보험사기방지 특별법의 개정방향 - 보험사기 조사의 활성화 방안을 중심으로 -

The Korean 「Special Act on Anti-Insurance Fraud」(hereinafter, the Special Act) enforced in 2016 aims to protect insurance policy holders, etc thereby regulating insurance fraud acts by the investigation, deterrence and criminal penalties. However, this Special Act doesn’t provide efficient methods of insurance fraud investigation and it also doesn’t have related devices enough to protect the rights of insurance policy holders, etc. The biggest drawback of this Special Act is that it doesn’t go along with civil remedies as it just depends on criminal penalties for insurance fraudsters. Moreover, when compared the sentences imposed on other general fraudsters, the sentences by this Special Act cannot intimidate potential fraudsters enough. Secondly, the current Presidential Decree of the Special Act give immunities to insurance companies about some cases prescribed in its Article 3 of the Decree. In these cases, the insurance policy holders, etc. should endure whatever damages and inconveniences they might encounter in favor of insurance companies. Thirdly, without installing an exclusive organization in charge of insurance frauds investigation in Korea, this Special Act chooses to solicit evaluation of hospitalization appropriateness to Korean Health Insurance Review & Assessment Service (hereinafter, HIRAS) of which original role is in pursuit of the Korean National Health Service’s financial secureness. Furthermore, this Special Act’s choice may harm the right of health and/or medical treatment held by each person. As long as all insurance fraud is subject to criticism because of insurance system’s intrinsic characteristic- utmost good faith of Insurance, not only policy holders, etc. but also insurance companies should have duties of satisfying their own good faith. Consequently, the Special Act also should have arranged to induce insurance companies to implement their own duties and to impose penalties both civil and (at least) administrative to companies (if any) violating their duties. However, the current Special Act has not prepared it at all. This paper analyses major problems about the current Special Act and it gives its attention to the issue of insurance investigation. In consideration of the Korean police’s difficulties of processing insurance fraud affairs, this paper suggests the installation of an exclusive organization in charge of insurance frauds investigation and also proposes this exclusive organization should have access rights for appropriate personal information from Korea Credit Information Services in search of efficient/fair outcome for its investigation under the limitation of obmutescence duty. Nevertheless, the current Special Act doesn’t require any installation of organization for insurance frauds investigation, so it needs to be extensively revised for this purpose.