2018 제3보험이론

제1장 제3보험이론 개론
제1절 인보험 총론
Ⅰ. 제3보험의 의의 ············································ 3
Ⅱ. 인보험의 특징 ··············································· 3
1. 피보험이익 및 보험가액 개념의 부존재 ········ 3
2. 분담주의, 보험자대위 및 손해방지비용의
불인정 ··························································· 4
3. 피보험자의 자격제한 ····································· 4
4. 사고발생기준증권과 발견기준증권 ··············· 4
Ⅲ. 제3보험의 급부 형태 ································· 5
1. 정액보상방식 ················································· 5
2. 준정액보상방식 ·············································· 5
3. 실손보상방식 ················································· 5
4. 치료비의 담보방식 ········································· 5
Ⅳ. 제3보험의 담보 내용 ··································· 6
1. 사망보험 ························································ 6
2. 상해보험 ························································ 7
3. 질병보험 ························································ 7
4. 간병보험 ······················································ 7
5. 비용보험 ························································ 7
제2절 상해질병보험약관 공통사항
Ⅰ. 보험계약의 성립 ··········································· 8
1. 보험계약의 성립 ············································ 8
2. 승낙의제 ························································ 8
3. 승낙의 거절과 보험료의 반환 ······················· 8
Ⅱ. 청약의 철회 ·················································· 9
1. 의의 ····························································· 9
2. 존재 이유 ······················································ 9
3. 청약 철회의 제한 ·········································· 9
4. 청약 철회의 효과 ········································ 9
Ⅲ. 설명교부의무 ············································ 10
1. 의의 ··························································· 10
2. 설명 및 교부 방법 ······································ 10
3. 의무위반의 효과 ·········································· 11
4. 보험료의 반환 ············································· 11
Ⅳ. 면책조항 ······················································ 11
1. 상해·질병 공통 면책사유 ····························· 11
2. 상해의료비 면책사유 ··································· 12
Contents
제3절 보험료 지급과 부지급의 효력
Ⅰ. 보험기간 ···················································· 13
1. 의의 ···························································· 13
2. 최초보험료 영수 시점과 보험기간 ················ 13
3. 거절할 사유와 입증책임 ································ 13
Ⅱ. 면책기간 ······················································ 15
1. 의의 ···························································· 15
2. 면책기간의 기산점 ········································ 15
3. 면책기간과 승낙전 보호제도 ····················· 16
4. 면책기간의 적용 ·········································· 16
5. 보험계약별 면책기간 ································· 16
6. 면책기간 중 사고와 보험자의 보상책임 ······ 17
Ⅲ. 계속보험료 부지급의 효과 ························ 17
1. 계속보험료의 의의 ······································ 17
2. 계속보험료 부지급의 효과 ························· 17
Ⅳ. 주소지 변경 통지의무 ······························· 18
1. 통지의무 ······················································ 18
2. 통지의무위반의 효과 ··································· 19
Ⅴ. 연체보험료의 자동대출납입 ······················ 19
1. 의의 ···························································· 19
2. 자동대출납입의 중단 ································· 19
3. 자동대출납입 기간 ······································ 20
4. 자동대출납입 후 계약의 해지 ····················· 20
5. 자동대출납입 종료 통보 ······························ 20
Ⅵ. 보험료의 납입연체로 인한
해지계약의 부활 ········································· 22
1. 계약의 부활(효력회복) 청약 ······················ 22
2. 연체보험료 및 연체이자의 납입 ·················· 22
3. 고지의무와 면책기간의 적용 ····················· 22
Ⅶ. 강제집행 등으로 인한 해지계약의
특별부활 ······················································ 23
1. 의의 ···························································· 23
2. 보험수익자에게 통지 ··································· 23
3. 특별부활의 청약 ·········································· 23
4. 특별부활시 고지의무와 면책기간의 적용 ···· 23
Ⅷ. 승환계약에 의한 부활 ······························· 24
1. 승환계약의 의의 ·········································· 24
