실손보험
갑상선고주파술에 대한 수술보험금 지급 요구

by 손찾사 손해사정사님 · 1 주전조회수 64

<div class="se-component se-text se-l-default" id="SE-a02553e7-844e-40f1-bc1b-fec0cbddabff" style="margin: 20px 0px 0px; padding: 0px; border: 0px; font-style: normal; font-weight: 400; font-size: medium; line-height: inherit; font-family: se-nanumgothic, &quot;\\B098눔고딕&quot;, nanumgothic, sans-serif, Meiryo; vertical-align: baseline; position: relative; color: rgb(85, 122, 116); text-align: left; text-indent: 0px; white-space: normal; background-color: rgb(255, 255, 255);"><div class="se-component-content" style="margin: 0px auto; padding: 0px 40px; border: 0px; font: inherit; vertical-align: baseline; max-width: 100%;"><div class="se-section se-section-text se-l-default" style="margin: 0px; padding: 0px; border: 0px; font: inherit; vertical-align: baseline;"><div class="se-module se-module-text" style="margin: 0px; padding: 0px; border: 0px; font: inherit; vertical-align: baseline;"><p class="se-text-paragraph se-text-paragraph-align-center " id="SE-b3b606e8-538a-4bd3-8313-9d82715ca70a" style="margin: 0px; padding: 0px; border: 0px; font-style: inherit; font-weight: inherit; font-size: 0px; line-height: 1.8; font-family: inherit; vertical-align: baseline; white-space: pre-wrap; text-align: left;"><span class="se-fs-fs19 se-ff-nanummaruburi " id="SE-c40eed13-984e-4cff-9ae8-999f9679a64f" style="margin: 0px; padding: 0px; border: 0px; font-style: inherit; font-weight: inherit; font-size: 19px; line-height: inherit; font-family: se-nanummaruburi, &quot;\\B9C8루부리&quot;, nanummaruburi, sans-serif, Meiryo; vertical-align: baseline;">오늘은 한국소비자원의 분쟁사례를 한번 살펴보겠습니다.</span></p><p class="se-text-paragraph se-text-paragraph-align-center " id="SE-b3ee27a9-9c16-432d-8cf5-6375bc3dca9e" style="margin: 0px; padding: 0px; border: 0px; font-style: inherit; font-weight: inherit; font-size: 0px; line-height: 1.8; font-family: inherit; vertical-align: baseline; white-space: pre-wrap; text-align: left;"><span class="se-fs-fs19 se-ff-nanummaruburi " id="SE-d86b2ebf-c87a-49d2-8dab-eb2a2f2e69fa" style="margin: 0px; padding: 0px; border: 0px; font-style: inherit; font-weight: inherit; font-size: 19px; line-height: inherit; font-family: se-nanummaruburi, &quot;\\B9C8루부리&quot;, nanummaruburi, sans-serif, Meiryo; vertical-align: baseline;">분쟁이 된 부분은 수술보험금인데, 그 중 수술에 대한 약관해석이 쟁점이 되는 사안입니다.</span></p><p class="se-text-paragraph se-text-paragraph-align-center " id="SE-ab62f313-512a-499f-8bd5-29bbcd89b013" style="margin: 0px; padding: 0px; border: 0px; font-style: inherit; font-weight: inherit; font-size: 0px; line-height: 1.8; font-family: inherit; vertical-align: baseline; white-space: pre-wrap; text-align: left;"><span class="se-fs-fs19 se-ff-nanummaruburi " id="SE-e67f6a6c-0937-4e4f-ad99-89b1730be837" style="margin: 0px; padding: 0px; border: 0px; font-style: inherit; font-weight: inherit; font-size: 19px; line-height: inherit; font-family: se-nanummaruburi, &quot;\\B9C8루부리&quot;, nanummaruburi, sans-serif, Meiryo; vertical-align: baseline;">신청인은 보험에 1999.10.11가입을 하고, 좌측 갑상선 결절로 고주파절제술을 시행 받은 후 보험회사(피신청인)에게 수술보험금을 지급받고, 우측 갑상선결절로 고주파술을 재차 시행 받은 후 보험회사(피신청인)에게 수술보험금을 청구하였으나, 거절당하였습니다.