• The Korean Society of Law and Medicine
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• v.10 no.2
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• pp.287-307
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• 2009

A person is injured in car accident caused by his/her slight negligence except he / she causes accident by his / her willfulness or gross negligence. Because the National Health Insurance Corporation (hereinafter called "Corporation") shall not provide any insurance benefit "when he has intentionally or through gross negligence caused a criminal conduct or intentionally contributed to the occurrence of an accident" referred to in Article 48 (1) 1 of the National Health Insurance Act. So, if he / she is insured by his / her own bodily injury coverage, he / she can be compensated for his / her medical expenses. The injured have the rights to file either National Health Insurance claim and Automobile Insurance claim but there is no clear and definite adjustment clause. The claim disputes between National Health Insurance (hereinafter called "NHI") and Automobile Insurance (hereinafter called "AI") in the own bodily injury coverage makes some problems. Firstly, there are some differences in co-payments which he / she chooses between NHI and AI. Profit per a patient is higher in the NHI than in the AI. Secondly, it can provoke criticism that people shall unnecessarily pay double contributions. Lastly, it can raise moral hazards. For example, if he / she can cover the compensations when the insured receives the compensations from his / her insurer, the Corporation can be claimed by medical care institution payment of the health care benefit costs. In conclusion, first of all, to improve the national health and preserve the insured's rights the Corporation shall keep notice these facts.

• Proceedings of the Safety Management and Science Conference
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• 2007.11a
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• pp.457-461
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• 2007

This study presents service quality systems such as automobile industry insurance, personal accident insurance service vehicle repair and tow services, and, the service for buying and selling of used motor vehicles. These service quality systems include contracting services, payment service, infrastructure, adjustment service, and, process.

• The Korean Society of Law and Medicine
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• v.13 no.1
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• pp.11-40
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• 2012

National Health Insurance Act has been enforced all over the People as part of the effort to assure the minimum constitutional human worth and dignity in the aspect of the right to pursue health for preventing misfortune that comes to death without even a chance to be received treatment for illness or injury. Meanwhile auto insurance is compulsory in certain parts in order to promote benefits of everyday life and the rapid recovery of the damage caused by traffic accident when one have negligently driven a car which has become the necessities in daily life. Any injured driver in a traffic accident can be treated by National Health Insurance without getting an auto insurance in various circumstances, but Article 3 paragraph 2 of Traffic Accident Act don't allow exception of criminal punishment when he has driven a car without license, drunken, or tresspassing the centerline, etc. When the injury occured by his own certain negligence is judged to 'when he has intentionally or through gross negligence caused a criminal conduct or intentionally contributed to the occurrence of an accident' of National Health Insurance Act, insurance benefits can be restricted. Such a restriction could harm the right to pursue happiness and health of People by depriving the poor, who cannot afford to pay, of chances to get treatment. Here we will see benefit restriction by 'gross negligence' of National Health Insurance Act Article 48 paragraph 1, which has largest portion of such restriction. It is desirable to delete 'gross negligence' clause from above paragraph and to interpret 'when' clause restrictively for diminishing confusion of interpreting and guaranteeing the right of health.

• Journal of Korean society of Dental Hygiene
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• v.13 no.4
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• pp.561-568
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• 2013

Objectives : The purpose of this study is to examine the recognition and needs on the national health insurance coverage of scaling in industry accident injury patients. National health insurance coverage of dental scaling will start in September, 2013. Methods : Subjects were 649 industrial injury patients and they completed self-reported questionnaire. Data were analysed using SPSS version 20.0 for percentage, chi-square test, t-test, ANOVA, post-hoc Scheffe test, and Pearson's correlation coefficient. Results : Recognition on national health insurance coverage of dental scaling was not fully known to industrial injury patients (24.5%). Highly educated and high income workers seemed to recognize national health insurance coverage of dental scaling (p<.001). Recognition for national health insurance coverage of dental scaling revealed a significance (r=.576, p<.001). Most of the industrial injury workers thought that 50,000 to 100,000 Korean Won of dental scaling fee is reasonable. The coverage of dental scaling should be more than twice over 20 years old. Conclusions : It is necessary to encourage the patients to take regular dental scaling checkup and make them know the health insurance coverage of scaling. The preventive oral health care may improve oral health care and quality of life.

• Journal of Trauma and Injury
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• v.25 no.4
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• pp.178-187
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• 2012

