Shin Jang-sik: “There is an explosion of medical advice to avoid children’s insurance payments” [2024 국감]

Suspicions have been raised that an insurance company selling actual cost insurance for children changed the diagnosis to avoid paying insurance benefits to children with developmental delays.

At the National Assembly’s Political Affairs Committee audit on the 17th, Shin Jang-sik, a member of the National Assembly for the Innovation Party of Korea, said, “Children’s actual loss insurance has an R code that allows actual loss treatment and an F code that excludes actual loss insurance due to a disability diagnosis,” and added, “Hyundai holds 44.6% of the total children’s actual loss insurance.” He pointed out, “There will be 91 cases in 2022 of the maritime industry failing to pay actual loss insurance premiums to children with developmental delays.”

Representative Shin explained, “Children with developmental delays are children whose physical, emotional, social, and linguistic development lags behind that of a certain age. If diagnosed and dealt with early, the delayed situation can be improved.” He continued, “It is said that a monthly investment of 3 million won is required to bring the child up to the level of a 3rd or 4th grade elementary school student,” and emphasized, “This is why many people rely on children’s actual cost insurance.”

Rep. Shin said, “To change an R code to an F code, medical advice is required, and the number of cases of this medical advice is rapidly increasing.” According to data released by Rep. Shin, the number of medical consultations related to developmental delay increased significantly from 376 in 2021 to 1,989 last year. As of June this year, there were 851 cases. Rep. Shin said, “99% were R codes (allowing actual loss insurance payments),” and said that the number of cases where diagnosis codes were changed after medical advice increased from 58 cases in 2021 to 972 cases last year.

Rep. Shin said, “As the problem continued to arise, Hyundai Marine & Fire Insurance introduced an opinion liability review system in June 2024 that pays insurance benefits based on the opinion of the attending doctor who has continued to treat the child.” “This has been confirmed, but in this case, we are asking questions that make it impossible to maintain the R code, such as ‘Is it impossible to assign an F code?’” he criticized.

Rep. Shin said, “I want to normalize my children’s delayed development by purchasing insurance, but Hyundai Marine & Fire Insurance is changing the development code to F code,” and asked, “Is the opinion liability review system being operated as intended by the Financial Supervisory Service?” did it He emphasized, “If the Financial Supervisory Service does not provide additional management and supervision, the dispute over selling children’s actual cost insurance and changing the code will continue.”

Lee Bok-hyeon, head of the Financial Supervisory Service, said, “It is difficult for us to criticize the sending of medical advice,” but added, “We tend to send it to neuropsychiatry or other departments that are prone to F codes, so we are trying to guide them so that they can be sent to various departments.”

He said, “Recently, we have tried to reduce the right to refuse payment to some extent, but we will fundamentally take care of it again so that insurance companies can do it properly.”