</span></p></div></div></div></div><div class="se-component se-image se-l-default" id="SE-81f32fe1-758d-4749-ae37-5002695ade4b" style="margin: 20px 0px 0px; padding: 0px; border: 0px; font-style: normal; font-weight: 400; font-size: medium; line-height: inherit; font-family: se-nanumgothic, &quot;\\B098눔고딕&quot;, nanumgothic, sans-serif, Meiryo; vertical-align: baseline; position: relative; color: rgb(85, 122, 116); text-align: left; text-indent: 0px; white-space: normal; background-color: rgb(255, 255, 255);"><div class="se-component-content se-component-content-fit" style="margin: 0px auto; padding: 0px 40px; border: 0px; font: inherit; vertical-align: baseline; max-width: 100%;"><div class="se-section se-section-image se-l-default se-section-align-center" style="margin: 0px auto; padding: 0px; border: 0px; font: inherit; vertical-align: baseline;"><div class="se-module se-module-image" style="margin: 0px; padding: 0px; border: 0px; font: inherit; vertical-align: baseline; position: relative; display: block; text-align: left;"><a class="se-module-image-link __se_image_link __se_link" data-linktype="img" data-linkdata="{&quot;id&quot; : &quot;SE-81f32fe1-758d-4749-ae37-5002695ade4b&quot;, &quot;src&quot; : &quot;https://postfiles.pstatic.net/MjAyMTEwMjFfMzIg/MDAxNjM0NzkxNzIzNzk1.n9Y-H2Kn1QB1w31wRFS58UDJpts4YQBU6Uy-sJPusdIg.40kaQJW_92P2WKgPIdST71r1zWa505nHqq5mgTVEgbsg.PNG.sonsp2020/image.png&quot;, &quot;originalWidth&quot; : &quot;1352&quot;, &quot;originalHeight&quot; : &quot;185&quot;, &quot;linkUse&quot; : &quot;false&quot;, &quot;link&quot; : &quot;&quot;}" area-hidden="true" style="margin: 0px; padding: 0px; border: 0px; font: inherit; vertical-align: baseline; position: relative; display: block;"><img src="https://postfiles.pstatic.net/MjAyMTEwMjFfMzIg/MDAxNjM0NzkxNzIzNzk1.n9Y-H2Kn1QB1w31wRFS58UDJpts4YQBU6Uy-sJPusdIg.40kaQJW_92P2WKgPIdST71r1zWa505nHqq5mgTVEgbsg.PNG.sonsp2020/image.png?type=w966" data-lazy-src="" data-width="886" data-height="121" alt="" class="se-image-resource egjs-visible e-rte-image e-imginline" style="border: 0px; margin: 0px; padding: 0px; font: inherit; vertical-align: top; position: relative; width: 886px;"></a></div></div></div></div><div class="se-component se-text se-l-default" id="SE-31b69259-e0ca-4e81-9028-672fee5e8d54" style="margin: 20px 0px 0px; padding: 0px; border: 0px; font-style: normal; font-weight: 400; font-size: medium; line-height: inherit; font-family: se-nanumgothic, &quot;\\B098눔고딕&quot;, nanumgothic, sans-serif, Meiryo; vertical-align: baseline; position: relative; color: rgb(85, 122, 116); text-align: left; text-indent: 0px; white-space: normal; background-color: rgb(255, 255, 255);"><div class="se-component-content" style="margin: 0px auto; padding: 0px 40px; border: 0px; font: inherit; vertical-align: baseline; max-width: 100%;"><div class="se-section se-section-text se-l-default" style="margin: 0px; padding: 0px; border: 0px; font: inherit; vertical-align: baseline;"><div class="se-module se-module-text" style="margin: 0px; padding: 0px; border: 0px; font: inherit; vertical-align: baseline;"><p class="se-text-paragraph se-text-paragraph-align-center " id="SE-e83fdf5d-ee96-4bdd-b1f6-60c5e018913f" style="margin: 0px; padding: 0px; border: 0px; font-style: inherit; font-weight: inherit; font-size: 0px; line-height: 1.8; font-family: inherit; vertical-align: baseline; white-space: pre-wrap; text-align: left;"><span class="se-fs-fs19 se-ff-nanummaruburi " id="SE-da3f08a5-04b1-4fd1-9145-52cd0f4c2027" style="margin: 0px; padding: 0px; border: 0px; font-style: inherit; font-weight: inherit; font-size: 19px; line-height: inherit; font-family: se-nanummaruburi, &quot;\\B9C8루부리&quot;, nanummaruburi, sans-serif, Meiryo; vertical-align: baseline;">당사자의 주장을 살펴보면, 신청인은 갑상선고주파술에 대한 수술보험금을 지급하고, 앞으로도 동일한 수술에 대하여 지급을 약속해달라는 것이며, 피신청인(보험회사)는 약관상 수술로 볼 수 없고, 금융감독원 분쟁조정사례에 따라 지급책임이 없다고 결정하였으나, 원만한 해결을 위하여 이번 수술에 한해서만 보험금을 지급하고, 앞으로는 지급하기 어려운 입장입니다.