2. 승환계약의 대상 ·········································· 24
3. 승환계약의 부활 및 취소 ···························· 25
Ⅸ. 해지환급금 ·················································· 25
Ⅹ. 보험료납입 면제 ······································· 26
제4절 조건부인수와 계약내용 변경
Ⅰ. 보험나이 ······················································ 27
1. 의의 ··························································· 27
2. 보험나이의 계산 ·········································· 27
Ⅱ. 계약내용의 변경 ········································· 27
1. 변경 가능한 계약내용 ································· 27
2. 보험수익자의 변경 ······································ 28
3. 보험종목의 변경 ·········································· 28
4. 보험가입금액의 감액 ··································· 28
5. 보험계약자의 변경 ······································ 28
Ⅲ. 변경약관이 효력을 미치는 범위 ·············· 29
1. 의의 ···························································· 29
2. 변경약관의 적용 원칙 ································· 29
3. 변경약관의 소급적용 ··································· 29
Ⅳ. 개별약정 ······················································ 30
1. 의의 ···························································· 30
2. 개별약정의 유형 ·········································· 30
3. 개별약정의 효력 ·········································· 31
4. 개별약정에 대한 규제 ······························· 31
Ⅴ. 단체취급 특별약관 ····································· 32
1. 의의 ···························································· 32
2. 피보험자의 동의 ·········································· 32
3. 보험수익자의 지정 ······································ 32
4. 피보험자의 단체 탈퇴 ································· 32
5. 대표자의 선정 ············································· 33
6. 피보험자의 추가, 감소 또는 교체 ··············· 33
Ⅵ. 특별조건부 인수계약 ································· 34
1. 의의 ···························································· 34
2. 특별조건의 유형 ·········································· 34
Ⅶ. 특정신체부위, 질병 부담보특약 ··············· 35
1. 의의 ···························································· 35
2. 부담보특약의 효력 ······································ 35
3. 부담보특약의 예외 ······································ 35
Ⅷ. 이륜자동차 운전 및 탑승중
상해 보상여부 ············································· 37
1. 서 ································································ 37
2. 부담보특약 ·················································· 37
3. 통지의무위반 ············································· 38
제5절 보험계약의 무효와 실효
Ⅰ. 보험계약의 무효 ········································· 40
1. 의의 ···························································· 40
2. 무효의 유형 ················································ 40
3. 보험계약의 무효와 보험료반환 ···················· 43
Ⅱ. 고지의무위반에 의한 해지 ························ 44
1. 의의 ···························································· 44
2. 고지의무의 적용 ·········································· 44
3. 고지의무위반의 요건 ··································· 44
4. 고지의무위반의 효과 ································· 46
Ⅲ. 사기에 의한 고지의무위반 ························ 47
1. 약관 규정 ···················································· 47
2. 취소의 효과 ··············································· 47
Ⅳ. 계약 후 알릴의무 ······································· 48
1. 의의 ···························································· 48
2. 2018.4.1. 주요개정 내용 (예정) ··················· 48
3. 통지의무위반의 경우 ···································· 51
Ⅴ. 중대 사유로 인한 해지 ··························· 53
1. 의의 ···························································· 53
2. 계약자 등의 고의 ········································ 53
3. 보험금 허위 청구 ········································ 54
Ⅵ. 보험자의 파산에 의한 해지 ···················· 54
Ⅶ. 보험계약의 당연 실효 ······························· 54
1. 서 ································································ 54
2. 피보험자의 사망 ·········································· 54
3. 고도 후유장해(80% 이상) ·························· 55
4. 장해 100% 발생 ········································ 55
5. 피보험자의 서면동의 철회 ·························· 55
제6절 보험금청구와 지급
Ⅰ. 2018.4.1. 규정 변경 내용 (예정) ·········· 56
