Article 1(Purpose) #
The purpose of this Decree is to prescribe matters delegated by the Special Act on Prevention of Insurance Fraud and matters necessary for enforcement of the said Act.
Article 2(Reporting, etc. on Insurance Fraud) #
Reporting prescribed in Article 4 of the Special Act on Prevention of Insurance Fraud (hereinafter referred to as the "Act") shall be made in writing, by electronic recording medium or other means prescribed by the Financial Services Commission in accordance with a format prescribed and announced by the Financial Services Commission, including the following matters:
1. Name of the relevant insurance company;
2. Date and place of conduct to be reported;
3. Persons related to conduct to be reported;
4. Details of conduct to be reported.
Article 3(Delay in Payment of Insurance Money and other Grounds) #
"Grounds prescribed by Presidential Decree" in Article 5 (2) of the Act means any of the following cases:
1. Where the terms and conditions of the relevant insurance contract or other statues prescribe that the payment of insurance money shall be delayed or rejected, or the amount of insurance money shall be reduced;
2. Where justifiable grounds exists to suspect that any of the following conduct committed by a policy holder, etc. prescribed in Article 4 of the Act, constitutes insurance fraud, in the course of an insurance company investigating insurance incident. In such cases, it shall be limited to where the payment of insurance money is delayed:
a. Where it is reported to the Financial Services Commission pursuant to Article 4 of the Act;
b. Where a report or a request for investigation is made to the competent investigative agency or other necessary measures are taken pursuant to Article 6 of the Act.
3. Where an insurance company is found to have committed any of the following conduct in relation to outcomes of investigations of insurance accidents: Provided, That where an insurance company is deemed to file a complaint or request for dispute conciliation for the purpose of unlawfully delaying payment of insurance money or inducing an agreement on reduction of insurance money or abandonment of the insurance claim shall be excluded herefrom:
a. Where a complaint is filed;
b. Where a request for dispute conciliation is made pursuant to the Judicial Conciliation of Civil Disputes Act or the Act on the Establishment, etc. of Financial Services Commission.
4. Other cases prescribed and publicly announced by the Financial Services Commission, where a resonable ground exists for an insurance company to delay or refuse the payment of insurance money, or to reduce the amount of insurance money.
Article 4(Entrustment of Affairs) #
The Financial Services Commission shall entrust affairs concerning receipt of reports prescribed in Article 4 of the Act to the Governor of the Financial Supervisory Service (hereinafter referred to as the "Governor of the Financial Supervisory Service") pursuant to Article 13 of the Act.
Article 5(Handling Sensitive Information and Personally Identifiable Information) #
Where it is deemed essential for performing the following affairs, the Financial Services Commission (including persons to whom affairs of the Financial Services Commission are entrusted pursuant to Article 13 of the Act), the Governor of the Financial Supervisory Service or Health Insurance Review & Assessment Service prescribed in Article 62 of the National Health Insurance Act may handle information on health prescribed in Article 23 of the Personal Information Protection Act, information on criminal records prescribed in subparagraph 2 of Article 18 of the Enforcement Decree of the Personal Information Protection Act and data including a resident registration number, passport number, driver's license number, foreigner registration number or local residence reporting number pursuant to Article 29 of the Credit Information Use and Protection Act :
1. Affairs involving receipt of reports prescribed in Article 4 of the Act;
2. Affairs on measures, such as accusation prescribed in Article 6 (1) of the Act;
3. Affairs on reviewing the propriety of hospitalization pursuant to Article 7 (2) of the Act.
Article 6(Standards for Imposition of Fines for Negligence) #
The standards for imposing fines for negligence prescribed in Article 15 (1) of the Act shall be as listed in the attached Table.