Purpose: In Korea, the nation's medical expenses were 12 billion won in 2010. The medical costs for individuals can also be overwhelming. If a patient has sustained severe trauma, his/her insurance company responsible may pay only part of the medical bills. In Korean, there are diverse types of medical insurance, such as health insurance, automobile insurance, and industrial accident compensation insurance. And each insurance system has a different type of payment system. Our study will be essential for establishing the optimal medical expense payment system. Methods: From January to December 2011, we retrospectively reviewed the medical charts of 161 patients who were admitted to our hospital's emergency room after having undergone severe trauma. Of those 161 patients, 125 were retrospectively reviewed. Written permission was obtained from all of the patients. We analysed the demographic characteristics, clinical outcomes, data of the trauma, type of the patient's insurance, and the entire bill when the patient was discharged. Results: Seventy-one patients had health insurance, 48 automobile insurance, and six industrial accident compensation insurance. High-deductible insurance included health insurance and industrial accident compensation insurance, with the deductibles up to 20.6% and 19.1%, respectively. We attempted to analyze the cause of the high deductible rate. In patients with health insurance, medicines, primarily sedatives, pain killers, antibiotics, and fluids. comprised a large proportion. On the other hand, industrial accident compensation insurance deducted for a high-grade hospital room charge. Conclusion: We found that medical expenses were diverse according to the type of insurance. In particular, health insurance forced patients to pay too much of the medical expenses. Therefore, in Korea we should try to identify the insurance problems and improve the wage system.

• Journal of Korean Society of Transportation
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• v.33 no.3
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• pp.223-236
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• 2015

This study dealt with regional characteristics in car insurance for reduction of traffic accidents. The objective was to establish scientifically the verification procedure in the application of regional auto insurance rate. To specify the objective, this study conducts the correlation analysis between factors which are various in each local traffic environment and the loss ratio in automobile insurance. Also, this provides a correlation and a modal in loss ratio, classifying human factors in locality in major cause result from traffic accident. Based on the results, this brings up the problems with applying a uniform criterion for automobile insurance rate although various factors have effect on traffic accidents in locality. Therefore, what stands out most from this study is that a policy on automobile insurance applied to regional factor should be introduced.

• Journal of Arbitration Studies
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• v.24 no.2
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• pp.81-107
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• 2014

ADR has recently been expanded, making it possible to solve traffic accident disputes, which is a matter of urgency for parties to avoid. This point serves as an important procedural element. Such disputes are an area that requires a quick resolution. To try to solve any dispute that occurs in the complex environment of modern times one-by-one through litigation does not make sense. It gives an undue burden on the judicial body and the investigation agency. Like litigation, today's arbitration system, should have effective conflict resolution. The arbitration of automobile traffic accident disputes can be seen as roughly adjusted through the insurance company, the Dispute Coordinating Committee, and the Crime Victims Protection Act. It consists of experts mainly, and the resolution of automobile traffic accident disputes can be resolved through the Sajonsa and workers insurance company. However, adjustments to failure incident mostly need attention. Most of a company's compensation insurance indemnity needs to be processed in practice. In addition, a vicious cycle of litigation and delay period is repeated if a lawyer is appointed. There are unreasonable adjustment systems in the midst of these. Avoiding traffic accidents allows parties to resolve disputes better. Arbitration of disputes in automobile traffic accidents handled by arbitration institutions is desirable. It is determined that the handling of a case by a village attorney is efficient.

• Journal of the Korea Safety Management & Science
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• v.12 no.3
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• pp.73-79
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• 2010

Currently, in Korea, an accident that takes place during a worker's commuting is generally not considered as work-related accident. However, there are several exceptions such as an accident that occurs in commuting while using transportation provided by an employer, an accident that happens during commuting time that can be regarded as part of a business activity (e.g. tending to work instructed by an employer on the way to or from work), and an accident that is caused by insufficient facility management by an employer. It is even more so as the workers' commuting distance increases with expanding scale of a city, and traffic accident occurs more frequent. Social risk of commuting-time accident is on the rise. Under this circumstance, it is an important social issue to explore how to protect workers from commuting-time accident.

• The Journal of the Korean life insurance medical association
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• v.29 no.1
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• pp.22-23
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• 2010

• Health Policy and Management
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• v.4 no.1
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• pp.138-175
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• 1994

The objectives of this study are (i) to review current situations and problems of the occupational health care system with emphasis on reforming the organizations and services, (ii) to find out a disirable occupational health system model based on integration of the occupational health system and the general health system, and finally, (iii) to suggest policy implications in occupational health services in the light of objectives of the newly emerging national health insurance reform in Korea. The major policy implications of this study are as follows: 1. In the long-run, within the occupational health system, preventive occupational health services such as employees' physical check-up, working environment examination, etc should financially be integrated with industrial accident compensation insurance. Currently separately paying expenses for each different category of services by the owner of an enterprise should be disbursed once through the payment of contributions of industrial accident compensation insurance. And then, it is necessary to strengthen and expand the role and function of industrial accident compensation insurance to cover preventive occupational health services. 2. The occupational health system should be integrated with general health system for its effective management. For the short-term policy, it is necessary to eliminate fiscal and access barrier between industrial accident compensation insurance and national health insurance by means of ex post facto settlement of accounts. The duplication of employees' physical check- ups between under the health insurance program and under the industrial health services must be coordinated in a manner either through mutual authorization by the two parties concerned or through merge into the health insurance. 3. The intent of current employees' physical check-up system focused on detection of occupational diseases, should be converted to an idea of medical surveillance system or biological moritoring system. The introduction of medical surveillance or biological monitoring system is a necessary condition to build a positive, effective and inexpensive occupational health care system.