Insurance Money Research Articles

A Time Series Study of Financial Sector Development and Original Sin in Nigeria

This study examined financial sector development and original sin in Nigeria financial market. Time series data was sourced from Central Bank of Nigeria Statistical Bulletin from 1990-2023. Original sin measured by Nigeria external debt per exchange rate, Capital market development as market capitalization to gross domestic product, Foreign exchange market as variation in naira exchange rate per US Dollar, banking sector development as percentage total bank assets to gross domestic product, money market development as insurance total assets to gross domestic product, Money market development as value of money market instrument to gross domestic product. The study employed descriptive statistics and multiple regression models to estimate the relationship that exists between the dependent and independent variables. The null Hypotheses (H0) were tested at 0.05 level of significance, Ordinary Least Square (OLS), Augmented Dickey Fuller Test, Johansen Co-integration test, normalized co-integrating equations and parsimonious vector error correction model were used to conduct the investigations and analysis. The study found that 57.0% variation on original sin can be traced and explained by variation on the independent variables as formulated in the regression model. However, the F-Statistics and the F-probability justifies that the model is significant and adequate in explaining variation on the dependent variable. The β coefficient shows that capital market development have negative effect on original sin, foreign exchange market have positive effect on original sin, banking sector development have negative effect on original sin, insurance sector development and money market development have positive effect on original sin. From the findings, the study concludes that the independent variables determine positively and negatively original sin in Nigeria. We recommend that the need for policies to deepen the capital market as this can cushion the effect of the negative effect of external borrowing and domiciled in Nigeria currency rather than international currency. There should be institutionalized policies to enhance the value of the naira against other international currencies as this can reduce the pressure of exchange rate variation in international debt and international monetary environment. Public expenditure should be directed to the productive sector of the economy as this can enhance the productive capacity of the economy and reduce the negative effect on balance of payment and other macroeconomic variables. Policies should be advanced to reduce external borrowings; this can reduce the debt burden and reduce the incidence of original sin in the financial market.

Manajemen Strategi Pemasaran Produk Manulife Saving Protector pada PT Asuransi Jiwa Manulife Surabaya Pusat

One of the best insurance companies in Indonesia is PT Asuransi Jiwa Manulife Indonesia, a financial services provider from Canada that operates in Asia, Canada and the United States. Headquartered in Toronto, Canada, Manulife has been serving customers for more than 155 years. Manulife is traded under the symbol ‘MFC’ on the Toronto, New York and Philippine stock exchanges, and under the symbol ‘945’ in Hong Kong. Manulife Indonesia has offered a variety of financial services including life insurance, accident and health insurance, investment services and pension funds to individual customers and business actors in Indonesia. Manulife Indonesia has served more than 2 million customers in Indonesia through a network of more than 11,000 employees and professional agents spread across 30 marketing offices. Given the increasing market potential in Indonesia, many insurance companies, both local and foreign, are trying to reach the market in Indonesia. In order for the company to be able to compete with other insurance companies, a sales strategy and product are needed that can attract the interest of its customers. One of the most popular products owned by PT AJ Manulife Indonesia is Manulife Saving Protector, which is the only individual dual-purpose life insurance product (endowment) that can provide Insurance Money of up to IDR 1.5 billion without having to undergo a medical examination first. The insurance industry in 2023 is projected to increase along with improving economic conditions in Indonesia. However, the level of public distrust can hinder the development of this industry. This causes many people to tend to delay opening an insurance policy.

The Life and Non-Life Insurance Market in the European Union

The article discussed on the situation of the life and non-life insurance market in the European Union as seen at the end of 2022. The market analysis was based on data derived from the European Insurance and Occupational Pensions Authority (EIOPA) and the Organization for Economic Cooperation and Development (OECD) and included such factors as the number of insurers, the division into life insurance and non-life insurance, and the key market indicators (written premium, density and penetration rates, and concentration index). The collected data shows the life and non-life insurance market in 27 European Union Member States. The largest number of insurers is in the French, German and Luxembourg markets, the smallest in the Slovak, Estonian, Lithuanian and Latvian markets. It was noted that the more insurers sell insurance in a country, the lower the concentration ratio. Germany and France had the largest share of the global business insurance market in 2022 from EU countries. Overall, EU residents in 2022 spent more on life insurance (€652.2 billion) compared to non-life insurance (€495.2 billion). Residents of EU countries spend most of their life insurance money on index-linked and unit-linked insurance and insurance with profit participation. The largest share of EU residents’ non-life insurance spending is in: Fire and other damage to property insurance, Motor vehicle liability insurance and Other motor insurance. Just as these countries differ significantly in economic terms, they also do so from the life and non-life insurance market standpoint.

