High Court Civil Division 9 (Presiding Judges Seong Ji-yong, Baek Suk-jong, Yoo Dong-gyun) upheld the first-instance ruling, dismissing the claim by insurance company A against doctor B in the second trial of the damages lawsuit.

The insured patients underwent surgery at Dr. B’s hospital, where radiofrequency was applied inside thyroid tumors to remove nodules, and subsequently received insurance payouts equivalent to actual medical expenses from company A. Company A filed the lawsuit, alleging that Dr. B performed false and excessive treatments, including surgeries on patients with relatively small thyroid nodules, causing the company to suffer losses by paying over 200 million won in insurance claims to patients.

The first-instance court rejected company A’s claims. The court stated, "Even if Dr. B’s treatment was false or excessive, unless there is evidence that the insured conspired, it cannot be considered a fraudulent act against company A’s insurance payments," and added, "The Medical Service Act’s provisions to prevent excessive medical treatment or excessive medical fees to patients are not intended to protect insurance companies."

The second-instance court reached the same conclusion. The court judged, "It is difficult to definitively conclude that the procedures performed by Dr. B on the insured were excessive or unnecessary based solely on some expert opinions reviewing the insured’s medical records." It also noted, "Some insured patients had family members who suffered from thyroid cancer, and such subjective circumstances may have influenced their decision to undergo the procedures."

The court further explained, "There is no evidence to suggest that Dr. B knew or could have known in advance whether the insured had contracts with company A for indemnity insurance in addition to the National Health Insurance when they visited Dr. B’s clinic and decided to undergo the procedures."

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