• Journal of Information Technology Services
• /
• v.6 no.2
• /
• pp.1-18
• /
• 2007

Many researches have been done in insurance fraud as the amount and frequency of insurance fraud have been increasing continuously. In particular, the development of insurance fraud detection system using large database management techniques including data mining or link analysis based on visual method have been the main research topic in insurance fraud. However, this kinds of detection system were very ineffective to find unintentional insurance fraud happened by accident even though it was so good to find intentional and organized crime insurance fraud. Therefore, this research suggests insurance fraud as an ethical decision making and applies TPB(Theory of Planned Behavior) for the finding of reasons and prevention strategies of unintentional insurance fraud happened by accident. The results of research show that TPB is very appropriate model to explain the behavior of insurance fraud and that insurance agents force to do insurance fraud as affecting perceived behavior control. Therefore, education and pubic relations for insurance fraud are very effective for preventing insurance fraud and developing insurance service industry.

• International Commerce and Information Review
• /
• v.10 no.4
• /
• pp.513-532
• /
• 2008

The purpose of this study was to analyze which factors have had impacts on extension export insurance charge of Korean export insurance. In order to attainment of this study, an empirical study was proceeded. The export insurance charge was hired as the dependent variable and export insurance premium, insurance compensation charge, export insurance collection charge and export insurance fund were used as independent variables. Data was used for estimation are the annually data from 1969 to 2007. From results of this analysis, we find the hired variables have highly correlation among them and the most influential factor turns out to be export insurance fund. Main results of this study was as follows : i) The export insurance fund must be increased immediately. ii) It is necessary that Korea Export Insurance Corporation give their attention to the compensate amount of export insurance compensation on specific insurance item. iii) It is necessary that Korea Export Insurance Corporation extension the collection efforts of the export insurance. iv) A reasonable raising of export insurance premium need to be done.

• Korea Trade Review
• /
• v.45 no.3
• /
• pp.133-146
• /
• 2020

In the UK's the insurance law 2015, a remedy for breach of warranty in marine insurance was introduced. Also, if the insured proves that breach of warranty in marine insurance does not affect damages, the insurer pays the insurance money to the insured. The UK's marine insurance law has served as the governing law that has been the standard for the marine insurance industry for a long time. Korea and China were heavily influenced by the UK maritime insurance law. Therefore, this study analyzed the cases of breach of warranty in marine insurance in Korea and China. Through this, the insurer avoid the insurance contract for an accident that occurred after the breach of warranty. this result will be different under the new revised insurance law system. With the revision to The Insurance Act 2015, one of the biggest change in the insurance system is that it is possible to remedy of the violations of warranty. However, such a revision of the law requires considerable attention as it also changes the interpretation and judgment of the courts. Accordingly, a practical response of the insurance industry is required. It is necessary to prepare for possible disputes in practice.

• Journal of Arbitration Studies
• /
• v.15 no.3
• /
• pp.267-301
• /
• 2005

Following the increased economic corporations between the South and North Korea, many companies participate the corporation program. They needs insurance policy as a scheme for the transfer of risk from those individual company to it to an insurer. This paper review the possibility of the North Korea insurance authorities and research the origin, history, structure and context of the North Korea insurance law. The North Korea Insurance law differ from the South Korea and China's. North Korea Insurance authority has not capability of doing insurance business both side of underwriting and indemnity. Partly, it caused the uncertainty, insufficient and vague of the insurance law. The writer conclude that the North Korea insurance law faced to the needs of modernization. Especially, the Gyesung Industrial Complex Insurance Regulation couldn't cover the investor and company's risk because it is not based on the nature and basic principles of insurance.

• Korean Journal of Artificial Intelligence
• /
• v.9 no.1
• /
• pp.9-14
• /
• 2021

This paper predicted a model that indicates whether to buy a car based on primary health insurance customer data. Currently, automobiles are being used to land transportation and living, and the scope of use and equipment is expanding. This rapid increase in automobiles has caused automobile insurance to emerge as an essential business target for insurance companies. Therefore, if the car insurance sales are predicted and sold using the information of existing health insurance customers, it can generate continuous profits in the insurance company's operating performance. Therefore, this paper aims to analyze existing customer characteristics and implement a predictive model to activate advertisements for customers interested in such auto insurance. The goal of this study is to maximize the profits of insurance companies by devising communication strategies that can optimize business models and profits for customers. This study was conducted through the Microsoft Azure program, and an automobile insurance purchase prediction model was implemented using Health Insurance Cross-sell Prediction data. The program algorithm uses Two-Class Logistic Regression and Two-Class Boosted Decision Tree at the same time to compare two models and predict and compare the results. According to the results of this study, when the Threshold is 0.3, the AUC is 0.837, and the accuracy is 0.833, which has high accuracy. Therefore, the result was that customers with health insurance could induce a positive reaction to auto insurance purchases.

