韩国车险轻伤长期治疗“8周规则”将于9月10日生效，行业称可改善赔付率2至3个百分点

An "8-week rule" designed to prevent excessive treatment of minor-injury patients from traffic accidents will take effect next month, about a year and six months after its introduction was delayed due to opposition from the medical community. Attention is focused on whether the rule can screen out so-called "fake patients," who continue treatment for extended periods even after minor collisions, to stem the leakage of insurance payouts and improve auto insurance earnings that have turned to losses.
According to the Ministry of Land, Infrastructure and Transport (MOLIT) and financial circles on the 4th, an amendment to the enforcement decree of the Automobile Accident Compensation Guarantee Act passed the Cabinet meeting that day and will take effect on September 10 this year. The core of the amendment requires minor-injury patients from car accidents to undergo a review of treatment necessity by a medical professional if they seek treatment beyond eight weeks after the accident. Under the so-called 8-week rule, the measure applies to patients with sprains and bruises among minor-injury patients rated in injury grades 12 to 14. Pregnant women and infants aged 7 or younger are excluded from the review. When a patient submits relevant documents such as a medical certificate, the Korea Automobile Accident Compensation Promotion Agency determines the necessity of extended treatment through a review by a medical professional.
The 8-week rule emerged from concerns that, although 90% of minor-injury patients complete their treatment within eight weeks of an accident, some excessive treatment has been driving up insurance premiums. Indeed, the number of minor-injury patients declined from 1.554 million in 2019 to 1.488 million in 2024, but over the same period, treatment costs increased from 1 trillion won to 1.41 trillion won. Cases of patients receiving long-term treatment for minor injuries while claiming excessive insurance payouts have increased, which critics have repeatedly noted ultimately burdens all subscribers with higher premiums.
At the center of the excessive-treatment controversy have been traditional Korean medicine institutions. Last year, auto insurance costs for traditional Korean medicine treatment reached 1.6972 trillion won, accounting for 60.4% of total auto insurance treatment costs. In particular, 87.8% of minor-injury patients who received treatment beyond eight weeks after their accidents used traditional Korean medicine treatment. As a result, the per-patient cost of traditional Korean medicine treatment for minor-injury patients last year reached about 1.08 million won, 3.1 times the cost of Western medicine treatment (360,000 won).
The insurance industry views the increase in treatment costs as being driven by so-called "set billing," in which acupuncture, cupping, pharmacopuncture, chuna manual therapy, and traditional Korean physical therapy are administered together regardless of the patient's symptoms, as well as the use of upgraded hospital rooms. In one case, a patient received 32 medical certificates over 303 days following a simple collision and collected 31.74 million won in treatment costs and settlement money.
The leakage of insurance payouts has led to worsening profitability for auto insurance. The loss ratio for auto insurance at the four major non-life insurers rose from 79.8% in 2023 to 87% last year and recorded 84.5% in the first half of this year. Operating profit turned to a loss of 9.7 billion won in 2024, then widened to a 708 billion won loss last year, and this year's annual loss is projected to reach 1.2 trillion won.
The non-life insurance industry expects that if the 8-week rule takes hold, the leakage of insurance payouts from long-term treatment will decrease, potentially improving the loss ratio by 2 to 3 percentage points. Applied simply to an annual premium volume of about 20 trillion won, 3% corresponds to about 600 billion won. However, since the system applies to accidents occurring after September 10, the effect on earnings improvement is expected to materialize in earnest from next year onward.
Concerns about a balloon effect also remain. A representative loophole is a diagnosis of concussion. Concussion is classified as injury grade 11 and is excluded from this system. Given the precedent that grade 11 claims increased after standards for compensating minor-injury patients were previously tightened, some point out that the possibility of circumventing claims by changing diagnoses must be watched.
"The 8-week rule is not a system that blocks patients' treatment but a mechanism to objectively confirm the necessity of long-term treatment," an insurance industry official said. "To enhance its effectiveness, the review standards for overlapping traditional Korean medicine procedures and upgraded hospital room charges must be made more specific, along with monitoring of abnormal claims."