</span></p></div></div></div></div><div class="se-component se-image se-l-default" id="SE-0d111c79-1479-4957-8d17-74c8f610d267" style="margin: 20px 0px 0px; padding: 0px; border: 0px; font-style: normal; font-weight: 400; font-size: medium; line-height: inherit; font-family: se-nanumgothic, &quot;\\B098눔고딕&quot;, nanumgothic, sans-serif, Meiryo; vertical-align: baseline; position: relative; color: rgb(85, 122, 116); text-align: left; text-indent: 0px; white-space: normal; background-color: rgb(255, 255, 255);"><div class="se-component-content se-component-content-fit" style="margin: 0px auto; padding: 0px 40px; border: 0px; font: inherit; vertical-align: baseline; max-width: 100%;"><div class="se-section se-section-image se-l-default se-section-align-center" style="margin: 0px auto; padding: 0px; border: 0px; font: inherit; vertical-align: baseline;"><div class="se-module se-module-image" style="margin: 0px; padding: 0px; border: 0px; font: inherit; vertical-align: baseline; position: relative; display: block; text-align: left;"><a class="se-module-image-link __se_image_link __se_link" data-linktype="img" data-linkdata="{&quot;id&quot; : &quot;SE-0d111c79-1479-4957-8d17-74c8f610d267&quot;, &quot;src&quot; : &quot;https://postfiles.pstatic.net/MjAyMTEwMjFfMTY1/MDAxNjM0NzkxODMwNDg2.BMjLzDGNEEmsR2MRoSP3EXmnj1jFYNgFPcRu7gUoISUg.kowlYUSwoGxWTb9sOt04EdqXFHIQWVWNNU6XEcBRL7Eg.PNG.sonsp2020/image.png&quot;, &quot;originalWidth&quot; : &quot;1320&quot;, &quot;originalHeight&quot; : &quot;190&quot;, &quot;linkUse&quot; : &quot;false&quot;, &quot;link&quot; : &quot;&quot;}" area-hidden="true" style="margin: 0px; padding: 0px; border: 0px; font: inherit; vertical-align: baseline; position: relative; display: block;"><img src="https://postfiles.pstatic.net/MjAyMTEwMjFfMTY1/MDAxNjM0NzkxODMwNDg2.BMjLzDGNEEmsR2MRoSP3EXmnj1jFYNgFPcRu7gUoISUg.kowlYUSwoGxWTb9sOt04EdqXFHIQWVWNNU6XEcBRL7Eg.PNG.sonsp2020/image.png?type=w966" data-lazy-src="" data-width="886" data-height="127" alt="" class="se-image-resource egjs-visible e-rte-image e-imginline" style="border: 0px; margin: 0px; padding: 0px; font: inherit; vertical-align: top; position: relative; width: 886px;"></a></div></div></div></div><div class="se-component se-text se-l-default" id="SE-b8e4a02c-57d3-47a5-aa3f-a6edbb56fa53" style="margin: 20px 0px 0px; padding: 0px; border: 0px; font-style: normal; font-weight: 400; font-size: medium; line-height: inherit; font-family: se-nanumgothic, &quot;\\B098눔고딕&quot;, nanumgothic, sans-serif, Meiryo; vertical-align: baseline; position: relative; color: rgb(85, 122, 116); text-align: left; text-indent: 0px; white-space: normal; background-color: rgb(255, 255, 255);"><div class="se-component-content" style="margin: 0px auto; padding: 0px 40px; border: 0px; font: inherit; vertical-align: baseline; max-width: 100%;"><div class="se-section se-section-text se-l-default" style="margin: 0px; padding: 0px; border: 0px; font: inherit; vertical-align: baseline;"><div class="se-module se-module-text" style="margin: 0px; padding: 0px; border: 