보험약관의 계약전 사고(발병) 부담보조항의 효력에 관한 고찰

Abstract

According to the pre-existing conditions exclusion clause, if there was a cause or symptom of an outbreak prior to the insurance contract, the insurer does not pay claims during the insurance period, even if the reason for the payment arises. Disputes concerning the effectiveness of the pre-existing conditions exclusion clause and its interpretation of the scope of application will often occur in the insurance practice. Usually, the policyholder does not know that he/she has a disease before signing the contract, it is not a problem with the violation of duty of disclosure and the pre-existing conditions exclusion clause sometimes leads to a refusal to pay insurance payments. At this point, the question is how to reconcile this conflict with the protection of well-intentioned policy-holders. Simply interpret the exclusion clauses in a literary way, if there is no evidence of treatment or diagnosis prior to the signing of the insurance contract, but objectively the disease that appeared after the contract existed before the subscription, the insurer does not pay insurance payments by applying the pre-existing conditions exclusion clause. From this point of view, this exclusion clause is a very disadvantageous provision for policy-holders. Due to such practical problems, the Financial Supervisory Service recently took measures to remove the pre-existing conditions exclusion clause from the standard agreement. However, I object to the deletion of unilateral clauses of the regulatory authorities, which were carried out without sufficient consultation between insurers and consumers. Rather, I suggest that the exclusion clause be amended as a way to protect policy-holders and to counter a malicious policyholder. The specifics are as follows. First, subjective requirements(the recognition of the insured) are added to the exclusion clause, or set a certain waiting period, in order to guarantee the performance of the insurer’s faithful explanatory obligations, I propose that the disadvantages of non-execution be specified in the exclusion clause.