1. 표준사업방법서, 표준약관에
본인서명사실확인제도 반영 ························· 56
Ⅱ. 보험금청구권자 ········································· 57
1. 의의 ····························································· 57
2. 보험수익자의 지정 및 변경 ···························· 57
3. 보험수익자의 확정 ········································ 57
4. 대표자의 지정 ·············································· 57
5. 보험수익자가 행위무능력자인 경우
보험금수령 권한 ·········································· 58
6. 보험수익자가 법정상속인인 경우 ·················· 59
Ⅲ. 지정대리청구서비스 특별약관 ·················· 60
1. 의의 ····························································· 60
2. 지정대리청구인의 자격 ································· 60
3. 지정대리청구인의 변경 및 소멸 ····················· 61
4. 보험금 지급 등의 절차 ··································· 61
Ⅳ. 선지급서비스 특별약관 ····························· 61
1. 의의 ···························································· 61
2. 조건 ···························································· 61
3. 사망보험금과의 관계 ································· 62
Ⅴ. 보험금의 청구 ············································ 63
1. 보험금 지급사유의 통지 ······························ 63
2. 보험금 청구서류 접수 및 보험금의 지급 ···· 63
3. 보험금 지급사유에 대한 조사?확인이
필요한 경우 ··············································· 63
4. 가지급보험금의 지급 ··································· 64
5. 지연이자의 지급 ·········································· 64
Ⅵ. 보험금청구권의 상실 ································· 66
1. 의의 ····························································· 66
2. 중대한 사유로 인한 해지 ······························· 67
Ⅶ. 보험금청구권 소멸시효 ····························· 67
1. 의의 ····························································· 67
2. 소멸시효의 기산점 ········································ 67
3. 소멸시효 중단사유 ········································ 68
4. 소멸시효 완성의 포기 ···································· 69
Ⅷ. 보험회사의 손해배상책임 ·························· 69
1. 약관 규정 ···················································· 69
제2장 의료 실비
제1절 실손의료비 담보 연혁적 고찰
Ⅰ. 의료비 담보의 연혁적 고찰 ······················ 73
Ⅱ. 2003.9.30 이전 ········································ 74
1. 국민건강보험으로 처리된 경우 ···················· 74
2. 국민건강보험 미적용의 경우 ······················· 75
3. 자동차보험, 산재보험 처리된 경우 ············· 75
Ⅲ. 2003.10.1 ~ 2009.9.30 까지 ·············· 75
1. 국민건강보험으로 처리된 경우 ···················· 75
2. 국민건강보험 미적용 또는 산재보험,
자동차보험 처리된 경우 ······························ 75
Ⅳ. 2009.10.1 이후 ~ 2012.12.31 까지 ··· 75
1. 입원의료비 ·················································· 75
2. 상급병실료 차액 ·········································· 76
3. 통원의료비 ·················································· 76
4. 감면된 입원의료비 ······································ 76
Ⅴ. 2013.1.1. ~ 2015.9.31. 까지 ·············· 76
1. 국민건강보험 처리된 경우 ·························· 76
2. 국민건강보험 처리되지 아니한 경우 ··········· 77
3. 통원의료비 공제금액 ··································· 77
Ⅵ. 2015.10.1. ~ 2015.12.31. 까지 ·········· 77
1. 국민건강보험 처리된 경우 ·························· 77
2. 국민건강보험 처리되지 아니한 경우 ··········· 77
3. 통원의료비 공제금액 ··································· 78
Ⅶ. 2016.1.1. 이후 ········································· 78
1. 국민건강보험 처리된 경우 ·························· 78
2. 국민건강보험 처리되지 아니한 경우 ········· 80
제2절 해외 여행자보험 실손의료비 담보
Ⅰ. 해외의료비 담보 ······································· 81
1. 서 ································································ 81
2. 담보종목 ······················································ 81
3. 해외에서 발생한 상해(질병) 의료비 ············ 82
4. 보상대상에 포함, 제외되는 증상 ················· 82
Ⅱ. 국내 귀국후 치료비 ································· 83
1. 담보조건 ······················································ 83
2. 보장기간 ······················································ 83
3. 담보 내용 ···················································· 83
제3절 국내실손의료비 담보
Ⅰ. 담보종목 및 용어의 정의 ························· 84
1. 담보종목 ······················································ 84
2. 용어의 정의 ·················································· 84
Ⅱ. 보상한도 ······················································ 88
