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Cosmetics (?), Treatment (?)
Cosmetic surgery such as molding, hair transplantation, LASIK, LASEK, etc. is not subject to insurance
The Saemaeul safeguard "The multifocal lens insertion is not subject to deductible"
The court rejected the payment of the "Insurance money" It was only an objective insertion for the treatment of cataracts "…
- A case of the Saemaul Coalition Fund, which refused to pay insurance for cosmetic surgery performed at an ancillary level, was revealed.
It is considered that the cosmetic surgery practiced at the subsidiary level of the treatment is only a cosmetic operation and refuses to pay the money for the treatment. insurance,
The general insurance policy states that insurers do not have to pay insurance for cosmetic surgery.
Due to typical cosmetic surgery, such as cosmetic surgery, hair transplant In the case of LASIK surgery and LASEK, it is common that the insured is not covered by insurance.
There are, of course, exceptions that require the payment of insurance benefits. If these cosmetic surgeries are performed at an ancillary level of surgery for treatment and if the surgical treatment is covered by the coverage conditions, the insurer must pay the insured the normal amount of insurance .
For example,
Originally, double-eyelid surgery is a typical cosmetic surgery, but in this case, surgery to treat a disease called ptosis The side of the double eyelid surgery is fact.
Another example is bad reconstruction for the bad, the so-called "bad," because the pancreas is usually a disease that is covered by the insurance policy. It is an operation to breed a bad that is not developed. Breast augmentation is also a typical cosmetic surgery, but here it is an ancillary treatment for the bad reconstruction surgery.
Unfortunately, some insurance companies still do not have the right to use cosmetics such as cosmetics, cosmetics, cosmetics, cosmetics, cosmetics, cosmetics, [19659004TheSaemaulUndongBankofKorea(hereinafterreferredtoas"SaemaulUndongBank")whichoffersinsuranceproductsasafranchiseSaemaulcoffin)wasthecaseTheSaemaulcooperativesaidthatthevisioncorrectionsurgerypracticedfortheinsuredcataractsurgeryhadanaestheticpurposeandrefusedthepaymentofinsurancemoneybutitwasrevealedthatthecourthadrenderedashortagejudgment19659003] In early 2010, Mr. A joined an insurance product guaranteeing full medical expenses and medical expenses paid by the disease among the deductions of the safe Saemons.
He established himself as disabled, insured and beneficiary of insurance,
These deductible products, as well as the contents of other insurance companies and insurance life, are not covered by the terms of the contract. Medical Expenses "
. This is due to the need for glbades, contact lenses, etc.
About five years after Saemaul's merchandise contract, Mr. A received an ophthalmic examination from the clinic Ophthalmology, and was diagnosed with unexplained cataracts.
Here, the implantation of multifocal lenses is one of the surgical procedures mainly used for cataract surgery, and is a lens special multifocal designed to correct normal eye refraction errors.
Mr. A paid medical expenses to the eye doctor at that time, and he immediately filed an application with the Saemaul security depot office asking him to pay the insurance money equivalent to 90%
However, Saemaul's security deposit was strongly opposed to the claim of deduction by MA
At that time , The inse One-off lenses are not an inevitable case for cataract treatment, but it is a cost incurred by the selection of patients according to the additional financial burden, so it is not deductible unless there is an additional cost guarantee. "
" Multifocal lens implantation is a vision correction aimed at replacing eyeglbades, contact lenses, etc., with the primary purpose of improving eyesight in addition to cataract surgery. "" The insurance is based on the hypothesis of hospitalization due to illness and Mr. A received treatment only for the outpatient clinic. "
only had to pay a small deductible, except for the insertion of a multifocal lens." 19659003] On the other hand, Mr. A strongly opposes the refusal from the Saemaeul bank to pay the deduction,
Mr. A received a claim for insurance claim against the Saemaul Undong Central Bank, which was received as "accessory" only for the purpose of treating cataracts.
After a harsh trial in the court of appeal, the appeal court did not accept most of the claims made by the Saemaul Undong Bank, and recently the court ruled that they would pay the deduction to Mr. A
First, the court ruled that A is not a monochromatic intraocular lens (contact lens) but a cataract surgery using an intraocular lens multifocal to replace glbades, contact lenses, etc. Correction of vision. "[1 9659004] In other words, if it is not treated in a timely manner, it can lead to complications such as glaucoma or cause a decrease in visual acuity.
The surgical treatment of these cataracts is in particular:
The use of contact lenses is essential, and the implanted lenses are implanted in the body to replace the functions of conventional lenses.
Even the doctor who treated treated cataracts
The court ruled that even if the conditions were fulfilled, the Saemaul funds would have sufficient reason to pay the proceeds to A.
In particular, the court said: "The effect of vision correction caused by the insertion of the focal IOL is only an incidental result of surgery for the treatment of cataract,
In the end, Saemaeul Safeguard has already decided to use other insurance companies, such as Samsung Medical Center,
In the event of future damages and wrongful damages, the Company will not responsible for any loss or damage resulting from the use of cosmetics or for therapeutic purposes.
Han Min-cheol, reporter [email protected]
