• The Korean Society of Law and Medicine
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• v.16 no.2
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• pp.87-130
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• 2015

In a case in which National Health Insurance Corporation (NHIC) pays medical care expenses to a victim of a traffic accident resulting in injury or death and asks the assailant for compensation of its share in the medical care expenses, as the precedent treats the subrogation of a claim set by National Health Insurance Act the same as that set by Industrial Accident Compensation Insurance Act, it draws the range of its compensation from the range of deduction, according to the principle of deduction after offsetting and acknowledges the compensation of all medical care expenses borne by the NHIC, within the amount of compensation claimed by the victim. However, both the National Health Insurance Act and the Industrial Accident Compensation Insurance Act are laws that regulate social insurance, but medical care expenses in the National Health Insurance Act have a character of 'an underinsurance that fixes the ratio of indemnification,' while insurance benefit on the Industrial Accident Compensation Insurance Act has a character of full insurance, or focuses on helping the insured that suffered an industrial accident lead a life, approximate to that in the past, regardless of the amount of damages according to its character of social insurance. Therefore, there is no reason to treat the subrogation of a claim on the National Health Insurance Act the same as that on the Industrial Accident Compensation Insurance Act. Since the insured loses the right of claim acquired by the insurer by subrogation in return for receiving a receipt, there is no benefit from receiving insurance in the range. Thus, in a suit in which the insured seeks compensation for damages from the assailant, there is no room for the application of the legal principle of offset of profits and losses, and the range of subrogation of a claim or the amount of deduction from compensation should be decided by the contract between the persons directly involved or a related law. Therefore, it is not reasonable that the precedent draws the range of the NHIC's compensation from the principle of deduction after offsetting. To interpret Clause 1, Article 58 of the National Health Insurance Act that sets the range of the NHIC's compensation uniformly and systematically in combination with Clause 2 of the same article that sets the range of exemption, if the compensation is made first, it is reasonable to fix the range of the NHIC's compensation by multiplying the medical care expenses paid by the ratio of the assailant's liability. This is contrasted with the range of the Korea Labor Welfare Corporation's compensation which covers the total amount of the claim of the insured within the insurance benefit paid in the interpretation of Clauses 1 and 2, Article 87 of the Industrial Accident Compensation Insurance Act. In the meantime, there are doubts about why the profit should be deducted from the amount of compensation claimed, though it is enough for the principle of deduction after offsetting that the precedent took as the premise in judging the range of the NHIC's compensation to deduct the profit made by the victim from the amount of damages, so as to achieve the goal of not attributing profit more than the amount of damage to a victim; whether it is reasonable to attribute all the profit made by the victim to the assailant, while the damages suffered by the victim are distributed fairly; and whether there is concrete validity in actual cases. Therefore, the legal principle of the precedent concerning the range of the NHIC's compensation and the legal principle of the precedent following the principle of deduction after offsetting should be reconsidered.

• Proceedings of the Korea Institute of Fire Science and Engineering Conference
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• 2013.11a
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• pp.187-188
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• 2013

실화책임법에 의하면, 화재 발생 시 실화자는 중대한 과실이 아닌 경우 경제적요건, 화재원인 등에 따라 손해배상액의 경감을 청구할 수 있다. 손해배상액의 경감의 여부는 실화피해자의 화재복구에 영향을 끼치게 된다. 화재발생 시 실화자가 손해배상경감청구에 책임을 입증하여야한다. 그리고 실화피해자의 원활한 화재복구를 위해 실화자의 화재보험가입의 의무와 계약자의 안전한 보호 및 보험사의 책임 일부를 분산하는 제도인 재보험의 선택적 가입을 규정하고자 한다.

• The Journal of the Korean life insurance medical association
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• v.29 no.2
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• pp.8-17
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• 2010

• Journal of Korea Port Economic Association
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• v.31 no.2
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• pp.41-53
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• 2015

