4-Week Diagnostic Certificate During Traffic Accident Treatment, When and How to Submit It — Gangbuk Suyu Korean Medicine Clinic Guide
Author: Director Lee Moon-young (Representative Director, Gangbuk Anjeong Korean Medicine Clinic)
This content has been prepared in compliance with relevant laws and regulations including the Medical Service Act.
Traffic Accident 4-Week Diagnostic Certificate, Key Points First — Why Is the 28-Day Mark from Accident Date Important?
Victims with minor injuries (injury grades 12–14) such as sprains and contusions are covered by treatment cost payment guarantee for up to 4 weeks (28 days) from the accident date without a diagnostic certificate. In other words, if pain persists after 4 weeks, you must obtain a diagnostic certificate just before the 4-week deadline and submit it to the insurance company to continue receiving treatment coverage.
According to the Financial Supervisory Service consumer caution notice, for accidents occurring after January 2023, failure to submit a diagnostic certificate will result in payment guarantee being suspended at the 4-week mark. Additionally, if the diagnostic certificate is submitted late, treatment costs incurred during the gap period may be excluded from compensation.
⚠️ This applies to minor injury patients (injury grades 12–14). Moderate to severe injury patients (grades 1–11) can receive treatment without time restrictions, and even minor injury patients (grades 12–14) can receive treatment for 8 weeks or longer if medical necessity is recognized.
What Changed Under the Revised Terms — Background and Structure of the Minor Injury Patient 4-Week Rule
Why Was This Regulation Created?
Numerous cases were reported in which traffic accident victims received long-term treatment without objective evidence and demanded excessive settlement amounts. To set objective treatment periods for minor injury patients, system improvements were made. According to the Insurance Research Institute (KIRI) report, the automobile insurance standard terms resolution occurred in December 2021, and with implementation in January 2023, the baseline treatment period for minor injury patients (injury grades 12–14) was set to 4 weeks, and submission of diagnostic certificates in 2-week units for treatment exceeding 4 weeks became mandatory.
4-Week Treatment Structure at a Glance
| Treatment Period | Diagnostic Certificate Requirement | Insurance Company Payment Guarantee |
|---|---|---|
| Accident date ~ 4 weeks (28 days) | Not required | Automatically maintained |
| Beyond 4 weeks and thereafter | Diagnostic certificate submission required before 4-week deadline | Resumes from submission time |
| Additional extension after 4 weeks | Additional diagnostic certificate submission in 2-week units | Extended for period stated in diagnostic certificate |
| Beyond 8 weeks | Insurance company review may intensify | Medical necessity evidence required |
If you fail to submit the diagnostic certificate by the deadline, the insurance company's payment guarantee for treatment costs will be suspended, and you may face the situation of having to pay for treatment yourself. The Financial Supervisory Service official guidance also states that "compensation resumes from the time of diagnostic certificate submission, and if submitted late, treatment costs during the gap period may be excluded from compensation."
"I Received a 2-Week Diagnostic Certificate, Will It Be Disadvantageous If I Go Beyond 4 Weeks?"
The diagnostic period in weeks refers solely to a primary period when intensive treatment is medically necessary, not a legal settlement deadline. Even if you received a 2-week diagnosis, you can continue treatment if pain remains, and it is advisable not to rush settlement before 4 weeks pass and to submit an additional diagnostic certificate before the 4-week deadline.
5-Step Diagnostic Certificate Issuance Procedure We Handle at Gangbuk Anjeong Korean Medicine Clinic
At Gangbuk Anjeong Korean Medicine Clinic (formerly Gwangdeok Anjeong Korean Medicine Clinic, Gangbuk Suyu Branch), we carefully assist with imaging tests at partner hospitals from the early stages of traffic accident care, systematic post-injury management, and diagnostic certificate schedule guidance.
✓ STEP 1. Visit Right After Accident — Secure Initial Records
Visit on the day of the accident or shortly after and record pain locations and symptoms without omission. After an accident, many people focus only on the most painful area initially, then experience pain in other areas a few days later. If additional pain develops, it is important to immediately inform your attending medical professional and request detailed examination of that area.
✓ STEP 2. After 1 Week from Accident — Coordinate Imaging Tests at Partner Hospital
Gangbuk Anjeong Korean Medicine Clinic can coordinate detailed imaging tests such as MRI and X-ray at partner hospitals one week after the accident date. Imaging test results are later utilized as objective evidence for diagnostic certificate issuance and insurance company review.
✓ STEP 3. Week 3 Visit — Confirm Diagnostic Certificate Issuance Schedule with Attending Director in Advance
Working backward from the 4-week expiration date, discuss the timing of diagnostic certificate issuance with the attending director during week 3 visit. It is also important to clearly communicate the purpose of the diagnostic certificate. If for traffic accident insurance processing purposes, requesting specific documentation of items such as "causal relationship with traffic accident" and "whether daily activities and work are affected" can work favorably in insurance company review.
✓ STEP 4. Before 4-Week Deadline — Issue Diagnostic Certificate and Submit to Insurance Company
If pain persists after 4 weeks, obtain an additional diagnostic certificate from your attending medical professional 2-3 days before the expiration date and submit it to the insurance company. You can pick up the diagnostic certificate and medical confirmation directly after your visit, or contact the clinic to receive it by fax.