Tabarru’ Fund Sharia Insurance Using The 2019 Mortality Table, Mortality Law and Cost of Insurance Method

The sharia life insurance program has two ways of managing funds, namely involving a savings element and not involving a savings element. Programs that do not involve a savings element do not have a clear division of tabarru’ funds that must be paid participant so it is the company's job to calculate it . In calculating the percentage of tabarru' funds used method Cost of Insurance (COI) . The COI method is method for calculating tabarru’ funds with using several parameters, namely mortality tables , investment value , management fees and discount factors . In this research, we will discuss how to obtain tabarru' funds using the 2019 Indonesian mortality table and the 2019 Indonesian mortality table with the Gompertz mortality law, Makeham mortality law and De Moivre mortality law. with method Cost of Insurance . Based on the case illustration, the results show that the tabarru' funds that must be paid by participants are directly proportional to the participant's age, management fees and insurance money, but inversely proportional to the investment value. Tabarru' funds will be greater if using the De Moivre mortality table so this can be a consideration for the company while the Makeham mortality table can be a consideration for participants.

신원보증보험계약상 사용자 구상권의 범위

The employer who compensated for damages suffered by a third party due to an employee's illegal activities in an insurance policy of fidelity guarantee can use the right to indemnity against the employee for the remaining damages without being transferred to the insurance money received from the insurance company. However, the criteria for setting the scope of the specific amount of money are different from the original trial and the Supreme Court. The Supreme Court presupposes that the plaintiff's damages are the total damages paid to the third party due to the defendant's fault in determining the amount of indemnity for the policyholder of the insured. However, the Supreme Court overlooked that liability insurance is a contract that guarantees legal damages on the insured. In addition, in order to calculate the specific insurance premium in the event of an insurance accident, the liability limit of the fidelity guarantor must be determined after confirming the scope of legal liability for damages of the policyholder. This judgment of the Supreme Court does not correspond to the legal principle of liability for employer's liability under the civil law. In view of the fact that the plaintiff, who is the insured, enjoys unfair excess profits, it also violates the principle of actual expense compensation in the non-life insurance system. Therefore, the judgement of the court of first instance is right which judged the plaintiff's indemnity amount deducting the insurance money already paid from the legal damages.

국민건강보험법상 임의비급여 진료비 부당이득반환채권에 대한 보험회사의 채권자대위 가능성

If a medical institution's medical practice to a patient is not listed on the benefit coverage or statutory non benefit coverage under the National Health Insurance Act, the medical practice is a arbitrary non-benefit coverage that has not been approved for safety and effectiveness. In principle, it cannot perform the medical practice on the patient and of course cannot receive medical expenses. These arbitrary non-benefits coverage are not covered by private medical expense insurance. The court's basic position on arbitrary non-benefit coverage treatment and receipt of medical expenses is said to be invalid as a violation of compulsory laws unless there are special circumstances. The Supreme Court interprets that the receipt of medical expenses is valid if several conditions are met even for arbitrary non-benefit coverage medical treatment. It is difficult to say that there was sincere consent from the patient in the target judgment in this paper, and it is difficult to find the inevitability or urgency of implementing arbitrary non-benefit coverage medical practices without implementing other medical practices listed on the benefit coverage or statutory non-benefit coverage list. Therefore, the conditions proposed by the Supreme Court were not met, and the arbitrary non-benefit coverage treatment act is interpreted as illegal. The patient will have a claim to return unfair gains from the medical institution, and if the patient receives insurance money equivalent to medical expenses from the private medical expense insurance company, the insurance company will have the right to claim the return of unfair gains from the patient. At this time, there is a question of whether an insurance company can exercise the unjust enrichment claim of medical expenses that the patient has against the medical institution to satisfy his/her claim. The Supreme Court recently determined that it was impossible for insurers to exercise their subrogation rights to medical institution. As a basis, it is cited that the debtor is insolvent and that the insurance company can individually exercise the right to claim the return of insurance money against the insured(patient). However, the debtor's incapacity requirement is not necessarily required at a time when the purpose of exercising the creditor's subrogation right is changing from the preservation function of the responsible property to a means of realizing the creditor's rights. In addition, it is clear that insurance companies cannot freely file a lawsuit against their customers for the return of insurance money due to regulations by financial regulators. Insurance companies that fail to recover insurance money even after paying insurance money for arbitrary non-benefit coverage will suffer disadvantages such as a rise in the loss rate, which will eventually lead to an increase in insurance premiums. It is unfair to allow medical institutions that have performed arbitrary non-benefit coverage treatment activities that are not allowed to keep medical expenses as they are. Under these circumstances, subrogation right of creditors should be allowed to insurance companies.