Ⅲ. 입원의료비 ·················································· 89
1. 보상대상의료비 ············································ 89
2. 본인부담상한제 ············································ 89
3. 공제면책금액 ··············································· 92
4. 상급병실료 차액 ········································ 94
5. 국민건강보험을 적용받지 못하는 경우 ········ 94
6. 보상기간 ······················································ 95
7. 하나의 질병 ················································ 96
Ⅳ. 상해(질병) 통원의료비 ······························ 97
1. 공제면책금액 ··············································· 97
2. 통원의료비와 처방조제비 보상기간 ············· 98
3. 보상한도 ······················································ 98
4. 지급보험금 계산 ·········································· 98
5. 국민건강보험을 적용받지 못하는 경우 ········ 99
6. 감면된 통원의료비 ···································· 100
7. 동일한 상해(질병)로 2회 이상 통원치료 ·· 100
Ⅴ. 면책조항 ··················································· 100
1. 일반적 면책사유 ········································ 100
2. 보상 대상에 포함, 제외되는 증상 ············· 101
3. 상해의료비 면책사유 ································· 101
4. 질병의료비 면책조항 ································· 102
5. 상해의료비, 질병의료비 공통면책사유 ······ 103
6. 특약 면책사항 ··········································· 105
Ⅵ. 의료비 분담조항의 적용 ························· 106
1. 서 ······························································ 106
2. 분담방법 ··················································· 106
Ⅶ. 포괄수가제도 ·········································· 109
1. 7개 질병군 포괄수가제의 의의 ················· 109
2. 장점 ·························································· 109
3. 적용대상질병군 ········································· 109
4. 적용되는 범위 ··········································· 110
제4절 실손의료비 특약
Ⅰ. 비급여 도수치료·체외충격파치료·증식치료
실손의료비 특별약관 ······························· 111
1. 용어의 정의 ·············································· 111
2. 보상내용 ··················································· 111
Ⅱ. 비급여 주사료 실손의료비 특별약관 ···· 112
1. 용어의 정의 ·············································· 112
2. 보상내용 ··················································· 113
Ⅲ. 비급여 자기공명영상진단(MRI/MRA)
실손의료비 특별약관 ······························· 114
1. 용어의 정의 ·············································· 114
2. 보상내용 ··················································· 114
제5절 노후 실손 의료비 담보
Ⅰ. 노후 실손의료비 기본형 ························· 115
1. 보장 종목 ·················································· 115
2. 보상내용 ··················································· 115
Ⅱ. 요양병원 실손의료비 특별약관 ·············· 116
1. 보장종목 ···················································· 116
2. 보상내용 ···················································· 116
Ⅲ. 상급병실료 차액보장 특별약관 ·············· 117
1. 보장종목 ··················································· 117
2. 보상내용 ··················································· 117
제6절 의료비 계산문제
Ⅰ. 의료실비 계산문제 1 ······························ 118
Ⅱ. 의료실비 계산문제 2 ······························ 120
Ⅲ. 의료실비 계산문제 3 ···························· 122
Ⅳ. 의료실비 계산문제 4 ······························ 124
Ⅴ. 의료실비 계산문제 5 ······························ 126
Ⅵ. 의료실비 계산문제 6 ······························ 128
Ⅶ. 의료실비 계산문제 7 ······························ 132
Ⅷ. 의료실비 계산문제 8 ······························ 134
Ⅸ. 의료실비 계산문제 9 ······························ 136
Ⅹ. 의료실비 계산문제 10 ···························· 138
제3장 질병보험
제1절 질병보험의 개요 / 145
제2절 암보험
Ⅰ. 한국질병분류표 제5차, 제6차 변경시
암보험 변경 사항 ···································· 146
1. 제5차 질병분류표 변경 주요 내용(2008년)146
2. 제6차 질병분류표 변경 주요 내용
(2011년 1월부터 시행) ···························· 146
Ⅱ. 종양의 분류 ·············································· 147
1. 양성종양과 악성종양 ································· 147
2. 경계성종양 ················································ 148
3. 유암종 ······················································· 149
4. 상피내 암종 ·············································· 149
5. 암보험에서 담보별 암의 분류 ··················· 149
6. 종양의 분류 ·············································· 151
Ⅲ. 암의 진단, 담보책임 개시 및 보험계약의
