손해사정 관련 2024년 개정 보험업법 평가 및 과제

Claims adjustment is the process of confirming the occurrence of damage, judging the appropriateness of the application of insurance terms and conditions, calculating the amount of damage and insurance money, preparing a Claims adjustment report, and providing it to insurance companies and policyholders. This is a core procedure that serves as the basis for determining whether or not to pay insurance money and the amount, and is based on Article 185 of the Insurance Business Act, etc. Korea introduced the Claims adjustment system through the revision of the Insurance Business Act in 1977, and it developed into a hybrid system that borrowed the concept of an American-style independent adjusters while being based on the Japanese insurance company-centered system. However, it has been continuously criticized for falling short of the purpose of introducing the system, which was to ensure fairness and expertise. It has been pointed out that the subject of Claims adjustment work and its procedures are under the influence of insurance companies, which hinders objectivity and independence. The revised Insurance Business Act of 2024 stipulates the right of policyholders, etc. to appoint an independent adjusters, but the specific requirements, procedures, and cost burden are still unclear. In particular, although the payment of success fees may violate the Attorney-at-Law Act, it is customarily acknowledged in practice, which causes legal controversy. In addition, the difference in the terms of consignment between subsidiaries and non-subsidiaries among loss adjusters performing loss adjustment work also leads to issues of fairness. While subsidiary loss adjusters receive tangible and intangible support from insurance companies, non-subsidiary loss adjusters operate under low fees and relatively unfavorable conditions. This can cause imbalances in the market and hinder the sound development of the entire loss adjustment ecosystem. Loss adjustment work should be understood as an independent role that provides the basis for the judgment of insurance companies, not as an essential work of insurance companies. There is concern that insurance companies directly determining insurance benefits without receiving loss adjustment reports may harm fairness, and accordingly, efforts are needed to reduce the practice of self-assessment and switch to a procedure centered on policyholders. In order to realize the original purpose of the Claims adjustment system, institutional improvements are needed to ensure the actual role of independent adjusters, establish a clear legal basis for the burden of Claims adjustment costs, procedures, payment standards, etc., and secure fairness between subsidiaries and non-subsidiaries, while promoting balanced development of the Claims adjustment ecosystem. The domestic insurance market is ranked 9th in the world and shows a high level compared to the size of the economy, but has entered a low-growth phase due to slow economic growth and a decrease in new contracts. Accordingly, it is necessary to improve the insurance solicitation and insurance payment system for qualitative growth of the insurance industry. Taking the past case of indiscriminate sales of fixed-rate annuity products as a lesson, product design and appropriate sales that consider profitability and sustainability are required. In addition, securing fairness and objectivity in Claims adjustment play an important role in restoring the trust of insurance consumers, and the recent decrease in complaints is interpreted as a result of such improvements. The importance of Claims adjustment work should be emphasized to ensure fair insurance payments when insurance accidents occur, and the reliability of insurance should be increased through objective Claims adjustment. In most cases, when an insurance policyholder appoints an independent loss adjuster, it is when the insurance company refuses or reduces payment. This process exposes institutional limitations, such as the possibility of an insurance company’s judgment error or the loss adjuster’s illegality. The revised Insurance Business Act of 2024 seeks to alleviate unfairness in the loss adjustment process and reflects efforts to improve problems that may arise in direct, subsidiary, and non-subsidiary loss adjustment methods. However, issues such as compensation and supply of loss adjusters and the lack of distinction between investigation and examination work still remain as tasks for improvement. In particular, the difficulty in accurately determining the number of loss adjustment cases can serve as grounds for reexamining the self-loss adjustment system. As our insurance market has entered a mature stage, the insurance industry and financial authorities must have an advanced perspective that is in line with the times, and it is necessary to expand the supervisory and legislative methods in the direction of institutionalizing best practices, which are voluntary norms. Ultimately, continuous efforts to improve the system are required to ensure fair and ethical loss adjustment and insurance payment through cooperation between the insurance industry and the loss adjustment industry.