✓ STEP 5. After 4 Weeks — Extend with Additional 2-Week Unit Diagnostic Certificates
According to the Insurance Research Institute (KIRI) report, to continue treatment after 4 weeks, you must submit additional diagnostic certificates in 2-week units, and payment guarantee is maintained only by reissuing and submitting another diagnostic certificate before each period expires. You can continue treatment while repeating this procedure until your physical condition recovers.
Must Confirm Before Treatment
Before submitting a diagnostic certificate during traffic accident treatment, check the following items yourself.
✓ Confirm your injury grade is 12–14 (minor) — Procedures differ according to injury grade.
✓ Personally calculate 28 days from accident date — Check the expiration date on a calendar.
✓ Request diagnostic certificate 2-3 days before 4-week deadline — Allow time for issuance; request in advance.
✓ Verify that diagnostic certificate includes disease name, treatment period, and causal relationship — Specific documentation rather than simple "treatment necessary" can work favorably in insurance company review.
✓ If pain in other areas develops later, immediately add to records — According to relevant legal materials, areas omitted from initial records become increasingly difficult to prove causal relationship with the accident as time passes.
✓ Confirm diagnostic certificate issuance cost — While it varies by facility, generally 10,000–20,000 won; confirm with your attending medical professional whether diagnostic certificate issuance costs for traffic accident insurance processing purposes can be handled through insurance later.
✓ For proxy issuance — Power of attorney and proxy's identification are required.
⚠️ Warning (General Limitations of Treatment): Even after submitting a diagnostic certificate, the insurance company may adjust treatment period or costs through review. Regarding this, please inquire at the Financial Supervisory Service civil complaint center or consult with your attending medical professional. Results may differ depending on individual circumstances.
If you are looking for a Suyu Station Korean Medicine Clinic or Gangbuk-gu Traffic Accident Korean Medicine Clinic, or considering Mia-dong traffic accident treatment, the key to recovering treatment costs is maintaining systematic records from the early stages of the accident and carefully managing the diagnostic certificate schedule.
4-Week Diagnostic Certificate, We Consult Step by Step from the Beginning
At Gangbuk Anjeong Korean Medicine Clinic, from diagnostic certificate issuance scheduling to coordinating imaging tests at partner hospitals and individualizing herbal medicine formulations for blood stagnation management, we consult step by step on treatment after 4 weeks.
If a minor injury patient fails to submit a diagnostic certificate to the insurance company before 4 weeks (28 days) pass, payment guarantee is suspended, and treatment costs from that point until diagnostic certificate submission become difficult to obtain compensation for. Many people find it difficult to manage this procedure alone. Traffic accident aftereffects may not be immediately noticeable, but blood stagnation can accumulate or pain can become chronic, making it important to maintain consistent records from the early stages of the accident and continue treatment.
Gangbuk Anjeong Korean Medicine Clinic operates 365 days a year without holidays, beginning medical service from 8 AM on weekdays, weekends, and holidays, and online booking through Naver is available. We keep our doors open for immediate visits even right after an accident. Located near Exit 3 of Suyu Station with complete elevator facilities, you can use the large parking lot at the nearby Garden Tower (Dobong-ro 328) free of charge.
Frequently Asked Questions
Q1. If I'm not a minor injury patient but a moderate to severe injury patient (grades 1–11), must I submit a 4-week diagnostic certificate?
Minor injury patients with injury grades 1–11 do not have the 4-week standard applied and can receive treatment without time restrictions. The 4-week diagnostic certificate mandatory submission rule applies only to minor injury patients (grades 12–14). If you are curious about your injury grade, you can confirm it with your insurance company or the medical facility you visit.
Q2. Can a Korean medicine clinic issue a diagnostic certificate?
Yes, Korean medicine clinics can issue diagnostic certificates and medical confirmation certificates. After your visit and treatment is completed, request from the attending director, or you can contact the clinic later to receive it by fax. It helps to clearly communicate the purpose (traffic accident insurance processing).
Q3. Who bears the cost of diagnostic certificate issuance?
Diagnostic certificate issuance costs are generally borne initially by the patient, but in the case of traffic accident insurance processing, it may be possible to bill the insurance company later for reimbursement. For the exact handling method, please inquire with your insurance company or the medical facility you visit.
Q4. If I submit the diagnostic certificate after 4 weeks have passed, what happens to the treatment costs during that time?
According to the Financial Supervisory Service official guidance, compensation resumes from the time of diagnostic certificate submission, so treatment costs incurred during the gap from the 4-week deadline to submission may be excluded from compensation. Please make sure to submit the diagnostic certificate before the 4-week deadline.
Q5. If continued treatment is needed after 4 weeks, how many more times must I submit a diagnostic certificate?
After 4 weeks, you must submit additional diagnostic certificates in 2-week units, and payment guarantee is maintained only by reissuing and submitting another diagnostic certificate before each period expires. You can continue treatment by repeating this procedure until your physical condition fully recovers.
Results may differ depending on individual circumstances.