• Health Policy and Management
• /
• v.27 no.2
• /
• pp.103-113
• /
• 2017

There have been many achievements for 40 years since the introduction of compulsory health insurance. Despite many achievements, it has many challenges in health insurance. Aging, non-communicable disease, and low growth economy are threatening the sustainability of health insurance, and it is time to reform the health insurance. A long-term reform plan will be an absolute necessity for reform of health insurance and health care system. Health insurance and health care reform should be an extremely revolutionary content that completely changes the framework. This reform should deal with the philosophy of health, approach of medical education and doctor training, changing supply of medical service, the innovation of primary medical care, reform of public health system, the management of medical utilization, the integration of medical cure and care services, enhancing the benefit coverage, prohibition of covered and non-covered services, etc. Therefore, it is urgent to form a consensus on the necessity of reform, to establish the health insurance plan on this consensus, and to make efforts to make health insurance sustainable.

• Convergence Security Journal
• /
• v.16 no.6_2
• /
• pp.53-60
• /
• 2016

Security measures for the current insurance crime has focused on the capture oriented and reactive response in the screening stage of insurance payments. However, since leaving the damages that can not be healed by post-punishment, it is necessary to take measures to prevent the insurance crimes in advance. In this paper, I would like to try to identify problems through analyzing the characteristics and cases of the insurance crimes, and to present alternatives to it. The problems with the current insurance system that causes the insurance crimes are, First, When signing the insurance contract, it is too inattentive to confirm about the credit status of the policyholder, duplicate join or not, whether voluntarily sign up etc. Second, a thorough investigation or criminal charges in case of insurance accident is not being done properly. Third, information exchange and management to malicious policyholders is not being done properly. Therefore, in order to guard people from insurance crimes, First, it should strengthen the audit of such credit conditions, accident experiences in the insurance contract at the policyholders. Second, we need to block insurance crimes in advance through the continuous upgrades of insurance fraud analysis systems and social network. Third, it is necessary to strengthen the surveillance systems for the insurance crimes by the information sharing.

• The Journal of the Korean life insurance medical association
• /
• v.28 no.1_2
• /
• pp.31-35
• /
• 2009

Background : Many of internists have been working for insurance industry. Insurance medicine is use of medical knowledge for insurance industry. There is social role of insurance medicine in terms of soundness of insurance administration. Recently social role of internists also have been being watched. Although theme of insurance medicine is medical risk selection, insurance claims administration also needs medical experts'opinion. There are not any corroborative study of medical consulting for insurance claims. Among insurance industry, someone called this medical review of insurance claims as 'medical claims review'. Aim : To investigate usefulness of medical review of insurance claims. Design : Questionnaire survey with claim staffs in one of insurance claim adjustment company in Korea. Methods : 265 claim staffs were divided into 4 groups and conducted survey using a questionnaire of 20 questions. Utility score, job satisfaction score, and difficult factors of claims administration were measured. Results : Utility score and job satisfaction score are highest in medical claims review group. The most difficult in claim administration to claim staffs was demonstrated to medical knowledge. Conclusion : Medical review of insurance claims is proved to be worthy. Document-based consulting method, namely medical claims review, is more useful than telephone-based simple query among claim staffs...Subjects of the medical claims review are medical record and it's principle is independent medical examination with evidence-based approach, it also has role of protecting fraud of insurance claims. Two main question types of medical claims review are verification and advice.

• THE INTERNATIONAL COMMERCE & LAW REVIEW
• /
• v.61
• /
• pp.165-190
• /
• 2014

The purpose of this study is to measure the trade insurance's macroeconomic effects by analyzing the causality between major economic variables(GDP per capita, market interest rate, inflation, unemployment rate, exchange rate) and trade insurance variable. I conducted empirical analyses using First-difference GMM(Generalized Method of Moments), System GMM and Panel-VAR Model, with panel data from 11 countries(Korea, United States, Japan, BRICs, Indonesia, Singapore, Hong Kong, Vietnam) between 1992 and 2011. There are several important findings. Above all, Trade insurance is positively and significantly related to GDP. This results show that trade insurance serves to increase economic growth. In other words, trade insurance leads to economic growth by helping increase GDP per capita. Especially, trade insurance negatively related to unemployment rate, it is for sure that trade insurance contribute to decrease unemployment rate. And trade insurance helps control of inflation. It is also confirmed that trade insurance contributes to price stability, which in turn serves to stabilize the overall economy. And this research finds as uncertainty in the market increases, seen it as increase of exchange rate, increasing trade insurance supply is stabilize the exchange rate.

• The Journal of the Korean life insurance medical association
• /
• v.32 no.1
• /
• pp.8-14
• /
• 2013

Evidence-based medicine(EBM) or evidence-based health care has been used in clinical medicine. Recently, it also has been applied to areas of social medicine such as independent medical examination. Insurance medicine is one of social medicine, as for it's role is maintenance of sound insurance system or for insured of life insurance. Practical application of EBM to the insurance medicine are; confirming question, finding evidence, and evaluation that selected evidence is best or not in terms of practical aspect.