0px; font: inherit; vertical-align: baseline;"><p class="se-text-paragraph se-text-paragraph-align-center " id="SE-197a728a-5454-4e37-a616-764377f3bea0" style="margin: 0px; padding: 0px; border: 0px; font-style: inherit; font-weight: inherit; font-size: 0px; line-height: 1.8; font-family: inherit; vertical-align: baseline; white-space: pre-wrap; text-align: left;"><span class="se-fs-fs19 se-ff-nanummaruburi " id="SE-93148e1b-b700-4dba-aef1-291a20f92400" style="margin: 0px; padding: 0px; border: 0px; font-style: inherit; font-weight: inherit; font-size: 19px; line-height: inherit; font-family: se-nanummaruburi, &quot;\\B9C8루부리&quot;, nanummaruburi, sans-serif, Meiryo; vertical-align: baseline;">판단을 보면, 수술의 정의와 관련 판례, 금융감독원 및 국민건강보험의 고시 등을 종합하여, 수술보험금을 지급하는 것이 상당하라는 판단이며, 보험금을 지급하라는 결정이 정하여졌습니다.</span></p></div></div></div></div><div class="se-component se-image se-l-default" id="SE-3addc83c-12c9-469d-af98-0cff1714382b" style="margin: 20px 0px 0px; padding: 0px; border: 0px; font-style: normal; font-weight: 400; font-size: medium; line-height: inherit; font-family: se-nanumgothic, &quot;\\B098눔고딕&quot;, nanumgothic, sans-serif, Meiryo; vertical-align: baseline; position: relative; color: rgb(85, 122, 116); text-align: left; text-indent: 0px; white-space: normal; background-color: rgb(255, 255, 255);"><div class="se-component-content se-component-content-fit" style="margin: 0px auto; padding: 0px 40px; border: 0px; font: inherit; vertical-align: baseline; max-width: 100%;"><div class="se-section se-section-image se-l-default se-section-align-center" style="margin: 0px auto; padding: 0px; border: 0px; font: inherit; vertical-align: baseline;"><div class="se-module se-module-image" style="margin: 0px; padding: 0px; border: 0px; font: inherit; vertical-align: baseline; position: relative; display: block; text-align: left;"><a class="se-module-image-link __se_image_link __se_link" data-linktype="img" data-linkdata="{&quot;id&quot; : &quot;SE-3addc83c-12c9-469d-af98-0cff1714382b&quot;, &quot;src&quot; : &quot;https://postfiles.pstatic.net/MjAyMTEwMjFfMTEy/MDAxNjM0NzkyMDM4OTk5.M6zgTaV3HMF-3xrxd0GauqUifOrM9hyO7WKrUlVopoIg.z4uyLkF8Iu8mRLBtyZs0lJhr9GIce4CEHF07Di1jVM4g.PNG.sonsp2020/image.png&quot;, &quot;originalWidth&quot; : &quot;1332&quot;, &quot;originalHeight&quot; : &quot;737&quot;, &quot;linkUse&quot; : &quot;false&quot;, &quot;link&quot; : &quot;&quot;}" area-hidden="true" style="margin: 0px; padding: 0px; border: 0px; font: inherit; vertical-align: baseline; position: relative; display: block;"><img src="https://postfiles.pstatic.net/MjAyMTEwMjFfMTEy/MDAxNjM0NzkyMDM4OTk5.M6zgTaV3HMF-3xrxd0GauqUifOrM9hyO7WKrUlVopoIg.z4uyLkF8Iu8mRLBtyZs0lJhr9GIce4CEHF07Di1jVM4g.PNG.sonsp2020/image.png?type=w966" data-lazy-src="" data-width="886" data-height="490" alt="" class="se-image-resource egjs-visible e-rte-image e-imginline" style="border: 0px; margin: 0px; padding: 0px; font: inherit; vertical-align: top; position: relative; width: 886px;"></a></div></div></div></div><div class="se-component se-text se-l-default" id="SE-88d5ceb9-8e35-4aa8-8da4-7f54f02f4ea4" style="margin: 20px 0px 0px; padding: 0px; border: 0px; font-style: normal; font-weight: 400; font-size: medium; line-height: inherit; font-family: se-nanumgothic, &quot;\\B098눔고딕&quot;, nanumgothic, sans-serif, Meiryo; vertical-align: baseline; position: relative; color: rgb(85, 122, 116); text-align: