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KMID : 0365420110300020008
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Journal of the KLIMA
2011 Volume.30 No. 2 p.8 ~ p.11
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Claims Insurance Medicine
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Lee Sin-Hyung
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Abstract
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Insurance medicine has been known to medical risk selection. The role of insurance medicine is sound maintenance of insurance system. So it’s function is medical underwriting of life risks. However, emerging market has insufficient medical epidemiological research that is necessary for estimation of extra-risk and such market is usually lack of full understanding of life insurance among insurance customers. This problem makes difficult of performing the medical underwriting, as an original insurance medicine. Medical contributions at the stage of claims adjudication comparing the coverage provided in the product, with the information provided in the claims, based on medical records and the agreement between them. This is called medical verification. The insurance doctors can also use their medical knowledge to help the claims staff with informing claimants about the medical basis of claims decisions.
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KEYWORD
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life insurance, insurance medicine, medical underwriting, insurance claims
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