계약전 발병 부담보 조항에 관한 연구

In the past disease insurance terms and conditions, the definition of disease was expressed as “occurring during the insurance period,” and there was a problem in that the onset time depended on the patient's statement, or the insurance company claimed the onset time before the commencement of liability to avoid payment of insurance money. In addition, the Financial Supervisory Service revised the terms and conditions to protect consumer rights and interests and incorporated the pre-contract insurance policy into the standard terms and conditions. However, in June 2017, the Financial Dispute Mediation Committee of the Financial Supervisory Service determined that The pre-existing conditions exclusion clause was invalid, and in July 2018, the corresponding clause was deleted from the standard terms and conditions, so that all insurance companies stopped including the clause. When the terms and conditions were revised to protect the rights and interests of insurance consumers, the incorporated The pre-existing conditions exclusion clause refused to pay insurance money to insurance consumers who faithfully fulfilled the notification obligation. This is contrary to the insurance protection expectations of policyholders, so the Financial Supervisory Service's action to return it to its original state is acceptable. The pre-existing conditions exclusion clause itself may conflict with other terms and conditions, and it is unfair to protect the insurance company, such as restricting the payment of insurance money even when the insurance company signs an insurance contract intentionally or grossly. The problem of reverse selection, which some are concerned about, can be partially solved by the interpretation theory or law of the current insurance terms and conditions, so it is reasonable for the Financial Supervisory Service to delete the burden guarantee clause to protect insurance consumer rights.

Financial and economic security of agricultural business: specifics, analysis methodology, and measures of stabilization

Purpose. The article aims to improve the methodology and analysis of the financial and economic security of agricultural business in Ukraine for the identification of problematic aspects and the substantiation of policy measures needed to strengthen it.
 Methodology / approach. The article offers the methodological approach for the comprehensive analysis of the financial and economic security of agricultural business in a region. The conceptual task of the approach is to calculate the empirical indicator of security (composite method) and its structural components (resources, investment, money and credit, debt, finance-economy, and insurance components) based on the identification of the weight of indicators (Principal Components Analysis).
 Results. The article reveals that the appropriate level of all components of financial and economic security correlates with the financial independence of agricultural entities. In 2018, the index of insurance security (0.798) and money and credit (0.737), debt (0.724), and resources (0.720) components of agricultural business security in Lvivska oblast were above the moderate level. The period of 2018–2022 faced a significant weakening in the resources (by 16.2 p.p.), investment (16.9 p.p.), money and credit (20.6 p.p.), debt (19.0 p.p.), finance-economy (18.0 p.p.), and insurance (5.3 p.p.) components of the sector’s financial and economic security. The average level of financial and economic security in the period under review was 65.0 %, and the average annual rate of decrease was 4.1 p.p.
 Originality / scientific novelty. The article improves the methodological approach to the complementary assessment of financial and economic security of agricultural business in a region, contributing to the identification of the degree of financial resilience of business entities in the agricultural sector of the regional economy in conditions of war and instability, in order to develop the mechanism for increasing the investment and economic capacity of business.
 Practical value / implications. The article offers and substantiates an applied approach to assessing the degree of regional financial resilience of agricultural business. Its implementation will allow carrying out a sectoral cut of the state of financial and economic security of the region’s industry and build architectonics of determinants of financial and economic security of business entities.

