Insurance Litigation Lawyer | What to do when the insurer says no

Insurance Litigation | Common grounds insurers use to deny or reduce claims

Insurers rarely deny a claim outright without citing a reason. Understanding the reason they give is the first step to knowing whether it actually holds up.

Alleged breach of duty to disclose (pre-existing conditions)

Insurers frequently argue the policyholder failed to disclose a pre-existing illness or condition at the time of signing, which can allow the insurer to cancel the contract or deny the claim (상법 제651조). However, this right to cancel expires if the insurer does not exercise it within one month of learning the facts, and no later than three years after the contract began (상법 제651조). Whether the omission was intentional or grossly negligent, and whether the insurer's agent already knew the fact, are often the real battlegrounds.

Disputes over causation and exclusion clauses

Even where an accident or illness is not disputed, insurers often argue the specific cause falls under a policy exclusion, or that the injury was not the proximate cause of the loss claimed. Because exclusion clauses limit the insurer's liability, courts require them to be clear and to have been properly explained to the policyholder before signing; unexplained material terms may not bind the policyholder (약관의 규제에 관한 법률 제3조).

Dispute over degree of disability or extent of injury

In disability and personal accident insurance, insurers commonly rely on their own designated hospital's assessment to argue the disability grade is lower than the claimant believes, directly reducing the payout. Obtaining an independent medical opinion and comparing it against the insurer's assessment criteria is often central to resolving this dispute.

Insurance Litigation | Recurring dispute types by insurance product

The specific issue that ends up in litigation looks different depending on whether the policy is auto, health/disability, or fire/property insurance.

Auto insurance and underinsured/uninsured motorist claims

When the at-fault driver's insurer disputes the degree of fault or offers a settlement based on standardized injury tables that undervalue lost income or future care costs, the victim can reject the offer and pursue a direct claim or lawsuit rather than accepting the insurer's first number.

Health, disability, and critical illness insurance

Disputes here often center on whether a diagnosis meets the policy's specific definition of the covered illness, which can be narrower than the everyday medical definition. Reviewing the exact wording of the definition clause against the medical records is essential before accepting a denial.

Delay in claim review and payment

An insurer is generally required to complete its review and pay out within a set period after receiving all necessary documents; unnecessary requests for additional documents can function as a way to stall payment. Persistent, poorly justified delay can itself support a claim for the delay penalty in addition to the principal payout.

Insurance Litigation | From claim denial to resolution

Insurance Litigation | How fees are typically structured in insurance litigation

※ Costs vary depending on case complexity and specific circumstances; exact fees will be provided during consultation. No specific outcome is guaranteed.

Insurance Litigation | Self-Check Before You Contact an Insurer's Lawyer

Frequently Asked Questions

Official References

• Korea Law Information Center — https://www.law.go.kr
• Easy-to-Find Everyday Legal Information — https://easylaw.go.kr
• Korea Legal Aid Corporation — https://www.klac.or.kr