건강보험과 자동차보험의 선택적 우선적용에 대한 고찰 - 경과실 자기신체피해 교통사고를 중심으로-

Abstract

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.