Death of a Salesman

Death of a Salesman

2022년 보험법 중요 판례 분석

In the field of insurance law, many precedents continue to emerge, and in particular, an important judgment in the field of insurance law was declared in 2022. Judicial precedents are also a mirror through which we can grasp the issues and problems of the society. The insurance system operated in order for the people to be guaranteed through private insurance in preparation for various risks has the characteristics of a speculative contract and a bona fide contract. In addition, many disputes are inevitable due to the nature of the system, such as stipulating various reasons for exemption in insurance terms and conditions. Case law has been an important milestone in the field of insurance so far, including the invalidity of ineffective contracts, the relationship between the obligation to explain insurance contracts under Article 638-3 of the Commercial Act and Article 3, Paragraph 4 of the Act on Regulation of Standard Contract Terms, and the scope of application in the case of exemption from driving without a license. , Intentional exemption of personal insurance, drunk driving, driving without a license, death insurance of others and the effect of lack of consent by the insured, designation and change of insurance beneficiary, requirements for opposition, and unilateral acts without the other party. In various insurance precedents sentenced in 2022, the scope of recognition of subrogation by the insurer, measures to prevent leakage and damage prevention obligations, and the problem of applicability of costs, insurance for the purpose of illegal acquisition of insurance money and Article 103 of the Civil Act, contract invalidity, and aftereffects Issues such as the relationship between the insurance money and the death insurance money, the leakage of the loss insurance money, and the recognition of the subrogation of the right to claim became issues. In these precedents, some rationality and validity are acknowledged. However, in some judgments, there are also disappointing parts. In particular, it is very problematic that the insurer’s subrogation of claim rights is not allowed for voluntary non-payment of indemnity insurance. Reconsideration is required in terms of economics of litigation or reasonable resolution of disputes. Through critical examination of precedents, it is necessary to continue to play the role of a milestone in setting the future direction of precedents in the insurance field.

상해보험에서 자살사고에 대한 증명책임의 귀속과 실무상 증명내용에 대한 고찰

Accident insurance, which is defined as an insurance accident in the accident insurance clause, requires contingency in the sense of an accident that is not intentional. At the same time, “in case the insured intentionally harms himself” is stipulated as the reason for indemnification of the insurer, and in the proviso that the insured is “in a state where he or she is unable to make free decisions such as mental or physical loss,” the exemption is allowed and the insurance money is paid. stipulated as a reason As such, the structure of the provisions of the accident insurance clause is complicatedly intertwined, and the connotation and extension of the requirements set forth in each reason for payment and reason for exemption are not clearly established, causing various problems regarding the burden of proof.
 In this paper, we reviewed how to distribute the burden of proof in order to recognize the liability of the insurer when the insured person dies by suicide. In this way, we looked at what was missed by the judgment in question, which only focused on medical findings.
 Accident insurance clauses stipulate that an accident that occurred intentionally is a reason for exemption from liability of the insurer, so the insurer must prove that the accident occurred intentionally.
 On the other hand, the state of being unable to make free decisions is a normative level of judgment that is distinguished from intention. Even if the insured was conscious of ending his own life and committed suicide intentionally, the fact that he was in a state of exclusion from free decision-making dilutes the possibility of blame for the insured's intentional death and mitigates the degree of destruction of good faith in the insurance contract. In other words, even though suicide is an intentional accident, it is exceptionally included in the scope of insurance coverage. According to precedent, the state of being unable to make free decisions is determined by comprehensively examining various facts.
 In the judgment at issue, when the motive for suicide, the method and mode of suicide, the progress of depression, and the greetings sent by the suicide just before suicide were comprehensively reviewed, it can be judged that the insured committed suicide in a state of free decision-making. The target judgment focused only on the fact that the deceased had been diagnosed with a “severe depressive episode” by a specialist during his lifetime, acknowledging the inability to make free decisions without properly examining other factors.
 The state of inability to make free decisions means what factual factors have influenced the formation process of the inner psychological state and to what extent they are influencing. Therefore, the tendency to rely exclusively on medical findings and to regard them as absolutes is unreasonable. It is necessary to make a comprehensive judgment on the various facts surrounding the suicide.

