A study about the effect of the pre-existing conditions exclusion clause

Abstract

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.