• Journal of the Korean Institute of Navigation
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• v.18 no.3
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• pp.51-79
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• 1994

Section 55 (1) of the Marine Insurance Act 1906 states that the insurer is liable for any loss proximately caused by a peril insured against but is not liable for any loss not proximately caused by a peril insured against. It is, therefore, essential to determine whether it is to be recoverable under the Marine Insurance Policy attaching the Institute Cargo or Hull Clauses. But a number of important losses are excluded from the policy by subsection 2 of the same section, unless the policy otherwise provides, although these losses are proximate causes of them. The purpose of this study is to investigate the meaning of proximate cause and excluded losses in the Act. The method of this study is a literature survey. In summary, (1) if the loss is considered to have been proximately caused by a certain peril, and the peril is insured against, the claim is recoverable, (2) if there are different causes resulting in separate losses, the claims recoverable will be those due to insured perils, (3) when the effective cause of the loss is established, remote causes can be ignored, (4) when causes of loss are combined, the claim is recovera-ble if the cause which is proximate in efficiency is an insured peril, (5) if there are two causes, equal in efficiency, the loss is recoverable if one of the causes is an insured peril, but always providing the other cause is merely an uninsured peril rather than a specific exclusion, (6) although certain losses are exclu-ded by section 55 (2) of the Act, with the exception of wilful misconduct of the insured, it is permitted for provision to be made in the policy to widen the terms to include such losses.

• Journal of Korea Port Economic Association
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• v.20 no.2
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• pp.73-87
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• 2004

The purpose of this paper is to setup reasonable criterion for underwriters to reimburse the expenses of suing and labouring incurred by assured, using game theory. As for the upper limit for the reimbursement, MIA and ICC do not mention at all but stipulate that proper and reasonable expenses shall be reimbursed, while ITC-Hulls set the amount insured as the upper limit to compensate the sum of expenses and damage loss. And as for failed measures of averting and minimizing loss, MIA and ICC do not mention either, while ITC-Hulls stipulates underwriters shall compensate the expenses and damage loss within the amount insured. The main results of this paper are as follows: First, it is for the benefit of underwriters to reimburse the expenses incurred to take such reasonable measures to avert or minimizing a loss which would be recoverable under the insurance. Second, the expenses of single measure should not be above the amount insured. Third, even if the measures failed, the expense should be reimbursed if it is less than the expected value of the subject-matter insured that could be recovered by the measures. Last, if the measures are taken several times individually, even if the sum of expenses might be above the amount insured, it should be reimbursed.

• Proceedings of the Korean Operations and Management Science Society Conference
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• 1992.04b
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• pp.403-412
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• 1992

This note examines a situation where a risk-neutral insurer and a risk-averse individual (prospective insured) negotiate to reach an arbitration point of the price of insurance over the terms of an insurance contract in order to maximize their respective self-interests. The situation is modeled as a Nash bargaining problem. We analyze the dependence of the price of insurance, which is determined by the Nash solution, on the parameters such as the size of insured loss, the probability of a loss, the degree of risk-aversion of the insured, and the riskiness of loss distribution.

• THE INTERNATIONAL COMMERCE & LAW REVIEW
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• v.55
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• pp.209-240
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• 2012

Since the age of Lord Mansfield, who laid the foundation of the modern English insurance contract law in the second part of the 18th century, English insurance law has developed a unique rule of warranty. Lord Mansfield adopted very different approach and afforded such a strict legal character to insurance warranty, because the promise, given by the insured, played an important role for the insurer to assess the scope of the risk insured at that time. It is still important that the insured keep his promises strictly to the insurer under the insurance contract, but legal environments have changed dramatically since the times of Lord Mansfield. English Law Commission proposed some proposals for reforming the warranty regime to reflect the changes of legal environment in CP 2007. This article is, therefore, designed to examine the proposals and consider their legal and practical implications. The proposals of Law Commission is summarized as following. First, in CP 2007, Law Commission made two principal proposals for reform of the law on warranty. The first is that the insurer should not be entitled to rely on a breach of warranty unless the insured has been provided with a witten statement of what they have undertaken under warranty. The second is that the insurer should not be entitled to reject a claim on the ground that the insured has breached a warranty unless there was a causal connection between the breach and the loss. Secondly, for consumer insurance, the rule requiring a causal connection would be mandatory, whereas for business insurance, it would be possible for the parties to agree on the effect a breach of warranty should have, provided they use clear language to express their intentions. Thirdly, where the insured contracted on the insurer's written standard terms of business, some statutory controls would be afforded to the contract to ensure that the cover was not substantially different from what the insured reasonably expected. Finally, Law Commission propose that a breach of warranty give the insurer the right to terminate the contract, rather than automatically discharging it from liability, but (unless otherwise agreed) only if the breach has sufficiently serious consequences to justify termination under the general law of contract. Having evaluated the proposals of the Law Commission and considered their legal and practical implications, it is quite clear that the proposed rule interfere with freedom of contract and create legal uncertainty. But change can not made without any victims, so Law Commission's attempt to change severe and injust aspects of the warranty regime would be very welcomed and respected.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.34 no.2
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• pp.38-52
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• 2021

