상해보험 정신질환면책약관에 관한 연구

Abstract

This study deals with the area of ​​the accident insurance that the insurer assumes responsibility for the insurance amount and other benefits when there is an insurance accident about the bodily injury of the insured person.In particular, there is a controversy in practice about the validation/invalidation of the terms of the Mental Disability Indemnity in the accident insurance. Article 7, Paragraph 1, Item 5 of the Specified Insurance Standard Terms and Conditions for Long Term Non-Life Insurance Standard Article 14 of the Specified Insurance Standard Terms and Conditions before amendment in 2010 shall be determined by the insurer's immunity for the injury caused by "mental or physical loss and illness of the insured person". The damage of injury caused by the mental disease of the insured person in the accident insurance is judged as separate independent immunity unlike the intention or suicide of the insured person. Injury insurance policies that did not recognize the liability of the insurer for ‘the injury caused by the mental illness of the insured person’ were changed to the current standard of the disease and injury insurance policy and is being operated as ‘the case of hurting himself at the circumstance which the insured was not freely able to decide due to the mental or physical loss of the insured person’. An issue in relation to the terms of the Mental Disability Indemnity in the accident insurance is that the terms and condition recognized as the insurer’s indemnification in the case of injury due to the mental and physical loss or illness is changed to disadvantageous to the insurance contractors in Article 739 and 2 of Article 732, and is about the questions of Whether it violated the relative enforcement provisions of Article 663 of the Commercial Code, and whether these provisions violated the Regulation Law. The Supreme Court acknowledges the validity of the terms of the Mental Illness Indemnity Clause, saying that they are not unfairly disadvantageous to the customer and therefore can not be construed as a loss of fairness. The reason why the insurer’s exceptions clause for the insurance accident caused by the mental illness is considering the situation that the risk of injury is increased due to the deterioration of the cognitive ability or judgment ability from the insured person's mental illness, and is because the insurer can determine the risk of taking over the insurance product as long as it does not comply with the principles and mandatory policies of insurance. The Supreme Court's judgment that ‘the insured person is exempted from the insurer's obligation to pay the insurance claims under the exceptions clause of the above if he has reached a state where he can not make free decisions due to mental illness, so that causes the insurance accident‘ is valid.