• The Journal of the Korean life insurance medical association
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• v.24
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• pp.97-117
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• 2005

Internally Korean insurance market is that whole life products' growth are becoming slowdown that's why new insurance products have appeared on the market in consideration of consumer's needs recently. Externally domestic insurance market competitions has drifted from insurance industry to whole financial industry since bankasurance started. Life insurance companies should open up a new market to survive from severe competitions. Worksite marketing can be an alternative. An insurer make arrangements with an employer about an insurance terms which an insurer offers in Worksite marketing. Then eligible individuals enroll in the plans at their own discretion and pay 100 percent of the premium for coverage through payroll deductions. An employer doesn't need to pay extra money for additional benefit but can raise employee's loyalty and satisfaction of company through worksite marketing. An employee can be covered at discounted premium rate and less strict underwriting guidelines to an insurer compared to individual insurance. In developed countries specially U.S insurance market, Worksite marketing is getting very popular and growing rapidly due to the advantages. Worksite marketing has both individual insurance characters and group insurance characters. Individual insurance characters are that employees enroll in the plans at their own discretion and pay 100 percent of the premium for coverage. Group insurance characters are that actively at work and participation etc. An insurer have to reflect these two characters on Worksite marketing when an insurance company work out a plan for developing products and underwriting guidelines. When an insurer devise worksite products, one should consider participation level which means percentage of eligible employees participating. Participation is related to anti-selection. As we know underwriting is essential for every kind of insurance, especially underwriting plays major role in worksite marketing. We can see that in the below. Firstly, it has a function in calculation of premium rate. When calculate premium rate for worksite products underwriters have to estimate expected participation level and risk factors. So underwriters and acturies keep in close contact with each other. Secondly, underwriting methods are important. When an insurer underwrite worksite products, there are three kinds of underwriting methods. These are Simplified issue underwriting, Full underwriting and Guaranteed issue underwriting. Simplified issue underwriting typically requires no medical examination, but usually requires supplying satisfactory answers to one or several health and/or lifestyle questions. Full underwriting requires a complete medical history questionnaire that may further require an exam. Guaranteed issue underwriting means that coverage is issued without the employee having to provide evidence of insurability. When insurer set the GI limit are usually based on the type of industry, number of eligible employees, the average amount of coverage and participation level. In addition to insurer should have a clear definition of eligible employee on the insurance provision and application form. It will minimize possibility of trouble claims and anti-selection. An insurer also establish preexisting condition exclusion and special guidelines for late entrants. When an insurer introduce Worksite marketing to Korean insurance market, an insurer has to examine market research to analyze potential market and strategy of sales most of all. Also an insurer should review real situation of the U.S, England and Japanese market etc. There are a lot of new technologies about worksite marketing process that an insurer should learn. When an insurer consider many things which we explained it can be a real alternative.

• Journal of Preventive Medicine and Public Health
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• v.22 no.2 s.26
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• pp.259-267
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• 1989

The objective of this study was to analyze the influence of the hospital and insurer in causing delayed reimbursement of medical insurance benefits. We analyzed major variables at three different sized hospitals to examine the effect of the hospital and insurer using the two-way ANOVA method. The results were as follows: 1. The time interval between claim by hospitals and payment of the benefit was statistically different according to hospital in both admission and outpatient care. 2. The time needed by the insurer for investigating the claims was statistically different according to hospital and insurer in both admission and outpatient care. There was interaction between the hospital and insurer factors in outpatient care. 3. Although there was interaction between the hospital and insurer factors in admission care, the time interval between claim and payment was statistically different. In outpatient care, the payment interval between claim and payment was also statistically different according to the hospital and insurer.

• Health Policy and Management
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• v.30 no.2
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• pp.151-163
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• 2020

This study reviewed primary care purchasing issues of the Indonesian single-insurer, BPJS-K, in the context of triangular power relations between the government, the insurer, and the providers, and considered its challenges of purchasing as the national single-insurer. Some literature reviews and interviews with Indonesian stakeholders and residents were used to describe the historical and social contexts of Indonesian healthcare and social health insurance systems especially focusing legal and institutional status of BPJS-K and primary care provision and delivery conditions in remote areas. Though BPJS-K directly belongs to the presidential office of Indonesia, it has limited power in terms of purchasing as a single insurer. Mainly it was due to the lack of primary care resources, Ministry of Health's strong power as the regulator and provider, and BPJS-K's powerlessness against monitoring and quality of care assessment. Ambiguous accountability was another issue among the insurer and the Ministry of Health. This created confusions in primary care provision. It is suggested that each agencies' accountability should be obvious in terms of legal, political, and social contexts.

• THE INTERNATIONAL COMMERCE & LAW REVIEW
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• v.76
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• pp.125-145
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• 2017

Where an insurer has unreasonably refused to pay a claim or paid it after unreasonably delay, the existing law in England does not provide a remedy for the insured. Accordingly, the insured is not entitled to damages for any loss suffered as a result of the insurer's unreasonable delay. This legal position differs from the law in Scotland and most major common law jurisdictions. LC thought that the legal position in England is anomalous and out of step with general contractual principles. LC considered that a policyholder should have a remedy where an insurer has acted unreasonably in delaying or refusing payment of claim, and, therefore, recommended a statutory implied term in every insurance that the insurer will pay sums due within a reasonable time and breach of that term should give rise to contractual remedies, including damages. More detailed recommendations of LC are as followings. First, it should be an implied term of every insurance contract that, where an insured makes a claim under the contract, the insurer must pay sums due within a reasonable time. Secondly, a reasonable time should always include a reasonable time for investigating and assessing a claim. Although a reasonable time will depend on all the relevant circumstances, for example, the following things may need to be taken into account, that is, (1) the type of insurance, (2) the size and complexity of the claim, (3) compliance with any relevant statutory rules or guidance, and (4) factors outside the insurer's control. Thirdly, if the insurer can show that it had reasonable grounds for disputing the claim(whether as to pay or not, or the amount payable), the insurer does not breach the obligation to pay within a reasonable time merely by failing to pay the claim while the dispute is continuing. In those circumstances, the conduct of the insurer in handling the dispute may be a relevant factor in deciding whether the obligation was breached and, if so, when. Fourthly, Normal contractual remedies for breach of contract should be available for breach of the implied term to pay sums due within a reasonable time. Finally, In non-consumer insurance contracts, the insurer should be permitted to exclude or limit its liability for breach of the obligation to pay sums due within a reasonable time, unless such breach was deliberate or reckless, and such an insurer's right to contract out will be subject to satisfying the transparency requirements.

• Journal of the Korean Institute of Navigation
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• v.15 no.3
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• pp.53-72
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• 1991

The marine cargo insurance compensates the cargo losses that happened during navigation . at the early days of the marine insurance, the insurer inclusively covered all risks that happended during navigation. But since the feature of the risks have been changed due to the development of the shipbuilding technique and commerce, the insurer could not bear all of the perils inclusively. So, the insurer have taken the limitation of the risks insured and the losses paid by exclusion clauses. Therefore, the purpose ;of this paper is to compare the exclusion clauses in the new Institute Cargo Clause (hereafter I.C.C.) with those in the former I.C.C.(all risks, F.P.A) and to make clear the scope of insurer's liability through the theoretical interpretation, clarification of various excluded risks in laws and clauses relating to marine cargo insurance. From what 1 mentioned above, 1 conclude that through continued study on the exclusion sin the new I.C.C., we should organize and establish a system which will satisfy both underwriters and the assured in making the application and the effectiveness equal for each party.

• THE INTERNATIONAL COMMERCE & LAW REVIEW
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• v.47
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• pp.337-353
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• 2010

On payment of the insurance money the insurer is entitled to be subrogated to all right and remedies of the assured in respect of the interest insured in so far as he has indemnified the insured. The purpose of subrogation is to prevent the assured from recovering more than once for the same loss, e.g. where goods are lost owing to a collision, the assured cannot claim the insurance money from the insurer and then sue the owners of the ship that negligently caused the collision. Under the doctrine of subrogation the right to sue owners of the negligent ship passes from the assured to the insurer on payment of the insurance money. The insurer is subrogated to the assured 'rights against the carrier under the contract of carriage. To defeat the cargo underwriters' subrogation righters, the carriers inserted in their B/L a clause allowing the carriers to have the "benefit of the shipper's insurance. But, in the Hague Rules, Hamburg Rules, Rotterdam Rules, its makes void any clause that assigns a benefit of insurance of the goods in favour of the carrier. In practice the insurer asks the assured to sign a letter of subrogation and retains the documents in order to prosecute the rights subrogated to him.

• Journal of applied mathematics & informatics
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• v.28 no.3_4
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• pp.863-875
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• 2010

In this paper we apply the martingale approach, which has been widely used in mathematical finance, to investigate the optimal investment problem for an insurer under the criterion of mean-variance. When the risk and security assets are described by the L$\acute{e}$vy processes, the closed form solutions to the maximization problem are obtained. The mean-variance efficient strategies and frontier are also given.

