갑상선암 임파선 전이와 암보험금 지급에 관한 주요 쟁점 분석 – 금융분쟁조정위원회 조정 결정 및 최근 법원 판례를 중심으로

According to the National Cancer Center’s “2020 Cancer Registry Statistics and 2014-2018 Regional Cancer Incidence Statistics Press Release,” released on December 30, 2022, thyroid cancer was the most common cancer among both men and women with cancer. Lee (2003) states that the majority of thyroid cancers are “papillary” and that more than 90% of them have lymph node metastases. If thyroid cancer has metastasized to the lymph nodes, the disease classification numbers in the Korean Standard Classification of Diseases and Causes of Death are C73 and C77, respectively, and under cancer insurance policies, C77 is classified as a general cancer and C73 as a small cancer. The problem is that in the case of a diagnosed lymph node metastasis (C77) for thyroid cancer (C73), the insurance consumer expects to receive a general cancer diagnosis, but the insurance company only pays for thyroid cancer, which is a minor cancer, according to the ‘primary site criteria clause’ in the policy. In this case, the insurance consumer expects to be able to receive the general cancer diagnosis fee, but the insurance company only pays insurance money for thyroid cancer, which is a small amount of cancer, according to the ‘primary part standard clause’ in the contract. In response, the Financial Dispute Mediation Committee (Mediation No. 2019-17) recommended on December 24, 2019, that all cancer insurance benefits be paid based on the insurer’s violation of the duty of explanation for the ‘primary site criteria clause’ and the ‘author disadvantage principle’ in the interpretation of the policy, but judgments vary from court to court. It was recommended that all cancer insurance payments be paid based on the violation of the insurance company’s duty to explain the ‘primary part standard clause’ and the ‘principle of disadvantageous writer’ in the interpretation of the terms and conditions. However, different courts decide differently on the same issue. Therefore, after comparing the grounds for payment according to the Financial Dispute Settlement Commission’s settlement decision and the attitude of recent judgments, this study suggests implications and improvements, such as the need to revise the implementation of insurance companies’ explanation obligations and product manuals required by the ‘primary site standard clause’.