韩国拟对轻伤交通事故超8周治疗引入专家审查以压降车险赔付

To curb so-called "fake patients" who undergo prolonged hospitalization to claim insurance payouts, anyone seeking traffic accident treatment beyond eight weeks will now need to undergo a review by a medical specialist.
The Ministry of Land, Infrastructure and Transport (MOLIT) said the amended enforcement decree of the Automobile Accident Compensation Guarantee Act (Automobile Compensation Act) was approved at a Cabinet meeting on the 4th. The amendment takes effect next month on the 10th.
After the effective date, minor-injury patients seeking treatment beyond eight weeks must undergo a review of treatment necessity by a medical specialist at the Korea Automobile Insurance Development Institute. The measure applies to patients in Grades 12-14 among the Grades 1-14 injury classifications under the Automobile Compensation Act enforcement decree. These are mainly patients with sprains and bruises.
The review process has three stages. When a patient submits documents such as a medical certificate, the insurance company and the automobile mutual aid association request a review from the institute. The institute notifies the patient, the insurance company, and the mutual aid association of the review results. If the patient objects to the results, they can request a reexamination from the Mutual Aid Dispute Mediation Subcommittee. The application can be filed directly by the patient or through the insurance company.
The amendment was pursued to prevent insurance payout leakage caused by excessive treatment. The number of minor-injury patients fell from 1.554 million in 2019 to 1.488 million last year, a decline averaging 0.9% annually. In contrast, treatment costs for minor-injury patients rose from 1 trillion won to 1.41 trillion won over the same period, an average annual increase of 7.0%.
MOLIT also established safeguards to reduce public inconvenience. The costs of issuing review documents and the treatment costs before the review is completed will be borne by insurance companies and mutual aid associations. This also includes treatment costs during any period of delay in the review. Mutual aid associations previously did not cover the cost of issuing medical certificates needed to extend treatment.
The amendment also includes measures to guarantee the right to treatment. The review targets are limited to minor-injury patients with sprains and bruises, such as spinal sprains, simple sprains of the arm and leg joints, and chest bruises without rib fractures. Dental prosthetics and ruptured eardrums are excluded. Pregnant women and infants aged 7 or younger can continue treatment without going through the review process.
The screening system will be operated through a computerized system. MOLIT will appoint about 200 medical and Korean-medicine specialists with more than 10 years of experience at general hospitals as review committee members. Even after implementation, it plans to analyze review results each quarter and refine the review targets and screening criteria.
MOLIT expects that reducing unnecessary insurance payouts will also ease the burden on insurance policyholders. The measure is being pursued alongside an amendment to the Financial Supervisory Service's detailed rules on insurance business supervision, which pays future treatment costs only to seriously injured patients. Another anticipated benefit is that reviews by experienced medical professionals could identify additional injuries not detected in prior examinations.
"This enforcement decree amendment is intended to ease the public's automobile insurance premium burden and establish a culture of appropriate compensation," said Park Jun-hyeong, director general of the Mobility and Automobile Bureau at MOLIT. "We will do our best to effectively screen out fake patients while ensuring there is no public inconvenience from the system's improvement."