실효 여부 ·················································· 153
1. 암의 진단 방법 ········································· 153
2. 진단시기 ·················································· 155
3. 암보험 책임개시 ······································ 155
4. 면책기간 내 암 진단과 보험계약의 효력 ·· 156
5. 면책기간 이후 암진단과
보험계약 실효 여부 ·································· 157
Ⅵ. 개별암 검토 ·············································· 157
1. 갑상선암 ··················································· 157
2. 대장점막내암 ············································· 158
3. 랑게르한스세포조직구증의 암진단비 지급 · 159
Ⅶ. 암 조기검진사업의 대상이 되는 5대암과
이들의 검진방법 ······································ 159
1. 의의 ·························································· 159
2. 내용 ·························································· 159
Ⅷ. 암관련 지급 보험금 ································· 160
1. 암진단비 ··················································· 160
2. 두 번째 암 진단비 지급 특별약관 ············ 162
3. 암수술비 ··················································· 162
4. 방사선치료가 수술에 해당되는지 여부 ······ 164
5. 암입원일당 ················································ 164
6. 암소득보상보험 ········································· 166
7. 암사망특약, 암사망유족연금 ······················ 166
8. 항암방사선?약물 치료비 특별약관 ············ 167
제3절 암보험 계산문제
Ⅰ. 암보험 계산문제 1 ·································· 168
Ⅱ. 암보험 계산문제 2 ·································· 169
Ⅲ. 암보험 계산문제 3 ·································· 171
Ⅳ. 암보험 계산문제 4 ·································· 172
제4절 혈관질환과 보험
Ⅰ. 서 ······························································· 175
Ⅱ. 뇌혈관질환 진단비 ·································· 176
1. 뇌졸중 ······················································· 176
2. 뇌졸중 진단방법 ········································ 177
3. 담보 제외되는 뇌혈관질환 ························ 177
4. 열공성 뇌경색의 경우 ······························· 177
Ⅲ. 관상동맥질환 진단비 ····························· 178
1. 유형 ·························································· 178
2. 진단 방법 ·················································· 178
제5절 중대한 질병보험(CI보험)
Ⅰ. 의의 ··························································· 179
Ⅱ. 상품의 유형 ·············································· 179
1. 사망보험금 선지급형 ································· 179
2. CI 보험금 추가지급형 ······························· 180
3. CI 보험금 단독보장형 ······························· 180
Ⅲ. CI 보험에서 담보하는 위험 ··················· 180
Ⅳ. 면책기간 ··················································· 180
1. 책임개시일 ················································ 180
2. 책임개시 전 보험사고의 발생 ··················· 181
Ⅴ. 중대한 암 ················································· 181
1. 의의 ························································ 181
2. 중대한 암의 진단 확정 ····························· 181
3. 중대한 암에서 제외되는 질병 ··················· 181
4. 일반암과 중대한 암의 비교 ······················ 182
Ⅵ. 중대한 뇌졸중 ·········································· 183
1. 의의 ·························································· 183
2. 중대한 뇌졸중의 진단확정 ························ 183
3. 보장에서 제외하는 질병 ···························· 183
Ⅶ. 중대한 급성심근경색증 ··························· 184
1. 의의 ························································ 184
2. 중대한 심근경색에서 제외되는 질환 ········· 184
3. 급성심근경색과 중대한 급성심근경색의
차이 ························································ 185
Ⅷ. CI보험의 중증 질환 ································· 185
1. 말기신부전증 ············································· 185
2. 중증 만성간질환 ······································ 186
3. 중증 만성폐질환 ········································ 186
4. 중대한 화상 및 부식 ································· 188
Ⅸ. CI보험에서 담보되는 중대한수술 ·········· 189
1. 관상동맥(심장동맥)우회술 ························· 189
2. 대동맥류인조혈관치환수술 ························ 190
3. 심장판막수술 ············································· 190
4. 5대장기 이식수술 ····································· 190
Ⅹ. 계산문제 ··················································· 191
1. CI 보험 계산문제 1 ·································· 191
제6절 기타 질병 특약
Ⅰ. 중증 재생불량성빈혈 ······························· 193
