금융감독원(이하 금감원)이 보험업법上 ‘설명의무’와 같은 기본조차 지키지 않은 보험사들을 제재했다고 공시했다.

금감원의 제재 공시에 따르면, 지난달 4個 보험사들이 보험업법上 기본 의무인 ‘(1)설명의무’와 ‘(2)기초서류 준수의무’를 지키지 않아 과징금과 과태료 등의 제재를 받은 것으로 나타났다. 

제재를 받은 4개 보험사는 미래에셋생명보험, 농협생명보험, DB생명보험, 흥국화재해상보험이다.

‘(1)설명의무(說明義務, Duty of Explanation of Insurance Terms and Conditions)’란 보험업법상 ‘보험계약 체결 시부터 보험금 지급 시까지의 주요 과정을 일반보험계약자*에게 설명’해야 하는 보험회사의 의무이다(보험업법 제95조의2, 동법 시행령 제42조의2).

* 보험업법상 보험계약자는 일반 소비자를 의미하는 ‘일반보험계약자’와 보험계약에 대한 전문성이 있는 ‘전문보험계약자’로 구분된다. 

보험회사는 보험업법에 따라 ‘보험계약 체결 시’와 ‘보험금 청구 시’에 설명의무를 이행해야 하나 위에서 언급한 4개 보험회사들은 모두 전자의 설명의무를 위반했다(보험업법 제95조의2 제3항 및 제4항). 

그리고 ‘(2)기초서류 준수의무(基礎書類遵守義務, Obligation to comply with Insurance Basic Documents)’란 해당 보험상품 개발·취급 등의 기초가 되는 기초서류의 내용을 준수해야 하는 보험회사의 의무이다(보험업법 제127조의3).

보험회사가 보험상품을 개발하며 신고한 서류이고 동시에 보험계약자와 체결한 보험계약의 기초가 되는 서류이므로 당연히 준수해야 함에도 이를 위반한 것이다.  

참고로 기초서류는 ①사업방법서, ②보험료 및 해약환급금 산출방법서, ③약관으로 구성되며 보험사는 이를 보험상품별로 작성해야 한다. 

표 1. 금융기관별 위반 법규 및 제재 내용

자료: 금융감독원 제재 공시

사진: 연합뉴스

English version>>

FSS sanctions a number of insurance companies for failing to comply with the basic ‘duty of explanation’ under the Insurance Business Act

The Financial Supervisory Service (FSS) announced that it had sanctioned insurance companies that did not even comply with basics such as the ‘duty of explanation’ under the Insurance Business Act.

According to the FSS’s sanctions disclosure, four insurance companies were sanctioned with fines and etc. last month for failing to comply with the basic obligations such as ‘(1) Duty of explanation of Insurance Terms and Conditions’ and ‘(2) Obligation to comply with Insurance Basic Documents’ under the Insurance Business Act.

The four insurance companies that received sanctions are MiraeAsset Life Insurance, Nonghyup (NH) Life Insurance, DB Life Insurance, and Heungkuk Fire & Marine Insurance.

‘(1) Duty of Explanation of Insurance Terms and Conditions’ is the duty of an insurance company under the Insurance Business Act to ‘explain to general insurance policy holders* the main process from the time of signing an insurance contract to the payment of  insurance payments’ (Article 95-2 of the Insurance Business Act, Article 42-2 of the Enforcement Decree of the same Act).

* Under the Insurance Business Act, insurance policy holders are divided into ‘general insurance policy holders’, which refer to general consumers, and ‘professional insurance policy holders’, who have expertise in insurance contracts.

According to the Insurance Business Act, insurance companies must fulfill their duty to explain when signing insurance contracts and claiming insurance payments, but all four insurance companies mentioned above violated the former duty to explain (Article 95-2 (3) and (4) of the Insurance Business Act).

In addition, “(2) Obligation to comply with Insurance Basic Documents” is the obligation of the insurance company to comply with the contents of the basic documents that are the basis for the development and handling of the insurance products (Article 127-3 of the Insurance Business Act).

It is a document that the insurance company developed and reported to the supervisory authority, and at the same time, it is a document that is the basis of an insurance contract concluded with the policyholder, so it violates this even though it must be observed.  

For reference, the basic documents consist of ① business plan for an insurance product, ② insurance premium and surrender refund calculation method, and ③ terms and conditions, and insurance companies must prepare them for each insurance product.