After cataract surgery, the practice of being covered by actual loss insurance was put to a halt.
The Supreme Court has ruled that inpatient treatment for cataract surgery cannot be recognized collectively.
Correspondent Ahn Hee-jae.
Mr. A was diagnosed with cataract 3 years ago.
At the recommendation of a doctor, he underwent cataract surgery, which involves inserting multifocal lenses in both eyes, over two days, and claimed about 6.8 million won in loss insurance.
The indemnity insurance that Mr. A subscribed to had a limit of 50 million won for inpatient medical expenses.
However, the insurer refused to pay for inpatient medical expenses, and a court battle began.
A's side claimed that it was 'hospitalized medical care', saying that he also received a confirmation of admission and discharge, and the court of first instance also accepted it.
However, in the second trial, the opposite conclusion was reached.
The insurance company raised the hand saying that Mr. A's operation should be viewed as 'outpatient treatment'.
According to the relevant insurance terms and conditions, Supreme Court precedent, and notice from the Ministry of Health and Welfare, the court pointed out that in order to receive inpatient medical expenses as insurance money, it is necessary to stay in the hospital room for at least 6 hours or undergo treatment and observation. I did.
In addition, the hospital did not have an inpatient room, so it was questionable whether hospitalization was possible.
Therefore, it has been decided that the insurance company only needs to pay 500,000 won according to the limit of outpatient treatment in the loss insurance that Mr. A has subscribed to.
The Supreme Court's final decision was the same.
In the case of cataract surgery, if the operation takes place over two days and the confirmation of admission and discharge is cut off, the practice of admitting it as inpatient treatment is broken.
The insurance industry is welcoming, saying that it is possible to prevent excessive cataract surgery, which has emerged as the main culprit in the loss of indemnity insurance.
The medical community is concerned about chaos.
[Hwang Hong-seok / President of the Korean Ophthalmology Association: The judgment itself is regrettable.
People who know they will receive indemnity insurance will not benefit after surgery (confusion is expected.)]
While the possibility of a lawsuit over the payment of insurance benefits is predicted, cataract patients who require inpatient treatment are not harmed. It seems the rules need to be revised.
(Video editing: Park Ki-duk)Keywords: