Insurers Must Notify Consumers of Changes to Claims Review Standards

View of the Financial Supervisory Service in Yeouido, Seoul. 2026.02.20[Photo by Yoo Dae-gil]

Insurance companies will now be required to notify consumers in advance when they change their claims review standards based on Supreme Court rulings or decisions from financial authorities. This notification must occur before the changes take effect, which will be implemented after a specified period.
On June 21, the Financial Supervisory Service (FSS) announced new administrative guidance that mandates consumer notification regarding changes to claims review standards and strengthens internal controls.
This measure aims to reduce disputes that have arisen when consumers are informed of changes to claims review standards only after their claims have been denied.
Previously, insurers were not obligated to provide advance notice when they modified their review standards based on Supreme Court decisions, dispute resolution committee rulings, or regulatory interpretations. As a result, many consumers learned of these changes only after their medical claims were rejected.
The FSS determined that this information asymmetry has led to increased consumer harm and disputes.
Under the new guidance, insurers must inform all policyholders affected by significant changes to review standards through at least two communication channels and also publish the information on their websites. The notification must include the basis and purpose of the changes, details of the modifications, the effective date, and contact information.
The revised review standards cannot take effect until at least three business days after consumers have been notified.
This consumer notification requirement will take effect on June 22 and applies to all insurance products where changes to claims review standards could potentially harm consumers. Notably, the new rules were prioritized for health insurance, which has seen the highest number of complaints and disputes, following the launch of the fifth generation of policies last month.
However, changes to review standards that are favorable to consumers or aimed at preventing insurance fraud, which pose a lower risk of consumer harm, are exempt from this notification requirement.
The FSS stated, "By requiring advance notification of changes to claims review standards, we expect to alleviate information asymmetry, allowing consumers to make more informed decisions regarding medical and insurance matters. We also anticipate a reduction in disputes over insurance payments as a result of this process."

* This article has been translated by AI.