1. 정의 ··························································· 193
2. 진단확정 ··················································· 193
3. 제외 사항 ··················································· 193
Ⅱ. 루게릭병 ··················································· 194
1. 정의 ·························································· 194
2. 진단확정 ···················································· 194
Ⅲ. 다발성 경화증 ·········································· 194
1. 정의 ·························································· 194
2. 진단확정 ··················································· 194
Ⅳ. 중증 루프스신염 ······································ 195
1. 정의 ·························································· 195
2. 신장생체검사를 받지 않은 경우 ················ 195
Ⅴ. 크론병 진단비 특약 ································· 196
Ⅵ. 만성 당뇨합병증 진단비 특약 ················ 196
Ⅶ. 양성뇌종양 진단비 특약 ························· 197
Ⅷ. 크로이츠펠트-야콥병 진단비 특약 ········· 198
Ⅸ. 수혈에 의한 HIV 감염 ···························· 198
Ⅹ. 조혈모세포이식수술 담보특약 ················ 199
?. 유방절제수술비담보특약 ························· 200
?. 인공관절수술비 담보특약 ······················· 200
제7절 태아보험
Ⅰ. 특징 ··························································· 201
Ⅱ. 태아 보험의 중요 담보 내용 ················· 201
1. 신생아 장해출생진단 보장 ························ 201
2. 선천이상 수술비특약 ································· 202
3. 입원 일당 ·················································· 202
4. 질병특정고도장해 보장 ···························· 203
5. 출산 모성위험 ··········································· 203
Ⅲ. 태아보험 사례문제 ································· 204
제8절 간병보험
Ⅰ. 서 ······························································· 207
Ⅱ. 면책기간과 진단후 지속기간 ················ 207
Ⅲ. 중증치매간병 ············································ 207
1. 중증치매 간병 ········································· 207
2. 활동불능상태간병 ······································ 208
Ⅳ. 장기요양상태 ·········································· 209
Ⅴ. 장기요양진단비(간병비) ·························· 209
제9절 과로사 담보 특별약관
1. 보상하는 손해 ··········································· 210
2. 과중한 업무부담의 지속 ···························· 211
3. 업무 중 ····················································· 211
4. 돌연한 사망 ·············································· 211
5. 보상하지 않는 손해 ·································· 211
제4장 상해보험
제1절 상해보험
Ⅰ. 상해(재해)의 개념 ··································· 215
1. 서론 ·························································· 215
2. 생명보험에서 재해의 개념 ························ 215
3. 상해보험의 개념 ········································ 215
Ⅱ. 입증책임 ··················································· 219
1. 입증책임의 분담 ········································ 219
2. 우연성과 고의사고 입증책임 ····················· 219
Ⅲ. 상해와 질병의 경합 ································· 220
1. 의의 ·························································· 220
2. 상해가 질병을 야기한 경우 ······················ 220
3. 질병이 상해를 야기한 경우 ····················· 221
4. 상해가 기존질병을 가중한 경우,
질병이 상해를 가중한 경우 ······················ 221
Ⅳ. 상해보험 면책사유 ·································· 222
1. 고의 면책사유 ··········································· 222
2. 약관상 의료과실로 인한
후유장해?사망사고 ···································· 224
제2절 교통상해
Ⅰ. 서론 ··························································· 226
Ⅱ. 교통상해(재해)의 정의 ···························· 226
1. 교통상해(재해)의 의의 ······························ 226
2. 교통수단의 정의 ······································ 227
Ⅲ. 교통상해 면책조항 ·································· 228
1. 작업 중 사고 면책조항
(손해보험 및 생명보험 공통) ···················· 228
2. 설치, 수선, 점검, 정비, 청소 중 사고 ······ 228
3. 하역작업 중 사고 면책조항 ······················ 229
4. 시운전, 경기, 흥행 중 교통사고 면책조항 229
Ⅳ. 교통상해 담보 유형별 검토 ··················· 229
1. 탑승 중 교통사고 ······································ 229
2. 뺑소니?무보험교통상해담보 특별약관 ······· 230
Ⅴ. 대중교통이용 중 상해담보 특별약관 ···· 231
1. 약관규정 ··················································· 231
2. 대중교통수단의 의미 ································· 231
3. 대중교통수단 사고 ···································· 231
Ⅵ. 주말교통상해 ·········································· 232
