The Supreme Court ruled that even if an insurance payout is possible due to the insurer’s failure to properly explain policy terms, falsely documenting the cause of an accident to secure payment constitutes “insurance fraud.”
According to legal circles on the 3rd, the Supreme Court’s 3rd Division (Presiding Justice No Kyung-pil) overturned a lower court’s acquittal of A, a branch manager of a domestic non-life insurer charged with violating the Insurance Fraud Prevention Special Act, and remanded the case to the Jeju District Court.
A’s client, B, had enrolled their child as the insured in a May 2019 actual expense medical insurance and children’s insurance policy. Under the policy’s terms, the insured must notify the insurer if they begin continuously using two-wheeled vehicles, and no payout is made if injuries result directly from sudden, accidental external trauma caused by operating such vehicles.
B’s child suffered a fracture in November 2021 after falling from an electric kickboard. A, aware that kickboard accidents are ineligible for payouts, proceeded to fabricate documents to secure insurance money. An insurance planner involved in the scheme submitted claim documents received from B to A in exchange for a portion of the payout. A falsely listed the cause of injury as “injured from a fall” and intentionally omitted the emergency initial diagnosis chart detailing the accident. The company ultimately paid B 2,740,000 Korean won. A was indicted for manipulating...
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