Objectives : The purpose of this study is to analyze the use of insured herbal extracts and Korean medicinal treatments, which are mainly used to treat allergic rhinitis in Korean medicine. Methods : Among all HIRA(Health Insurance Review and Assessment Service) claims data in 2016, we included all statements that included J30(vasomotor and allergic rhinitis) or a subcategory of J30(J30.0, J30.1, J30.2, J30.3, or J30.4) as the main disease, using the Korean Standard Classification of Diseases(KCD-7). This study analyzed the most frequently used insured herbal extracts and Korean medicinal treatments for allergic rhinitis in Korean medicine. We performed a frequency analysis on subgroups based on treatment type(inpatient or outpatient), sex, age, insurance type, and medical institution type. Results : The result shows the 10 most frequently used insured herbal extracts and Korean medicinal treatments for allergic rhinitis. The total number of insured herbal extracts prescriptions was 82,533, and the most commonly prescribed insured herbal extracts was socheongryong-tang(35,131 prescriptions), followed by hyeonggaeyeongyo-tang(18,157 prescriptions), samsoeum(6,257 prescriptions), and galgeun-tang(4,465 prescriptions). The total number of Korean medicinal treatments prescriptions was 1,878,541, of which the most common Korean medicinal treatments was acupuncture(922,977 prescriptions), followed by moxibustion(372,120 prescriptions), cupping(242,094 prescriptions), and segmental acupuncture(161,553 prescriptions). Conclusions : It is expected that the results of this study can be used as a basis for establishing the priorities of evidence-based clinical research topics in the field of Korean medicine and making health care policy decisions to strengthen coverage in the future.

• The Journal of the Korean life insurance medical association
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• v.1 no.1
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• pp.110-118
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• 1984

The serum total cholesterol levels were measured by Rosenthal modified method for the insured persons who had passed the medical examination in a life insurance company, Seoul. The sera were obtained from 1,878 adults, 626 males and 1,252 fermales, from sep 1980 to Dec. 1981. The results obtained in the measurement were as follows; 1. The mean and standard deviation of serum cholesterol level in the healthy insured persons were $163{\pm}$ in male, and $157{\pm}24mg%$ in female. The difference of the values between male and female showed statistical signifi- (p<0.01). With regard to sex and age differences, female were significantly higher than male in the 10's, and male were higher than female in the 20's and 50's between both sexes. 2. The cholesteol of male was gradully increased about 12mg% according to the increase of every 10-year interval, but no increase was observed from the 40's to the 50's. The cholesterol level of female was higher in the 10's than in the 20's, and was increased gradually from the 20's to the 50's. 3. No significant difference in serum total cholesterol levels between the insured persons and other normal Korean groups was observed; the frequency distribution of the cholestrol level for the population showed normal distribution.

