현행 사회보험 권리구제제도의 문제점 및 개선방안

초록

This study was carried out to investigate the present conditions and discuss the issues of the administrative appeal system in the social insurance sector such as heath insurance, industrial accident compensation insurance and national pension. There are commonly two stages of appeal within the insurance system; a request for examination and a request for reexamination. The appealers can file an administrative litigation with or without the aforementioned administrative adjudication procedures. Approvals through administrative adjudication have been increasing in contrast to administrative litigation; this implies that the administrative appeal system has played an important role in protecting the rights of beneficiaries. The current appeal system has several problems in the following aspects; Firstly, there are too few experts to deal with the appeals within a legally regulated time limit. Secondly, the current system restricts the range of appeals in many parts therefore, many complaints cannot be solved under the current appeal system. Thirdly, there is a lack of objectivity in the process of examination and reexamination. In particular, in the case of industrial accident compensation insurance, there is no independent examination committee. In the case of health insurance, those who are responsible for reexamination delegate the reexamination procedures to the agencies responsible for first examination.

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