1. 약관 조항 ·················································· 232
2. 주말의 의미 ·············································· 232
3. 주말의 판단 시점 ······································ 232
제3절 특정 업무중 상해
Ⅰ. 업무 중 상해담보 특약 ··························· 233
1. 약관규정 ··················································· 233
2. 업무 중 사고의 판단 기준 ························ 233
3. 업무 수행 중에 대한 해석 ························ 233
4. 약관의 적용 범위 ······································ 234
Ⅱ. 학교생활 중 상해담보 특약 ··················· 234
1. 약관 규정 ·················································· 234
2. 피보험자의 정의 ········································ 234
3. 수업일의 의의 ··········································· 235
4. 사고의 장소 ·············································· 235
5. 면책사유 ··················································· 235
Ⅲ. 아동상해담보 특약
(유괴?납치?불법감금피해보장 특약) ····· 235
1. 약관규정 ··················································· 235
2. 억류상태 ··················································· 236
Ⅳ. 특정 여가활동 중 상해담보 특약 ·········· 236
1. 약관규정 ··················································· 236
2. 약관에서 정한 특정여가활동의 유형 ········· 236
Ⅴ. 레저보험 ··················································· 237
1. 의의 ·························································· 237
2. 골프보험 ··················································· 237
3. 낚시보험 ··················································· 237
4. 스키보험 ··················································· 237
5. 수렵보험 ··················································· 237
제4절 비용 담보 보험
Ⅰ. 비용담보보험 개론 ·································· 238
1. 정액담보와 실손담보 ································· 238
2. 분담조항의 적용 ········································ 238
Ⅱ. 운전자 보험 비용담보 특별약관 ············ 239
1. 운전자보험에서 담보하는 비용 ················· 239
2. 운전자보험의 담보 형태 ···························· 239
3. 운전자 비용 주요 담보 ····························· 240
4. 면책사유 ··················································· 241
5. 운전자보험 비용담보 사례문제 ················· 242
Ⅲ. 여행자보험 비용담보 ······························· 245
1. 서 론 ························································ 245
2. 여행자 보험 보험기간 ····························· 245
3. 해외여행자보험 특별비용보장 담보 ········· 246
4. 항공기 납치 특별약관 ······························· 247
5. 전쟁위험담보 특별약관 ····························· 247
제5장 후유장해
제1절 후유장해 총론
Ⅰ. 서 ······························································· 251
Ⅱ. 표준약관 내용을 포함한 후유장해 내용 251
1. 후유장해 보험금의 지급사유 ····················· 251
2. 장해의 정의 ·············································· 252
3. 장해판단시기 ·············································· 252
4. 후유장해 보험금 산출 방식 ·························· 253
5. 한시적으로 나타나는 장해 ··························· 256
6. 장해에 포함되지 않는 사항 ·························· 256
8. 장해진단서의 내용 ······································ 257
9. 준용장해와 최저장해 ·································· 258
10. 보험수익자와 회사가 보험금 지급사유에 대해
합의하지 못할 때 ······································ 258
11. 계약 전 알릴 의무에 해당하는 질병 ··········· 258
Ⅲ. 2018년 변경되는 주요 개정내용 ·········· 259
1. 보험보장 사각지대 해소를 위한 신규 장해기준 도입
······································································ 259
2. 소비자 권익 제고를 위한 장해판정기준 정비 259
3. 의학적 객관성 확보를 위한 장해검사방법 개선260
Ⅳ. 장해분류표의 총칙 ·································· 260
제2절 눈의 장해
Ⅰ. 장해의 분류 ·············································· 263
Ⅱ. 장해판정기준 ·········································· 264
Ⅲ. 추상장해와 병합 ······································ 266
Ⅳ. 장해검증 요령 ·········································· 266
제3절 귀의 장해
Ⅰ. 장해의 분류 ·············································· 267
Ⅱ. 장해판정기준 ············································ 268
Ⅲ. 장해 검증 요령 ········································ 270
제4절 코의 장해
Ⅰ. 장해의 분류 ·············································· 271
Ⅱ. 장해의 판정기준 ······································ 271
Ⅲ. 장해검증 요령 ·········································· 272
제5절 씹어 먹거나 말하는 장해
Ⅰ. 장해의 분류 ·············································· 273
Ⅱ. 장해의 판정기준 ······································ 274
제6절 외모의 추상장해