• Health Policy and Management
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• v.27 no.4
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• pp.336-346
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• 2017

Background: Due to the asymmetry of information and knowledge and the power of bureaucrats and medical professionals, it is not easy for citizens to participate in health care policy making. This study analyzes the case of the insured organization participating in the Health Insurance Policy Committee (HIPC) and provides a basis for discussing methods and conditions for better public participation. Methods: Qualitative analysis was conducted using the in-depth interviews with the participants and document data such as materials for HIPC meetings. Semi-structured interviews were conducted with purposively sampled six participants from organizations representing the insured in HIPC. The meanings related to the factors affecting participation were found and categorized into major categories. Results: The main factors affecting participating in the decision making process were trust and cooperation among the participants, structure and procedure of governance, representation and expertise of participants, and contents of issues. Due to limited cooperation, participants lacked influence in important decisions. There was an imbalance in power due to unreasonable procedures and criteria for governance. As the materials for meetings were provided inappropriate manner, it was difficult for participants to understand the contents and comments on the meeting. Due to weak accountability structure, opinions from external stakeholders have not been well received. The participation was made depending on the expertise of individual members. The degree of influence was different depending on the contents of the issues. Conclusion: In order to meet the values of democracy and realize the participation that the insured can demonstrate influence, it is necessary to have a fair and reasonable procedure and a sufficient learning environment. More deliberative structure which reflects citizen's public perspective is required, rather than current negotiating structure of HIPC.

• Korean Journal of Health Education and Promotion
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• v.6 no.1
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• pp.11-21
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• 1989

Among disease prevention methods, health education is an excellent and effective method low cost. However, enforcing health education has the following limitations: there is little health education for the supported, health education disregards the characteristics of those educated, education materials are not specified and published satistactorily, and so on. This study suggests systemic health education planning to the Korea Medical Insurance Corporation. The special methods are as follows: 1. Health education for primary prevention a. We educate the insured who are judged to be normal by the results of health screening, dividing them into three groups:completely healthy status, emotionally disturbed status, and early pathologic status. b. We educate the insured characteristically according to occupational disease. c. In an advanced sense, we educate the insured according to their health condition and occupational status. 2. Health education for secondary and tertiary prevention We educate the insured who are judged to be inn a risk group or to be disease group according to the results of health screening. a. Health education for the risk group By health education on elimination of the risk factors, the risk group can be prevented from the disease. b. Health education for the disease group By health education on the therapeutic process and the method of rehabilitation, the disease group can return to the previous state. We conclude that: 1). Reimbursement for preventive activities{health interview, health education) must be realized. 2) A special organization for health education must be established. 3) All of the insured must be educated and managed during their lifetime by a new special organization.

• The Journal of Society for e-Business Studies
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• v.14 no.1
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• pp.121-142
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• 2009

In this study, the marketing activity of medical service providers via Internet was considered as a new technology for approaching this problem and the consumers' acceptance of the new marketing activity was analyzed through the TAM (Technology Acceptance Model) path analysis. The path analysis was conducted for the non-insured medical departments and the insured medical departments. The path analysis revealed that the consumers felt usefulness of the marketing activity of non-insured medical service providers, which means that they have intention to accept and are satisfied with the Internet marketing activity provided by non-insured medical service departments. On the other hand, in the case of insured medical service, it was clarified that the 'easy of use' preferentially affects the users' intention of accepting the marketing activity rather than 'usefulness'.

• The Korean Society of Law and Medicine
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• v.10 no.2
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• pp.287-307
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• 2009

A person is injured in car accident caused by his/her slight negligence except he / she causes accident by his / her willfulness or gross negligence. Because the National Health Insurance Corporation (hereinafter called "Corporation") shall not provide any insurance benefit "when he has intentionally or through gross negligence caused a criminal conduct or intentionally contributed to the occurrence of an accident" referred to in Article 48 (1) 1 of the National Health Insurance Act. So, if he / she is insured by his / her own bodily injury coverage, he / she can be compensated for his / her medical expenses. The injured have the rights to file either National Health Insurance claim and Automobile Insurance claim but there is no clear and definite adjustment clause. The claim disputes between National Health Insurance (hereinafter called "NHI") and Automobile Insurance (hereinafter called "AI") in the own bodily injury coverage makes some problems. Firstly, there are some differences in co-payments which he / she chooses between NHI and AI. Profit per a patient is higher in the NHI than in the AI. Secondly, it can provoke criticism that people shall unnecessarily pay double contributions. Lastly, it can raise moral hazards. For example, if he / she can cover the compensations when the insured receives the compensations from his / her insurer, the Corporation can be claimed by medical care institution payment of the health care benefit costs. In conclusion, first of all, to improve the national health and preserve the insured's rights the Corporation shall keep notice these facts.