Insurers will cover all the expense of the so-called "8-week rule," which reviews whether it is appropriate for minor-injury patients from car accidents (injury grades 12–14) to receive treatment for eight weeks or longer.
According to the insurance industry on the 4th, the Ministry of Land, Infrastructure and Transport (MOLIT) and the insurance industry decided that insurers will bear the expense related to the 8-week rule. A committee composed of Western and Korean medicine doctors under the Traffic Accident Compensation Supervisory Service (TACSS), an agency under the Ministry of Land, Infrastructure and Transport, will review whether treatment beyond eight weeks is appropriate for minor-injury patients. Insurers will pay labor costs, operating costs, fees, and other expenses necessary for the work.
When the 8-week rule is implemented, minor-injury patients seeking treatment for eight weeks or longer must submit medical records and other documents. TACSS will review, based on the materials, whether an extension of treatment is warranted. If additional treatment is deemed necessary, patients can receive treatment covered by insurance benefits. Otherwise, they must pay out of pocket.
This is similar to the structure for reviewing automobile insurance medical bills. The Automobile Insurance Review Center within the Health Insurance Review & Assessment Service (HIRA) conducts reviews to determine whether the medical bills claimed by hospitals are appropriate. Insurers and mutual aid associations bear the expense, including labor costs, to operate the center.
Consumer groups and the medical community have raised concerns about an organization funded by insurers handling review work that is directly tied to the payment of insurance benefits. During the 2024 National Assembly audit, questions were also raised about the fairness of HIRA's medical bill reviews.
MOLIT and the insurance industry said they made this decision to avoid passing the expense on to patients. An official at MOLIT said, "We cannot ask customers or the medical community to pay the expense of reviewing insurance benefit payments, nor can we cover it with taxes."
Even now, minor-injury patients must submit a medical certificate and other documents after four weeks of treatment to receive additional care. However, the insurance industry argues that treatment is extended indefinitely without verification, leading to overtreatment. If some customers receive excessively frequent treatment, insurers' performance deteriorates, which in turn leads to higher premiums for other policyholders.
MOLIT pushed the 8-week rule on the view that treatment for minor-injury patients should conclude within eight weeks. Among last year's minor-injury patients at four non-life insurers (Samsung Fire & Marine Insurance, Hyundai Marine & Fire Insurance, DB Insurance, KB Insurance), 11.4% (138,991 people) received treatment for eight weeks or longer.