암보험약관상 ‘암치료를 직접목적으로 하여’ 또는 ‘암의 직접치료를 목적으로’의 의미에 관한 소고

The first cancer insurance was introduced in December 1980, and in 1988, life insurance companies jointly developed and sold term insurance for cancer. Over the past 40 years, current cancer insurance products, reflecting social changes and diverse customer needs, have faced new markets characterized by super-aged society. Recently, there has been controversy over the interpretation of the general terms and conditions for cancer insurance. A company has encountered dispute with consumers caused the interpretation of meaning of the reasons for the insurance claim under the cancer insurance sold in 2000. One of the reasons for claim is when the insured person has been diagnosed as a female specific cancer, intra-epithelial cancer or gynecological disease, and the patient has been admitted for more than 4 days for the purpose of treatment. There was a dispute with consumers regarding the meaning of ‘direct’ for direct purpose. At the time of the launch of the product, the general terms and condition of the product were defined as ‘for the purpose of cancer treatment’, but the phrase was changed to sequentially ‘direct treatment of cancer’ and ‘direct treatment of cancer’. These kinds of the wording added to the confusion of interpreting the terms and conditions under the cancer insurance to the customer. This seems to extend beyond the problem of interpreting the terms of the contract, and the consumer should be aware of the specific treatment of the disease. At present, the meaning of direct treatment of cancer, which is the standard for payment of insurance benefits, is very ambiguous. The meaning of the general terms and conditions under the cancer insurance can be interpreted differently depending on whether the word ‘direct’ in the direct aim of cancer treatment or direct treatment of cancer directs the treatment or indicates the purpose. However, the problem is that the insurer does not define a detailed meaning of direct, but merely interprets it from the viewpoint of themselves and suggests the policyholder (or insured person) with a standard of insurance payment that can not be met at the time of joining. Treatment of cancer under the insurance contract is intended to treat a cancer, not a specific way of treating cancer. All methods and contents that are clinically acceptable for the treatment of cancer are recognized, unless the purpose of treatment is not only a cure from cancer. It may or may not even have been effective in the treatment. In conclusion, ‘direct aim of cancer treatment’ is to understand that the ultimate goal of cancer treatment is to have a doctor's treatment or surgery to treat cancer. Therefore, direct treatment of cancer treatment or treatment of cancer directly refers to the so-called specific medical behavior, so it is not a literal interpretation that treatment is directed, or the treatment of cancer is directed. It is reasonable to base the necessity or necessity of whether the treatment is inevitable or necessary for cancer treatment. In the cancer insurance, it is very important whether the ‘direct purpose’ or ‘direct treatment’ in the ‘direct aim of cancer treatment’ is the matter that the insurer must fulfill the explanation obligation to the policyholder. The policyholder cannot fully anticipate or understand what admission or treatment for the purpose is of treating cancer directly without the detailed explanation by the insurer. Therefore, the insurer must fulfill the obligation to explain the general terms and conditions of the insurance to the policyholder so that the intent of the insurer to limit the reasons for insurance claims inherent in the cancer insurance can be recognized during the contracting process.