Hello, this is attorney Seunghyun Oh of Cheongchul Law Firm.

Cancer insurance is one of the most widely purchased insurance products in Korea. Yet when policyholders are actually diagnosed with cancer and file a claim, it is not uncommon for the insurer to deny it. Benefits are reduced or refused outright on grounds such as "the diagnosis was confirmed before the liability commencement date" or "this cancer qualifies only as a minor cancer."

This article outlines the main types of cancer insurance disputes and how Korean courts have actually ruled on them. We look at the grounds on which a claim denial can be contested, and what additional remedies are available when a delayed diagnosis was caused by medical negligence.

Delayed Cancer Diagnosis and Medical Negligence – How Courts Decide

① Lost Treatment Opportunity Due to Misdiagnosis

Where a physician could have suspected cancer but failed to order further tests or refer the patient to a specialist, resulting in a delayed diagnosis, courts recognize this as medical negligence. In a case where hepatocellular carcinoma was misdiagnosed as a hemangioma and treatment was delayed (Suwon District Court Pyeongtaek Branch, 2020Gahap13214, Sept. 16, 2021), the court found negligence in the misdiagnosis and the failure to conduct additional tests, and ordered damages of more than KRW 180 million to the bereaved family. In another case where additional testing was not performed for a combined hepatocellular-cholangiocarcinoma and the diagnosis was delayed (Jeju District Court, 2021Gahap10575, May 18, 2023), the bereaved family was awarded approximately KRW 40 million.

Keep in mind that a damages claim for medical negligence can be pursued separately from, and in addition to, your cancer insurance benefits.

② Failure to Report Health Screening Results or Recommend Further Testing

Failing to properly inform the examinee of abnormal findings from a health screening, or failing to recommend follow-up testing, is also recognized as negligence causing a delayed diagnosis. In a case where a Korean medicine doctor did not recommend a detailed examination to a patient with suspected cancer (Seoul Eastern District Court, 2019Gahap109283, May 7, 2020), the court found a breach of the duty to explain and ordered KRW 25 million in consolation money. Medical providers were likewise found negligent in a case involving a breach of the duty to explain during the diagnosis of endometrial cancer (Seoul Southern District Court, 2013Gadan206928, Sept. 11, 2015), a case where a CT scan was not re-read in a gallbladder cancer patient (Seoul Eastern District Court, 2020Gadan110138, June 9, 2022), and a case where additional testing was not performed for lung metastasis of head and neck cancer (Incheon District Court, 2018Gadan239607, Dec. 13, 2019).

If you were never properly notified of your health screening results, do not simply write it off as bad luck. It is worth reviewing whether legal action is possible.

Key Issues by Type of Cancer Insurance Dispute

① Disputes over the Date of Confirmed Cancer Diagnosis

Most cancer insurance policies pay benefits based on a "confirmed diagnosis by pathological methods such as a biopsy." Insurers apply this standard strictly and sometimes deny claims on the ground that the biopsy was performed before the liability commencement date. However, for cancers where a biopsy is not feasible (such as brain tumors or pancreatic cancer), a diagnosis by other methods is also accepted. Courts consistently apply the principle that policy terms are to be interpreted "in favor of the insured" (the contra proferentem rule). This means that where the wording of the policy can be read in more than one way, the insurer cannot insist on the interpretation that is unfavorable to the policyholder.

② Disputes over Cancer Classification – If You Disagree with a Minor Cancer or Borderline Tumor Determination

Insurers sometimes classify a diagnosed cancer as thyroid cancer (minor cancer), a borderline tumor, or carcinoma in situ (intraepithelial cancer), and sharply reduce the benefit. If the cancer medically qualifies as a general cancer, this can be fully contested in court. Courts base their judgment on the pathological diagnosis report and the opinions of medical experts, not on the insurer's own classification. If you accepted a minor cancer benefit and left it there, it is worth reviewing your diagnosis report again.

③ Cancer Diagnosed Shortly After Enrollment – Responding to Allegations of Non-Disclosure

When cancer is diagnosed shortly after a policy is taken out, insurers often deny the claim or attempt to terminate the contract, citing a breach of the duty of disclosure or fraud. However, courts hold that the insurer bears the burden of proving that symptoms already existed before the diagnosis and that the policyholder knowingly concealed them. The mere proximity between the enrollment date and the diagnosis date is not enough to establish a breach of the duty of disclosure. If you receive a denial, the first step is to obtain the insurer's written statement of reasons and examine the specific grounds.

Closing Remarks

Cancer insurance disputes involve many technical issues, such as "the date of confirmed diagnosis," "cancer classification," and "breach of the duty of disclosure," which makes them difficult to handle alone. If a misdiagnosis or delayed diagnosis is suspected, a medical malpractice damages claim should be reviewed at the same time. If you have received a claim denial, please contact Cheongchul Law Firm for a free consultation.

Thank you.