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(영문) 서울고법 2013. 10. 31. 선고 2013나2002915 판결

[보험금] 상고[각공2014상,1]

Main Issues

In a case where Gap suffered an injury due to Obameral accident since Eul concluded an injury insurance contract with Eul insurance company as the insured, and Byung did not notify Eul company of the operation of Obameral accident, the case holding that Eul company cannot claim as the content of the insurance contract the provisions of the insurance clause which did not perform its duty to specify and explain.

Summary of Judgment

In a case where Gap suffered bodily injury due to Obane accident after concluding the injury insurance contract with Eul insurance company as the insured by Eul and Byung, Byung did not notify Byung company of the fact of operation of Obane, the case holding that Eul company cannot assert the provisions of the insurance contract as the content of the insurance contract on the ground that the phrase "if the insured, after concluding the contract, has used a two-wheeled automobile or motorcycle directly, it shall be notified to Eul company" as the content of the insurance contract is an important matter not exempt from the duty to specify and explain the insurance clauses of Eul company under the insurance contract, on the ground that Gap's explanation of the insurance contract was made by the insurance solicitors belonging to other insurance company, not by Eul company, but by the insurance agencies belonging to Eul company or its insurance solicitors, on the ground that Eul did not perform the duty to explain and explain the insurance clauses of Eul company.

[Reference Provisions]

Article 638-3(1) of the Commercial Act, Article 3 of the Regulation of Standardized Contracts Act

Plaintiff, Appellant

Dongbu Fire Marine Insurance Co., Ltd. (Law Firm Vindication, Attorney Choi Gyeong-soo et al.

Defendant, appellant and appellant

Defendant (Attorney Cho Young-do, Counsel for defendant-appellant)

The first instance judgment

Incheon District Court Decision 2012Gahap1640 decided January 9, 2013

Conclusion of Pleadings

October 10, 2013

Text

1. Revocation of the first instance judgment.

2. The plaintiff's claim is dismissed.

3. All costs of the lawsuit shall be borne by the Plaintiff.

Purport of claim and appeal

1. Purport of claim

In relation to the traffic accidents listed in paragraph (1) of the attached list, it is confirmed that there is no insurance obligation of the plaintiff against the defendant based on the insurance contract listed in paragraph (2) of the attached list.

2. Purport of appeal

The same shall apply to the order.

Reasons

1. Basic facts

A. The insurance contract of this case

Around July 30, 2009, Nonparty 1 entered into an insurance contract in the attached Table No. 2 (hereinafter “instant insurance contract”) with the Plaintiff as the insured, the Defendant’s insured, and the Defendant’s physical injury due to an unexpected accident. The insurance clause applicable to the instant insurance contract provides for the following obligations to notify the policyholders and the insured after the contract is concluded.

Article 26 (Duty to Notify After Contract)

(1) Where the insured changes his/her occupation or duties or directly uses a two-wheeled motor vehicle or a motorcycle after concluding a contract, the contractor or the insured shall, without delay, notify the company in writing and obtain confirmation on the insurance policy.

(2) If the risk has decreased pursuant to paragraph (1), the company shall return the difference insurance premium, and where the risk has increased, it may request or terminate the contract within one month from the date of receipt of notice.

Article 27 (Effect of Violation of Obligation to Notify)

1. The Company may terminate this contract, regardless of the occurrence of damages, in the following cases:

(2) fails to perform the duty to inform after the conclusion of a contract prescribed in section 26(1) with respect to a significant increase in risk;

B. The instant accident

이 사건 보험계약 체결 후 피고는 2011. 8. 9.경 제2종 원동기장치자전거 운전면허를 취득한 후 소외 1이 구입한 무등록 100㏄ 오토바이를 주 2, 3회 정도 학교(○○○○고등학교) 등·하교길에 타고 다녔다. 그러던 중 피고는 2011. 9. 24. 21:23경 위 오토바이를 운전하여 부천시 소사구 (주소 1 생략) 세븐일레븐 앞 교차로를 진행하다가 오른쪽에서 진행하여 온 다른 차량과의 충격으로 넘어지면서 근처에 주차된 승용차에 머리를 부딪쳐 상해를 입는 교통사고를 당하였다(이하 ‘이 사건 사고’라 한다).

