A specialist review system to curb prolonged hospitalization by minor traffic accident patients takes effect Sept. 10. [Ministry of Land, Infrastructure and Transport]
A specialist review system to curb prolonged hospitalization by minor traffic accident patients takes effect Sept. 10. [Ministry of Land, Infrastructure and Transport]

South Korea is moving to stamp out the practice of minor traffic accident patients staying hospitalized for more than eight weeks, with a new rule requiring a mandatory specialist review before any such extended treatment can continue.

The Ministry of Land, Infrastructure and Transport said an amendment to the enforcement decree of the Automobile Damage Compensation Security Act was approved at a Cabinet meeting Tuesday and will take effect Sept. 10.

The amendment targets so-called "nailong" patients — minor-injury claimants who extend hospital stays to collect insurance payouts — and is designed to prevent the excessive drain on insurance funds they cause. According to the ministry, the number of minor-injury patients fell an average of 0.9 percent per year from 2019 to 2024, yet their medical costs rose an average of 7.0 percent annually over the same period, reaching 1.41 trillion won ($986 million).

Under the amended decree, minor-injury patients seeking treatment beyond eight weeks must undergo a medical necessity review by specialist physicians at the Korea Insurance Support Center. The rule applies primarily to injuries classified at severity grades 12 through 14, such as sprains and bruises.

Under the new process, a patient submits documents including a medical certificate, after which the insurer or automobile mutual aid association requests a review from the center. The center then notifies the patient, insurer and association of its findings. Patients who disagree with the outcome may appeal to a mutual aid dispute mediation subcommittee for a second review.

However, to minimize public inconvenience, insurers and mutual aid associations will cover the cost of issuing review documents as well as treatment costs incurred while a review is pending. Pregnant women and children aged 7 or under are exempt from the review requirement to protect vulnerable patients' right to treatment. To ensure prompt reviews, the ministry will build a dedicated IT system and appoint around 200 specialist physicians — in both Western and traditional Korean medicine — with at least 10 years of experience at general hospitals to serve as reviewers.

"This amendment to the enforcement decree is aimed at reducing unnecessary insurance expenditures caused by some cases of excessive treatment and at building a culture of appropriate compensation," said Park Jun-hyung, director general of the ministry's Mobility and Automobile Bureau. "We will do our best to effectively screen out fraudulent patients while ensuring the public faces no inconvenience from the new system."


smh@heraldcorp.com