FSC sanctions 29 insurance workers linked to fraud
Fake accidents, false hospitalizations used to bilk 8 insurers
Traffic accident manipulation most common, with 16 cases
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Twenty-nine insurance agents and loss adjusters who staged traffic accidents, filed false hospitalization claims and otherwise committed insurance fraud have had their registrations canceled or their operations suspended.
The Financial Services Commission announced Thursday that it had imposed sanctions — including registration cancellations and business suspensions — on 29 insurance industry workers found to have been involved in insurance fraud. The group comprised 28 insurance agents and one loss adjuster. The FSC held a hearing Aug. 26 and voted to impose the sanctions on Oct. 16.
By severity, registration cancellation was the most common penalty, applied to 19 people. Seven received 180-day suspensions and three received 90-day suspensions.
By type of fraud, traffic accident manipulation was the most prevalent, accounting for more than half of cases at 16. That was followed by false hospitalization (5 cases), falsification of medical records (4), false or exaggerated diagnoses (2), failure to disclose required information (1) and other violations (1).
In the traffic accident manipulation cases, perpetrators conspired with acquaintances to deliberately cause accidents and then reported them as genuine incidents to collect payouts. One agent colluded with multiple individuals to stage accidents and file fraudulent claims, defrauding eight insurers — including one identified as Company A — of 489.48 million won ($366,000) before having the registration canceled.
In the false hospitalization category, one agent exaggerated the severity of an illness that did not require inpatient care, checked into a hospital and submitted fabricated admission and discharge certificates to collect 9.89 million won from six insurers, including one identified as Company B Life. That agent's registration was also canceled.
Medical record falsification was also uncovered. One agent arranged for a policyholder who had undergone a simple circumcision to obtain a fraudulent diagnosis certificate bearing a disease code, then used it to collect 20.9 million won from five insurers, including one identified as Company C. That agent received a 180-day suspension.
In the false or exaggerated diagnosis category, one agent repeatedly sought outpatient treatment despite sustaining little or no injury, inflating the claimed damages to collect 47.28 million won from eight insurers, including one identified as Company D Life. That registration was canceled.
Cases involving family members were also uncovered. One agent enrolled a sibling in an insurance policy without disclosing the sibling's prior hospitalization history, then filed a claim for 200 million won with an insurer identified as Company E after the sibling died — an attempt that ultimately failed. In another case, an agent secretly took out multiple whole-life insurance policies on a former spouse who had a pre-existing condition, naming the former spouse as the insured, and after that person died filed claims for death benefits and surrender refunds totaling 467.46 million won with three insurers, including one identified as Company F Life — also without success. Both agents received 180-day suspensions.
won@heraldcorp.com