left; text-indent: 0px; white-space: normal; background-color: rgb(255, 255, 255);"><div class="se-component-content" style="margin: 0px auto; padding: 0px 40px; border: 0px; font: inherit; vertical-align: baseline; max-width: 100%;"><div class="se-section se-section-text se-l-default" style="margin: 0px; padding: 0px; border: 0px; font: inherit; vertical-align: baseline;"><div class="se-module se-module-text" style="margin: 0px; padding: 0px; border: 0px; font: inherit; vertical-align: baseline;"><p class="se-text-paragraph se-text-paragraph-align-center " id="SE-fbefd260-9e7c-4e29-b1f6-6d79fde07c66" style="margin: 0px; padding: 0px; border: 0px; font-style: inherit; font-weight: inherit; font-size: 0px; line-height: 1.8; font-family: inherit; vertical-align: baseline; white-space: pre-wrap; text-align: left;"><span class="se-fs-fs19 se-ff-nanummaruburi " id="SE-49da4a87-1080-48ed-b227-a3c282f5863d" style="margin: 0px; padding: 0px; border: 0px; font-style: inherit; font-weight: inherit; font-size: 19px; line-height: inherit; font-family: se-nanummaruburi, &quot;\\B9C8루부리&quot;, nanummaruburi, sans-serif, Meiryo; vertical-align: baseline;">손찾사에 올라오는 질문글을 보면, 당연히 지급해야 될 것인데도 불구하고, 지급하지 않는 사례가 많이 있으며, 이번 사건도 1회에는 수술보험금을 지급을 하였는데, 2회에는 수술이 아니므로 보험금을 지급할 수 없다는 보험회사의 논리를 이해가 잘 가지 않는 것이 사실입니다. </span></p><p class="se-text-paragraph se-text-paragraph-align-center " id="SE-fbefd260-9e7c-4e29-b1f6-6d79fde07c66" style="margin: 0px; padding: 0px; border: 0px; font-style: inherit; font-weight: inherit; font-size: 0px; line-height: 1.8; font-family: inherit; vertical-align: baseline; white-space: pre-wrap; text-align: left;"><span class="se-fs-fs19 se-ff-nanummaruburi " style="margin: 0px; padding: 0px; border: 0px; font-style: inherit; font-weight: inherit; font-size: 19px; line-height: inherit; font-family: se-nanummaruburi, &quot;\\B9C8루부리&quot;, nanummaruburi, sans-serif, Meiryo; vertical-align: baseline;"><br></span></p><p class="se-text-paragraph se-text-paragraph-align-center " id="SE-fbefd260-9e7c-4e29-b1f6-6d79fde07c66" style="margin: 0px; padding: 0px; border: 0px; font-style: inherit; font-weight: inherit; font-size: 0px; line-height: 1.8; font-family: inherit; vertical-align: baseline; white-space: pre-wrap; text-align: left;"><span class="se-fs-fs19 se-ff-nanummaruburi " style="margin: 0px; padding: 0px; border: 0px; font-style: inherit; font-weight: inherit; font-size: 19px; line-height: inherit; font-family: se-nanummaruburi, &quot;\\B9C8루부리&quot;, nanummaruburi, sans-serif, Meiryo; vertical-align: baseline;"><br></span></p><p class="se-text-paragraph se-text-paragraph-align-center " id="SE-fbefd260-9e7c-4e29-b1f6-6d79fde07c66" style="margin: 0px; padding: 0px; border: 0px; font-style: inherit; font-weight: inherit; font-size: 0px; line-height: 1.8; font-family: inherit; vertical-align: baseline; white-space: pre-wrap; text-align: left;"><span class="se-fs-fs19 se-ff-nanummaruburi " style="margin: 0px; padding: 0px; border: 0px; font-style: inherit; font-weight: inherit; font-size: 19px; line-height: inherit; font-family: se-nanummaruburi, &quot;\\B9C8루부리&quot;, nanummaruburi, sans-serif, Meiryo; vertical-align: baseline;">이처럼 보험회사에서 당연히 챙겨줄 것이라고 생각하지말고, 보험분쟁이 발생되면 관련기관에도 도움을 받으시고, 무료로 상담이 가능한 손찾사에서도 도움을 받으시기를 바랍니다.</span></p></div></div></div></div>

    #갑상선 #고주파술 #보험분쟁 #손해사정 #손해사정사 #수술보험금

상해·사망·후유장해 /질병·암진단비
손찾사 손해사정사

목록