손해사정 업무위탁 모범규준의 실효성 제고를 위한 개선 방안 연구 - 보험소비자 보호와 업계 상생을 중심으로 -

This study recognizes the importance of claims adjustment work, which is essential for ensuring fairness in insurance claim assessment and securing consumer trust. It particularly conducts an in-depth analysis of “improvement measures for enhancing the effectiveness of Standard Guidelines for Outsourced claims adjustment Operations.” The Guidelines, established in 2019 to enhance the transparency of claims adjustment operations and protect insurance consumer rights, have been continuously supplemented through the first amendment in 2023 and a significant amendment in 2024. However, various pending issues are still being raised due to their inherent limitation as self-regulation. As a result of the study, it was revealed that the current Guidelines alone cannot effectively resolve various multifaceted problems. These include: “undermining the independence and professionalism of loss adjusters,” with factors such as insurance companies‘ dominant position, an unfair remuneration system, and practical burdens being identified; “inadequate protection of insurance consumer rights,” with insufficient practical guarantee of the right to appoint, lack of transparency and information asymmetry, and limitations of the dispute resolution mechanism being exposed; also, “insufficient legal status and effectiveness of the Guidelines themselves,” where limitations of self-regulation and financial authorities’ oversight were pointed out; and “mutual distrust and conflict between the insurance industry and claims adjustment industry,” with identified issues such as lack of communication and deepening of unfair practices. In particular, the sharp conflict of interest and information asymmetry between insurance companies and the claims adjustment industry hinder the fairness of claims adjustment and serve as a core cause of deepening insurance consumer distrust. Therefore, this study proposes diverse improvement measures to resolve these problems and enhance the effectiveness of the Guidelines. Specifically, “measures to enhance the independence and professionalism of loss adjusters” include the introduction of a standard fee schedule, establishment of an ethics and disciplinary system, and expansion of educational support. “Measures to strengthen the protection of insurance consumer rights and resolve information asymmetry” propose the materialization of the right to appoint, enhancement of process transparency, and strengthening of information disclosure obligations. “Measures to strengthen the legal status and effectiveness of the Guidelines themselves” suggest the quasi-legalization of key contents, strengthening of sanctions, and reinforcement of financial authorities‘ oversight. And “measures for establishing a win-win cooperation system between the insurance industry and claims adjustment industry” propose the activation of communication channels and the establishment of fair outsourcing practices.