Assessing Psychosocial Risk Factors in Children with Sickle Cell Disease

Background and Objective: Most patients with sickle cell disease (SCD) in U.S. identify as Black/African American. This is an important psychosocial risk factor to consider given well-documented systemic racism in medicine resulting in disparate health outcomes, particularly for individuals managing a chronic health condition like SCD. The purpose of our research is to determine the level of psychosocial risk factors in children with SCD at Riley Hospital and assess the utility of Psychosocial Assessment Tools (PATs) in this setting. 
 Methods: The PAT is a validated caregiver-report screener administered as part of the clinical visit. Each PAT is scored by the SCD Social Worker to provide tailored resources to families. Scores are stratified into 3 risk tiers indicating level of psychosocial intervention necessary- Universal, Targeted, or Clinical. Descriptive analyses were performed to determine patient and caregiver demographics, experiences, beliefs, and overall risk categorization.
 Results: There were 141 completed PATs for analysis. Ninety-five percent of the patients identified as Black/African-American with an average age of 8.57 years (0-22 years). Most caregivers were Black, single women over 21 with at least a high school degree. Sixty-seven percent of patients fell into the Universal range, 29% in the Targeted range, and 4% in the Clinical range. The Family Structures/Resources Subscore had the highest average, and includes questions about insurance coverage, transportation, and money problems. Forty-six percent of families reported some form of financial difficulty, with housing, utility bills, and car costs as the most common.
 Conclusion and Impact: Implementation of a psychosocial risk screener in the SCD clinic identified financial challenges for almost half of families, allowing for timely resource support. Many of these families, however,were categorized as Universal, indicating that distribution of resources must not be based on total PAT score alone. Future steps include evaluating the effect of resource provision at SCD visits on improving barriers to care.

Insurance fraud detection: Pre-emptive analysis and prevention

Insurance companies have been facing the problem of false insurance claims, costing resources and money in detecting fraudulent claims among the many true ones. Many times, fraudulent claims are mistaken for genuine claims, and genuine ones mistaken for fraudulent claims. This paper aims to develop a Machine Learning algorithm to detect fraudulent claims and distinguish them with genuine claims. This project also aims to compare other algorithms and see which one is the most effective to deal with this growing problem that the insurance industry is facing.

“Lucky Enough”: The Music and Stories That Make Vaughan's Lounge, New Orleans, Louisiana, United States

“Lucky Enough”: The Music and Stories That Make Vaughan's Lounge, New Orleans, Louisiana, United States

판례 분석을 통한, 즉시연금보험 분쟁의 해결 방안 연구

In the disputes over immediate annuity insurance, the court's judgments of the first and second instances related to the insurer's duty to explain are presented. The disputes began in 2017, and the Financial Supervisory Service's Dispute Mediation Committee recommended that all inherited annuity products(maturity refund type) subscribers pay additional underpaid insurance, but insurers refused to pay collectively except for the mediation case. According to the precedents that consumers have won so far, insurers should specify the risks that “insurers can pay less than the minimum guaranteed rate at the time of the fall in interest rates” and “the monthly pension amount shall be paid after deducting the reserves for financing the maturity refund” in the terms and conditions. In addition, on the basis that the insurance company did not explain this to the customer, the court applied Article 3, Paragraph 4 of Act on the Regulation of Terms and Conditions to invalidate the incorporation into the contents of the insurance contract. Furthermore, the court orders the insurance company to pay the difference to the consumer based on the difference from the minimum guaranteed interest rate or the initial annuity insurance money (the amount without deducting the accumulated amount for the maturity refund fund). In this study, it was considered reasonable to apply Article 102 of the Old Insurance Business Act (current Articles 44 and 45 of Act on the Protection of Financial Consumers) rather than applying Article 3, Paragraph 4 of Act on the Regulation of Terms and Conditions when the insurer violates the duty of explanation. Also, the policyholder's negligence offset can be applied individually, and fairness can be established in accounting for unpaid insurance money. Moreover, in the immediate annuity insurance case, policyholders recognized that the insurer had violated the duty of explanation only after the monthly annuity less than the minimum guaranteed interest rate was paid. The question is whether to view it as the payment date of the monthly annuity of the company or as the time when the existence of the right to claim insurance money was known. In the judgments related to immediate annuity that have been issued so far, the position is that an insurer who refuses to pay insurance loses the lawsuit and that it is unacceptable as an abuse of rights against the principle of good faith that the statute of limitations for claiming insurance has expired. The Supreme Court precedent regarding accidental death benefit considered more emphasis on the pursuit of legal stability, refusing to recognize restrictions based on the principle of good faith, and strictly interpreting the extinctive prescription period. Presumably, the short-term limitation of three years (2 years in most cases subject to immediate annuity) applies to the right to claim insurance money, and it is difficult for general consumers to understand that they must file a claim in court to stop the extinctive prescription period. When the insurer refuses to pay the insurance money, the consumer believes the insurer's words and in most cases gives up on the claim, and even after a court judgment has been issued and the insurance claim is subject to the extinctive prescription period, the claim is frustrated again. Seems to be a very unreasonable result for consumers in. It is necessary to avoid the attitude of omitting key points and not explaining them in detail by delegating specific details to complex and difficult product terms and conditions. I think it's time to listen to the alternative of applying subjective starting points to insurance claims subject to short-term limitation period.