Ⅰ. 장해의 분류 ·············································· 277
Ⅱ. 장해의 판정기준 ······································ 277
Ⅲ. 장해 적정성평가 ······································ 279
제7절 척추(등뼈)의 장해
Ⅰ. 장해의 분류 ·············································· 280
Ⅱ. 장해의 판정기준 ······································ 281
제8절 체간골의 장해
Ⅰ. 장해의 분류 ·············································· 285
Ⅱ. 장해의 판정기준 ······································ 286
Ⅲ. 장해판정시 검증요령 ······························· 286
제9절 팔의 장해
Ⅰ. 장해의 분류 ·············································· 287
Ⅱ. 장해판정기준 ·········································· 288
Ⅲ. 도수근력검사 ············································ 290
제10절 다리의 장해
Ⅰ. 장해의 분류 ·············································· 291 Ⅱ. 장해판정기준 ············································ 292
제11절 손가락의 장해
Ⅰ. 장해의 분류 ·············································· 295 Ⅱ. 장해판정기준 ·········································· 296
제12절 발가락의 장해
Ⅰ. 장해의 분류 ·············································· 298
Ⅱ. 장해판정기준 ············································ 299
제13절 흉?복부 장기 및 비뇨생식기의 장해
Ⅰ. 장해의 분류 ·············································· 301 Ⅱ. 장해판정 기준 ·········································· 302
제14절 신경계?정신행동 장해
Ⅰ. 장해의 분류 ·············································· 305
Ⅱ. 장해판정기준 ············································ 306
Ⅲ. 일상생활 기본동작(ADLs) 제한 장해평가표
··································································· 312
1. 일상생활기본동작(ADLs) 제한 장해평가표 312
제15절 장해지급률이 100%인 장해상태
1. 눈의 장해 ·················································· 315
2. 씹어먹거나 말하는 장해 ···························· 315
3. 팔의 장해 또는 다리의 장해 ····················· 315
4. 신경계?정신행동 장해 ······························· 315
제16절 후유장해 보험금 계산문제
Ⅰ. 후유장해 계산문제 1 ······························ 316
Ⅱ. 후유장해 계산문제 2 ······························ 317
Ⅲ. 후유장해 계산문제 3 ······························ 320
Ⅳ. 후유장해 계산문제 4 ······························ 322
Ⅴ. 후유장해 계산문제 5 ······························ 324
Ⅵ. 후유장해 계산문제 6 ······························ 325
Ⅶ. 후유장해 계산문제 7 ······························ 327
Ⅷ. 후유장해 계산문제 8 ······························ 329
Ⅸ. 후유장해 계산문제 9 ······························ 331
Ⅹ. 후유장해 계산문제 10 ···························· 333
?. 후유장해 계산문제 11 ···························· 335
?. 신체부위별 장해의 분류와 지급률 ········ 337
제6장 보험 급부
제1절 사망보험금
Ⅰ. 사망보험금 개관 ······································ 341
1. 의의 ·························································· 341
2. 사망의 추정 ················································ 341
3. 80% 이상 후유장해 시 사망으로 간주하는 보험
······································································ 342
4. 사망보험금의 지급 ······································ 342
제2절 사망보험금 계산문제
Ⅰ. 사망보험금 계산문제 1 ·························· 343
Ⅱ. 사망보험금 계산문제 2 ·························· 344
Ⅲ. 사망보험금 계산문제 3 ·························· 345
Ⅳ. 사망보험금 계산문제 4 ·························· 346
Ⅴ. 사망보험금 계산문제 5 ·························· 347
Ⅵ. 사망보험금 계산문제 6 ·························· 348
Ⅶ. 사망보험금 계산문제 7 ·························· 350
제3절 입원급여금
Ⅰ. 입원급부금 개관 ···································· 352
1. 입원의 의의 ·············································· 352
2. 입원의 기준 ·············································· 352
3. 입원급여금 인정 기준 ······························· 352
제4절 수술급부금
1. 수술의 의의 ·············································· 355
2. 수술 인정 요건 ········································· 355
3. 수술급여금 보장 횟수 ······························· 356
■ 2017년 신체손해사정사 제2차 시험문제 ························································································· 357
■ 2016년 신체손해사정사 제2차 시험문제 ························································································· 368
■ 2015년 신체손해사정사 제2차 시험문제 ························································································· 379
■ 질병·상해보험 표준약관 ························································································································ 392