• THE INTERNATIONAL COMMERCE & LAW REVIEW
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• v.71
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• pp.171-194
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• 2016

In the UK, the legal principle for the duty of disclosure established in Carter v Boehm case was codified in the Marine Insurance Act 1906("MIA"). The duty of disclosure under the MIA is the pre-contractual duty by the insured and therefore, the insured should disclose the every material circumstance that would influence a prudent insurer's judgement. If the insured violates the duty of disclosure, the insurer is entitled to avoid the insurance contract, regardless of whether there was the deliberate or reckless breach, which is unfavorable to the insured. The Law Commission reviewed the duty of disclosure under the MIA in detail and provided the Insurance Act 2015 for the purpose of enhancing the interests of the insured. The Insurance Act 2015("Act"),while the basic legal structure of the duty of disclosure under the MIA still remains, amends it in respect of non-consumer insurance and furthermore, integrate the duty of disclosure and the duty not to misrepresent into the duty of fair presentation of risk. And according to the Act, the insurer is required to more actively communicate with the insured before entering the contract with the result that, if the insured fails to disclose the material circumstance but provides the sufficient information to put the insurer on notice, the insurer should further inquire for the purpose of the insured's revealing the material circumstance. In addition, the Act details the insured's constructive knowledge of material circumstance by reviewing the current case law and introduces a new system for the insurer's proportionate remedy against the insured's breach of the duty of fair presentation of risk.

• THE INTERNATIONAL COMMERCE & LAW REVIEW
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• v.42
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• pp.275-305
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• 2009

Marine insurance contracts, which intended to provide indemnity against marine risks upon the payment of price, known as a premium, originated in Northern Italy in the late 12th and early 13th centuries. The law and practice were later introduced into England through the Continent. It is, therefore, quite exact that English and European marine insurance law have common roots. Nevertheless, significant divergences between English and European insurance systems occurred since the late 17th century, mainly due to different approaches adopted by English courts. The rule of warranty in English marine insurance was developed and clarified in the second part of the 18th century by Lord Mansfield, who laid the foundations of the modern English law of marine insurance, and developed different approaches, especially in the field of warranty in marine insurance law. Since the age of Lord Mansfield, English marine insurance law has a unique rule on warranty. This article is, therefore, designed to analyse the overall rule of the rule of warranty in English marine insurance law. The result of analysis are as following. First, warranties are incorporated to serve a very significant function in the law of insurance, that is, confining or determining the scope of the cover agreed by the insurer. From the insurer's point of view, such the function of warranties is crucial, because his liability, agreed on the contract of insurance, largely depend on in, and the warranties, incorporated in the contract play an essential role in assessing the risk. If the warranty is breached, the risk initially agreed is altered and that serves the reason why the insurer is allowed to discharge automatically further liability from the date of breach. Secondly, the term 'warranty' is used to describe a term of the contract in general and insurance contract law, but the breach of which affords different remedies between general contract law and insurance contract law. Thirdly, a express warranty may be in any form of words from which the intention to warrant is to be inferred. An express warranty must be included in, or written upon, the policy, or must be contained in some document incorporated by reference into the policy. It does not matter how this is done. Fourthly, a warranty is a condition precedent to the insurer's liability on the contract, and, therefore, once broken, the insurer automatically ceases to be liable. If the breach pre-dates the attachment of risk, the insurer will never put on risk, whereas if the breach occurs after inception of risk, the insurer remains liable for any losses within the scope of the policy, but has no liability for any subsequent losses. Finally, the requirements on the warranty must be determined in according to the rule of strict construction. As results, it is irrelevant: the reason that a certain warranty is introduced into the contract, whether the warranty is material to the insurer's decision to accept the contract, whether or not the warranty is irrelevant to the risk or a loss, the extent of compliance, that is, whether the requirements on the warranty is complied exactly or substantially, the unreasonableness or hardship of the rule of strict construction, and whether a breach of warranty has been remedied, and the warranty complied with, before loss.

• Journal of Society of Preventive Korean Medicine
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• v.3 no.1
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• pp.67-82
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• 1999

This study was performed to investigate out-of-pocket money among medical expenses of an oriental medical university hospital by the use of internal data of an oriental hospital because medical insurance program data could not show us insuree's out-of-pocket money among medical expenses. The purpose of this study was to analyze out-of-pocket money among medical expenses of ambulatory and hospitalized patients. Under this purpose, We analyzed actual medical expenses data of 1389 out-patients and 858 in-patients of the oriental medical university hospital with 90 beds that could be approach to internal data from July 1, 1998 to March 31, 1999. The major findings are as follows : 1. In ambulatory patients, the cost share ratio of insuree & that of insurer was 90 : 10 respectly. 2. In hospitalized patients, the cost share ratio of insuree & that of insurer was 72 : 28 respectly.