Moral Hazard: The "Jew Risks" Affair of 1867

Moral Hazard:The "Jew Risks" Affair of 1867 Jeffrey A. Marx (bio) In late October of 1866, Alexander Stoddard, the general agent of the Underwriters' Agency, an umbrella group of four fire insurance companies based in New York, wrote a circular to their agents. Noting the high number of fraudulent claims that had been filed, he stated that it was now necessary for them to scrutinize the character of applicants, especially those who were strangers or recent inhabitants of their towns. He then went on to instruct: Hereafter all applications of Jews for insurance upon stocks of merchandise must be referred to the general agent for instructions before making the same binding. … We will only take under consideration applications of Jews who have resided in your city for a period of not less than five years and sustain a good reputation for fair dealers and integrity.1 That fall, while on a train in the South, Rabbi Isaac Leeser overheard an insurance agent state that Jews were incendiaries, and that insurance risks with them were hazardous, while in December, the American Israelite brought to light that the Hartford Fire Insurance Company had instructed their agents to "avoid Jews, unless the agents should personally know them."2 In early 1867, the Manhattan Fire Insurance Company of New York, apparently unaware that a Sephardic Jew, Harmon Hendricks, had been an early president of the company, instructed its agents: "Do not insure Jews for this Company, nor property exposed to their locality, under any consideration," and Stoddard instructed an agent in Georgia to cancel an existing policy because the names on it seemed to indicate that they were Jews, "a class of customers that we have found exceedingly unprofitable, especially in the Southern States."3 As these discriminatory practices against Jewish merchants came to light, the Jews of America gathered in large cities and small ones through the winter and spring of 1867 to protest and to fight against them. [End Page 255] Although the "Jew Risks" Affair has for the most part received only passing notice in histories of American Jewry, it is worthy of more detailed study.4 First, while previous antisemitic incidents summoned forth public responses from the American Jewish community—the 1840 Damascus Affair; the Swiss Confederation's economic sanctions against Jews between 1853 and 1858; and the Mortara Case in Bologna in 1858–59—these took place in lands outside the United States.5 (A fourth incident, Ulysses S. Grant's "General Orders No. 11," which in 1862 expelled all Jews from the war zone that he commanded, resulted in responses from only a small number of Jewish communities and communal organizations because Abraham Lincoln quickly rescinded the order.6) The "Jew Risks" Affair was the first nationwide Jewish communal protest in reaction to "extra-ordinary" American antisemitism.7 The affair reveals how the Jewish community viewed their Sitz im Leben in America at this time. While there was dismay at the evidence that antisemitism was to still be found in America, and that the organized private discrimination against them had the potential to impact their livelihoods, there was also their growing confidence to speak out publicly and claim their right as American citizens to combat this discrimination. Their successes and failures in doing so shed light on the strengths and limits of Jewish influence during this period. Second, the "Jew Risks" Affair illustrates how some Christians at this time continued to see the Jews of America through mythical lenses. Old, [End Page 256] deep anti-Jewish and antisemitic myths would be combined with current social factors and projected onto the Jew who stood before them. In this affair, the presidents of fire insurance companies, using a centuries-old trope, would see the Jews as scheming, unscrupulous merchants, resulting in their charge that Jewish clothing stores were set on fire in order to collect the insurance money. The "Jew Risks" Affair suggests that, while antisemitic episodes in America were not as severe as in Europe, especially because they were not engendered either by the government or by ecclesiastical authorities, antisemitic charges could nonetheless arise on American soil.8 At the same time, the affair also highlights that not...

