[In-It] You have followed all the terms and conditions, but insurance fraud?

It's sad to be hospitalized often and for a long time because of sickness, but an insurance company that drives them into insurance fraudsters, saying that it is a ‘hyper hospitalization’.

Investigation authorities recklessly pursue the information from insurance companies.

The financial authorities are eager to find fake patients who are aiming for insurance money by creating an insurance fraud prevention center, but are simply closing their eyes on the predatory behavior of insurance companies...

Many citizens left their valuable experiences through comments on the last time,'SBS [In-It] Insurance that saved living expenses, turned me into a fraudster'.

Citizens who have to attend an investigation agency after receiving a phone call saying, "A complaint has been received as an insurance scammer, please come to be investigated!" fears as if being bitten by a tiger's den.

However, like the experience in the comment, "If I am confident and have nothing to stab, there is no reason to tremble", we need to be more confident.

This is because'exaggerated hospitalization' is only an exaggerated paradigm established by insurance companies, and most people who are hospitalized according to the opinion of the attending physician and discharged according to that opinion cannot be driven as fraudsters.

Today is the second story related to'insurance fraud' following the previous article.

Insurance companies issue insurance terms and conditions to consumers when purchasing insurance and explain the main contents.

Insurance payment claims can be made at will, but insurance payments are paid only according to the terms and conditions.

That's why we have to look carefully at the terms and conditions and know for sure.

On the contrary, however, there was a case where he was investigated as a fraudster for requesting insurance payment by carefully reviewing the terms and conditions.

What stupid sound is this?

In the insurance policy that Mr. A joined in 2003, the following payment requirements were stated in relation to hospitalization benefits.

After enrolling in insurance, Mr. A, who had difficulties due to the onset of severe hypoglycemia and diabetes complications, confirmed the insurance policy that if 180 days have not elapsed after being hospitalized for 120 days, he will not be able to receive hospitalization benefits. Even if the doctor advised him to receive additional hospital treatment afterwards, he lasted 180 days (6 months) with outpatient treatment.

This is because according to the terms and conditions, hospitalization benefits cannot be received for 180 days after being hospitalized for 120 days.

Mr. A, who did not subscribe to the actual inpatient insurance, which is paid for hospital expenses when hospitalized, was able to barely endure a long period of illness by using most of the money received as hospitalization benefits for hospital expenses. I refused, and eventually I got a call like this from the police station.

The insurance company adjusted the hospitalization schedule to the maximum number of days for paying insurance premiums for the same disease, which is 120 days, and the fact that the average number of hospitalization days for diabetics per year is 20 days, and that he was hospitalized for up to 90 days for a year. He argued that he must have attempted to fraudulently claim the insurance money and steal it.

Mr. A said that it is unfair for real patients who are sick and need hospitalization treatment to fraudulently adjust hospitalization schedules according to insurance payment requirements because of financial difficulties.

He wasn't pretending to be a fake patient, and he said he wasn't a fraudster, and he said he wasn't a fraudster.

In the end, the police raised the hand of the insurance company and sent the record to the prosecution, commenting that Mr. A was an insurance fraudster.

However, the prosecution raised Mr. A's hand, saying that he could not be regarded as an insurance fraudster, and finally dismissed him without prosecution.

(Suwon District Prosecutors' Office, Ansan Branch, 2015 Brothers No. 7121 Case)

Many people keep the terms and conditions of their insurance in their closets.

Like Mr. A, it may seem a bit unfamiliar to the ``discreet insurance life'' of carefully reviewing and using insurance terms and conditions, but if you think about it, this is just a consumer's choice and judgment.

For example, suppose you have insurance that only pays for surgery once a year.

What to do if a doctor recommends surgery due to severe knee and ankle pain, which is a chronic disease while living a'zipcock' avoiding coronavirus?

It is entirely up to the individual to choose whether to receive insurance for the knee and ankle surgery at once, or whether to receive surgery from the knee and ankle surgery next year.

In other words, a patient who adjusts the treatment schedule according to the insurance payment terms cannot be called a fraudster.

Likewise, Mr. A, who adjusted his hospitalization schedule according to the terms and conditions for the payment of hospitalization benefits, is only living a wise insurance life, and for this reason, the prosecution would have raised Mr. A's hand, contrary to the claims of the insurance company and the opinion of the police.

The Financial Supervisory Service has revised the insurance industry supervision regulations, and since 2015, the Insurance Association has been compelling to compare and disclose the'number of lawsuits related to payment of insurance claims and the ratio of lawsuits to claims for insurance claims' through the Internet website. The insurance company is supervised, and citizens are provided with the information through the Internet website.

(Article 7-46 of the Insurance Business Supervision Regulations)

However, there are no regulations that the Insurance Association compares and discloses through the website for'the number of complaints and complaints of insurance fraud,'

and'Results of

complaints and complaints of insurance fraud'.

Because of this, citizens have no way of ascertaining which insurance companies engage in predatory acts that drive insurance consumers into fraudsters.

The Financial Supervisory Service should fulfill its natural duty to protect citizens who lead a'discreet insurance life' by supervising insurance companies who are making reckless complaints and complaints as soon as possible.

#In-it #In-it #Choi Jung-gyu #Struggle for common sense # Meet'In-

[In-It] Insurance to save living expenses, turned me into a scammer