In Paracomon Inc. v. Telus Communication, Realice's anchor became entangled with a working fiber-optic submarine cable during its voyage and are presentative of the shipowner(the captain) cut the cable. The owner of the cable brought a claim for the repair cost against the shipowner. The shipowner then advanced a third party claim against a liability insurance underwriter. The Supreme Court of Canada (SCC) held that the shipowner was entitled to limit its liability under the 1976 Convention on the Limitation of Liability for Maritime Claims. The SCC also ruled that even though the misdeed of the shipowner was insufficient to break its right to limitation of liability, its wrongdoing constituted willful misconduct under the 1993 Canada Marine Insurance Act, allowing the underwriter to deny coverage for the incident. Thecasewasthefirsttoaddresstheinterrelationship between the shipowner's right to limit liability under the international convention regime and the availability of liability insurance with respect to such limited liability. This study analyzes the reasoning behind the SCC's judgment and evaluates the appropriateness of this court's decision based on the current maritime industry as well as prevailing maritime law. It concludes that the SCC's decision to declare that the shipowner retained the right to limit its liability is appropriate under the Limitation Convention (1976). However, its declaration that the liability insurer was discharged from liability is not correct in due consideration of the common recognition in the maritime industry, the intended purpose of a third party's right against the liability insurer, and the adoption process of the conduct barring limitation. Based on the SCC's decision, this study finally reviews the issue of the shipowner's right to limit and the coverage of the liability insurer in the Sewol case (2014).

• Information Systems Review
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• v.5 no.1
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• pp.49-60
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• 2003

The purpose of this study is to empirically and practically verify the applicability of visualization data mining tool in detecting real-word insurance frauds that are now emerged as one of the most serious problems socially and economically. For the verification, Analyst's Notebook by i2, which has been known as the most effective visualization data mining tool, was adopted. With Analyst's Notebook, fraud-probable insurance transactions from a very large insurance claims are selected and then substantiation for insurance frauds are attempted. The results show that Analyst's Notebook not only detects insurance fraud transactions from a vast number of insurance claims, but is also able to pinpoint organized crime group by associating one fraud transaction to another fraud transaction. Therefore, it is safe to conclude that visualization data mining is very effective in detecting false transactions and crime behaviors including insurance fraud.

• Journal of the Korean hospital association
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• v.18 no.9 s.167
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• pp.46-52
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• 1989

• Journal of the Korean hospital association
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• v.16 no.10 s.148
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• pp.9-13
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• 1987

• Journal of the Health Care and Life Science
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• v.11 no.1
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• pp.11-23
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• 2023

In this study, a practice model that can improve healthcare information management ability using Chat GPT and SQL was studied. For SQL utilization, learners were asked to use Chat GPT to easily access the database and write SQL for data extraction. For the contents analyzed in the claims database, the sum of insurance claim amount, insurance claim amount by treatment item, claim details corresponding to a specific amount, other diagnosis names of specific prescription patients, examination details of specific diagnosis names, and total amount by item were calculated. As a result of executing SQL statements written for each subject in Chat GPT, it was confirmed that the analysis contents were the same. It is believed that the use of ChatGPT as progressed in this study will contribute to improving the ability of healthcare data management to increase accuracy and efficiency in database management and analysis work, rather than simply simplifying or automating tasks.

• The Korean Society of Law and Medicine
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• v.14 no.2
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• pp.11-41
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• 2013

Article 347 of criminal law provides the act of deceiving another, thereby taking property or obtaining pecuniary advantage from another. On the other hand, the concepts of fraud and abuse are confused upon interpretation since the definition in National Healthcare Insurance Law is unclear, and it affects closely to the administrative measures such as surcharge levy by the period of inspection, therefore, the disputes continue in the forms of formal objection, administrative ruling and administrative litigation. This study aims to look over the legal problems on application of criminal fraud toward the abuse of 'Paid Medical Expenses(Article 57, Sections 1 and 4 of the National Health Insurance Act)'. The main issues are concept of abuse(Article 57, Sections 1 and 4 of the National Health Insurance Act), the problems of Directions of Health-Welfare Ministry on aspect of 'Nullum crimen sine lege' Principles, the proper sentenc-ing guidelines of fraud.

• The Korean Journal of Applied Statistics
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• v.25 no.1
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• pp.81-87
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• 2012

A continuous time risk model is considered, where the premium rate is constant and the claims form a compound Poisson process. We assume that an injection is made, which is an immediate increase of the surplus up to level u > 0 (initial level), when the level of the surplus goes below ${\tau}$(0 < ${\tau}$ < u). We derive the formula of the ruin probability of the surplus by establishing an integro-differential equation and show that an explicit formula for the ruin probability can be obtained when the amounts of claims independently follow an exponential distribution.