2021년 중요 보험판례와 그에 대한 분석

Significant judgments were also made in relation to insurance in 2021. The Supreme Court suggested that if a medical opinion is submitted as evidence, it cannot be denied arbitrarily, and if the court wants to infer a causal relationship differently from such a medical opinion, it should make a careful judgment based on other medical and professional data. However, this position is difficult to accept. This is mainly because the attending physician makes the decision, because it is difficult to guarantee the objectivity of the attending physician’s opinion. Another thing that draws attention is whether the civil prescription of 10 years is applied as the prescription for the right to claim the refund of unfair profits when the insurance contract is invalid or whether the prescription of 5 years is applied by analogy with Article 64 of the Commercial Act. Insurance money is paid by the insurer through commercial activities. Therefore, it is correct to think that the five-year prescription applies to expeditious processing of commercial transactions to claim the return of the insurance contract because it is invalid. Claiming the refund of the insurance money paid when the insurance contract is invalid is seeking the return of the benefits themselves made on the basis of the contract, which is a commercial activity. This is because it should be regarded as a case in which there is a need to solve the problem as quickly as possible. The Supreme Court ruled that a 10-year civil prescription applies to the right to claim the return of unfair profits due to illegal dividends. It is difficult to see that there is a great need to quickly confirm the exercise of the right to request the return of unreasonable profits for the purpose of recovering the amount paid due to illegal dividends. Accordingly, it is reasonable as the attitude of the Supreme Court to consider that the right to claim the return of unfair profits due to illegal dividends is subject to Article 162 (1) of the Civil Act and is subject to the civil statute of limitations of 10 years. Another important issue is whether the insurer is allowed to preemptively file a non-obligation lawsuit in the event of a dispute with the insurer as to whether the policyholder has violated the obligation to notify. It can be affirmed that if the strong insurer indiscriminately files a debt non-existence suit, the weak consumer is inferior in intellectual or economic ability, so there is a problem. However, the people’s right to a trial is recognized as a basic right under the Constitution (Article 27 Paragraph 1 of the Korean Constitution). Therefore, it is not permissible to fundamentally prevent the insurer from taking a preemptive action for non-obligation. However, it should be considered permissible to stipulate that financial business operators, such as insurers, are not permitted to file lawsuits again by limiting certain amounts in the relevant special laws, such as the Financial Consumer Protection Act, by recognizing one-sided binding force on the results of dispute mediation. I think it is reasonable to set the standard of 10 million won as the standard. The role of precedents in the field of insurance law is very large. It is necessary to continuously monitor Supreme Court precedents in the future.

실손의료보험에서 백내장 수술 진료비의 보상책임에 관한 판례 평석

Cataract is a disease in which the lens becomes cloudy due to aging and causes loss of vision. It is treated with surgery to remove the cloudy lens and insert an artificial lens. There are single vision lenses and multifocal lenses as types of intraocular lenses, which are the treatment materials used at this time. Monofocal lenses have the disadvantage of requiring separate corrective glasses for near vision even after insertion, but they are inexpensive and require medical treatment under the National Health Insurance Act. On the other hand, multifocal lenses have the advantage of correcting both near and far vision, but they are expensive and do not qualify for medical care benefits under the National Health Insurance Act.
 In this case, while the state determines the price of the salary, the non-insurance price is set by the medical institution, so the medical institution has an incentive to make a profit by arbitrarily setting the cost of treatment for non-insured items. In particular, in the case of non-insured items covered by medical insurance for indemnity insurance, the patient can claim most of the medical expenses from the insurance company as insurance money. There may be cases in which overpayment or overtreatment may occur.
 In relation to cataract surgery, some eye clinics, mainly in the Gangnam area of Seoul, arbitrarily adjust the cost of examination or multifocal lenses, which are representative non-covered items, according to changes in the health insurance benefit system or medical insurance policy, without reasonable standards. It is confirmed that they are taking advantage of the business by misusing them. For example, in September 2020, when health insurance was applied to the examination fee, it was no longer possible to claim high medical expenses for the examination fee. Excessive indemnity payments are being made in the medical insurance for loss by processing hospitalization and issuing a confirmation of hospitalization, and the damage is being passed on to good medical consumers and insurance organizations.
 However, in the recent judgment of 2021 na 2013354 of the Seoul High Court on January 20, 2022, the scope of claims for medical insurance for medical loss for insured persons who underwent cataract surgery was limited to the amount of out-of-patient insurance, not hospitalization. Based on the Supreme Court’s general definition, it was emphasized that ‘the substance of hospitalization’ should be provided in addition to the standards of the Ministry of Health and Welfare notification. He also pointed out that the fact that the comprehensive fee-for-service system is applied in cataract surgery is completely different from judging whether or not the patients were actually ‘hospitalized’.
 As such, it can be said that the above judgment on the criteria for ‘hospitalization’ for cataract surgery is not limited to the clinic in this case, but is also applied to general ophthalmology clinics performing cataract surgery. Although there is regret in the interpretation of the terms and conditions related to the exemption, I hope that the judgment of the subject judgment regarding hospitalization will be an opportunity to suppress unnecessary and reckless cataract surgery.
 It seems to be a very desirable direction for government ministries, financial supervisory authorities, and the industry to take an interest in the recent cataract surgery and other problems of the surge in medical expenses and to make various efforts and attempts. As a member of society, the court also expects effective and rational judgments that can effectively suppress turmoil in the medical market and protect the rights and interests of good medical care and insurance consumers.

