By Kim Bo-eun
The Financial Supervisory Service (FSS) is in a dilemma over its plans to take action against Samsung Life Insurance over its refusal to make payments for claims on cancer insurance policies, after the top court ruled in favor of the insurer in a legal dispute on the matter.
The head of a group of claimants, surnamed Lee, filed a suit against Samsung Life in November 2017 over its nonpayment of a cancer insurance claim, but the Supreme Court last month dismissed an appeal against a lower court's ruling.
Lee's disputed insurance claim centered on expenses for treatment at a rehabilitation center after undergoing cancer surgery and treatment at a general hospital in 2017. She spent six months at the center the same year.
Samsung Life provided Lee 94.88 million won in payments for the cancer diagnosis and surgery, but stated it would not pay the 55.58 million won in expenses accrued at the center.
The lower court stated that it could not recognize the expenses of treating after effects or complications from receiving treatment for cancer as cancer-related treatment expenses.
Reports stated the FSS had planned on convening a disciplinary meeting this month to review punitive measures for Samsung Life after a comprehensive audit of the company last year.
The process usually takes about a year for the supervisory authority to reach a conclusion on sanctions after detecting irregularities via the audit of a financial firm.
Refusals to make payments for claims has been a key issue the authority has had with Samsung Life.
However, the ruling by the top court has placed the FSS in a tricky position, as imposing sanctions for refusal to make payments on cancer policies would go against the ruling.
The FSS declined to comment on the matter.
"We cannot comment on a case until matters concerning sanctions are concluded," an official said.
There appears to be little ground for sanctions on Samsung Life, considering it also revised standards last December to provide more payments for policyholders' claims regarding rehabilitation expenses, following the FSS inspection.
Data from Rep. Kim Byung-wook of the ruling Democratic Party of Korea shows Samsung Life had the lowest percentage of refused payments after receiving medical advice among the top three life insurers here in 2019. Hanwha Life Insurance topped the list with 77 percent, followed by Kyobo Life with 72 percent. Samsung Life's figure was 65 percent.
"The ruling bears significance as it shows the court's view on the policy's terms," an official of an insurer said.
"We have provided payments on claims which we recognize as aligning to policy terms, and it has been our stance that we cannot provide further payments beyond these," he said.
The group of cancer patients protesting the insurance companies continue to occupy a customer center of Samsung Life.
The court ruling has left the group with little grounds to continue the protest there, but it has vowed to request another review by the court.
The group occupied the space at the insurance company's headquarters in southern Seoul in January this year.
In May, Samsung filed an injunction banning the group from protesting at its headquarters, citing it was illegally occupying its office space.
A court order accepted the injunction, but the group has refused to leave the premises.
Samsung Life last month filed a compensation suit demanding over 600 million won against the group, for losses sustained during the occupation.
 |
| The Financial Supervisory Service building's entrance on Yeouido, Seoul / Korea Times file |
The head of a group of claimants, surnamed Lee, filed a suit against Samsung Life in November 2017 over its nonpayment of a cancer insurance claim, but the Supreme Court last month dismissed an appeal against a lower court's ruling.
Lee's disputed insurance claim centered on expenses for treatment at a rehabilitation center after undergoing cancer surgery and treatment at a general hospital in 2017. She spent six months at the center the same year.
Samsung Life provided Lee 94.88 million won in payments for the cancer diagnosis and surgery, but stated it would not pay the 55.58 million won in expenses accrued at the center.
The lower court stated that it could not recognize the expenses of treating after effects or complications from receiving treatment for cancer as cancer-related treatment expenses.
Reports stated the FSS had planned on convening a disciplinary meeting this month to review punitive measures for Samsung Life after a comprehensive audit of the company last year.
The process usually takes about a year for the supervisory authority to reach a conclusion on sanctions after detecting irregularities via the audit of a financial firm.
Refusals to make payments for claims has been a key issue the authority has had with Samsung Life.
However, the ruling by the top court has placed the FSS in a tricky position, as imposing sanctions for refusal to make payments on cancer policies would go against the ruling.
The FSS declined to comment on the matter.
"We cannot comment on a case until matters concerning sanctions are concluded," an official said.
There appears to be little ground for sanctions on Samsung Life, considering it also revised standards last December to provide more payments for policyholders' claims regarding rehabilitation expenses, following the FSS inspection.
Data from Rep. Kim Byung-wook of the ruling Democratic Party of Korea shows Samsung Life had the lowest percentage of refused payments after receiving medical advice among the top three life insurers here in 2019. Hanwha Life Insurance topped the list with 77 percent, followed by Kyobo Life with 72 percent. Samsung Life's figure was 65 percent.
 |
| Samsung Life Insurance's headquarters in southern Seoul / Yonhap |
"We have provided payments on claims which we recognize as aligning to policy terms, and it has been our stance that we cannot provide further payments beyond these," he said.
The group of cancer patients protesting the insurance companies continue to occupy a customer center of Samsung Life.
The court ruling has left the group with little grounds to continue the protest there, but it has vowed to request another review by the court.
The group occupied the space at the insurance company's headquarters in southern Seoul in January this year.
In May, Samsung filed an injunction banning the group from protesting at its headquarters, citing it was illegally occupying its office space.
A court order accepted the injunction, but the group has refused to leave the premises.
Samsung Life last month filed a compensation suit demanding over 600 million won against the group, for losses sustained during the occupation.
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