암보험 약관의 개선방안 연구- “암의 치료를 직접목적으로 하는 경우” 조항을 중심으로 -

Abstract

In Korea, insurance companies began to sell cancer insurance policies, starting 1980. As their loss increased due to rising cancer incidence, however, the sales of cancer insurance products were stagnant since 2003. Recently, a variety of cancer insurance products have come on the market. In practice, there were a lot of disputes over cancer insurance products between consumers and insurance companies. In the process of mediating these conflicts, there have been many reviews on precedents in interpreting the terms of the cancer insurance. In fact, there has been a big disparity between consumers and insurance companies in interpreting the clause. Therefore, this study has investigated related precedents in accordance with Regulation of Adhesion Contracts Act and analyzed actual cases to come up with a solution. According to the Regulation of Adhesion Contracts Act, insurance terms should be fairly interpreted in accordance with the principle of good faith. In general, terms and conditions including insurance terms are set by the company at its sole discretion so that the amendment by the judiciary is usually approved. In terms of disclaimer clauses, if they are interpreted without limit, they become null and void. Therefore, it is right to interpret the terms and conditions within the scope of the legally acceptable cases to keep them effective. In case of precedents as well, this principle is applied. Even though the court of justice restricts the insurances terms set by the insurance company in accordance with the principle of good faith, they can be interpreted voluntarily regardless of the court’s interpretation with a goal of rendering insurance policyholders’ rights null and void fully or partially. In other words, the insurance terms developed by the insurer are interpreted by the insurance company at its sole discretion, which destructs the basic principles for the interpretation of terms of conditions suggested by the court of justice. In interpreting the clause ‘taking the treatment of cancer as the direct purpose,’ for example, the insurance companies’ arbitrary interpretations should be avoided, and judicial decision and good faith-based restricted interpretation should follow. In addition, the enactment and interpretation of insurance terms in a more detailed manner would be helpful for insurance companies to accomplish sustainable growth. In particular, even though whether or not how well the insurances sales agents explained and informed the insurance terms (‘taking the treatment of cancer as the direct purpose’) to the consumers would be judged in a court, this study has aimed to reduce conflicts and dispute over cancer insurance products through the clear and accurate interpretation of the insurance terms.