자동차 경성 사기 방지방안에 관한 연구

The main culprit of car hard fraud is using social media to recruit people through a legal method of recruiting part-time jobs and engaging them in crimes. Through this, criminals intentionally cause traffic accidents targeting vehicles that violate the law and acquire insurance and settlement money from the victim driver or insurance company. As a result, the purpose of the study is to present measures to prevent insurance leakage and increase insurance premiums for auto insurance subscribers. The method of research is to identify the status and trend of insurance fraud by the Financial Supervisory Service, identify cases of auto-hard fraud based on Internet and domestic and foreign research data, and identify what measures insurers are taking to prevent damage to insurance fraud. As a result of the study, car-hard fraud is causing an accident by intentionally colliding a vehicle that violates traffic laws. Through this, the high proportion of the victim drivers' negligence and the fact that the perpetrator claims to be a negligence accident are exploited by the insurance company. Insurance companies are responding by establishing a system that can detect habitual criminals, but it is less efficient in crime prediction and detection, and it seems that there is a limit for insurance companies to respond to and detect first-time criminals. Therefore, it was derived that it is possible to prevent insurance fraud only by preparing countermeasures through a more scientific and detailed approach. In conclusion, car-hard fraud are becoming increasingly intelligent, and as a result, it is difficult to arrest criminals, so crimes are on a continuous increase. In order to eradicate such crimes, a control tower should be created under the Financial Supervisory Service to predict and arrest insurance fraud crimes. The first offender of a fraudulent crime using a car has a limit that cannot be arrested. Therefore, a detective system should be established to approach from the recruitment stage through social media, participate in crime execution, secure evidence, and request an investigation to an investigative agency. Car fraud criminals target vehicles that violate traffic laws, so if an accident occurs in violation of traffic laws, the driver is obligated to receive compliance education from the Korea Transportation Safety Authority, and The punishment regulations should be revised so that criminals can be reasonably punished.

Fabricating insurance subject matter and defrauding insurance money: a civil wrong or a criminal offence?

ABSTRACT Insurance fraud is a serious problem and is dealt with mainly by the mechanisms of civil liability and criminal punishment in China. This article critically examines these mechanisms and their application to different types of fraud, identifies the existing and potential problems with them, and also propose solutions to the problems with reference to the English common law fraudulent claims rule and the Fraud Act 2006 (UK). Chinese Criminal Law provides a unique type of insurance fraud, namely, ‘fabricate insurance subject matter and defraud insurance money’, but no definition of this type of fraud is provided in the Law, this causes judicial difficulty in the trial of the fraud cases. This type of fraud is committed at two stages: ‘fabricate insurance subject matter’ at the stage of conclusion of the contract and ‘defraud insurance money’ at the stage of making claims. It argues that the phrase of ‘fabricate insurance subject matter’ should be construed in a narrow sense that it only refers to the fraud where a non-existent insurance subject matter is fabricated into an existent one; while fabrication of the features or characters of the insurance subject matter should not be taken as the fraud of ‘fabricate insurance subject matter’. This article examines the circumstances under which this type of fraud may be dealt with by civil law or criminal law and puts forward guidelines for the determination of this type of fraud and for the correct application of civil remedies or criminal sanction for the fraud.