After the occurrence of the instant accident, Nonparty 1 claimed the Plaintiff to pay the insurance money under the instant insurance contract, but on January 19, 2012, the Plaintiff notified the Defendant and Nonparty 1 that the instant insurance contract will be terminated in accordance with Article 27 of the said insurance contract without paying the insurance money on the ground that the Defendant and Nonparty 1 did not perform the duty of disclosure under Article 26(1) of the said insurance contract.

[Reasons for Recognition] Unsatisfy, entry of Gap 1 through 11, the purport of the whole pleadings

2. The parties' assertion

A. The plaintiff's ground for claim

The Defendant’s act of driving Otoba is an important fact that significantly increases the risk of the insurance accident against the Defendant, the insured under the instant insurance contract. Nonparty 1 or the Defendant should have notified the Plaintiff pursuant to Article 26(1) of the said insurance contract. Nevertheless, the Defendant and Nonparty 1 did not perform the above duty of disclosure, and the Plaintiff terminated the instant insurance contract on January 19, 2012 in accordance with Article 27 of the said insurance contract, and accordingly, sought confirmation of the absence of the obligation to pay the insurance proceeds in relation to the instant insurance accident.

B. Defendant’s assertion

The insurance contract of this case was recruited by Nonparty 2, an insurance solicitor, who is not the Plaintiff’s affiliated non-party, and the explanation was made only by Nonparty 2, and did not explain according to the insurance terms and conditions at the time of entering into the contract. In addition, Nonparty 2 did not properly explain to Nonparty 1 the content of the insurance clause that “if the insured acquired and operated a two-wheeled vehicle license after entering into the contract, the insured shall be notified the Plaintiff, and if the contract is violated, the contract may be terminated.” Therefore, the Plaintiff cannot terminate the insurance contract of this case on the ground of the violation of the duty of disclosure by the Defendant and Nonparty 1. Therefore, the Plaintiff cannot terminate the insurance contract of this case on the ground of the Defendant’s violation

3. Determination

A. Facts of recognition

The following facts can be acknowledged in light of the contents of evidence Nos. 3, 4, 9, and 11 and the partial testimony of Non-Party No. 2 by Non-Party No. 1 (excluding the parts not trusted in the rear).

① Around July 2009, Nonparty 1 asked Nonparty 2, an insurance solicitor of the school news life, known to ordinary knowledge, about the insurance coverage against the Defendant’s injury, disease, etc., and Nonparty 2, who heard Nonparty 1’s wish, offered the instant insurance contract, which is the Plaintiff’s insurance product, on the ground that Nonparty 2 did not treat the insurance products corresponding thereto in the school life life and handled the Plaintiff.

② Accordingly, Non-party 3, an insurance solicitor of the Hyspon Co., Ltd. (hereinafter “Hyspon”) who was responsible for the conclusion of the instant insurance contract, requested Non-party 2 to receive the signature of Non-party 1 in the insurance subscription form. Accordingly, Non-party 2 presented the insurance subscription form of the instant insurance contract to Non-party 1 in front of Non-party 1’s workplace around 15:00 on July 30, 2009, in front of the ○○○-si located in the Maspon-si ( Address 2 omitted), Non-party 2 was seated in the driver’s seat, and Non-party 1 was seated in the front seat, and Non-party 2 presented the insurance subscription form of the instant insurance contract to Non-party 1.

(3) Upon receipt of the insurance subscription form as above, Nonparty 1 stated in the item of “the insured is under duty to inform before the contract” in the insurance subscription form “the insured is under duty to drive at present” as the item of “influence” in the “influence” column of “influence,” and indicated “+” on the item of “influent ownership” in the “influence” column of questioning whether or not the two-wheeled vehicle owns, and under the question above, Nonparty 1 stated that “* a two-wheeled automobile includes the engine and inform the company thereof at the time of any subsequent change of the above contents (motor vehicle driving, etc.). In addition, Nonparty 1 stated and signed the name at the bottom of the “matters to be notified

④ Nonparty 3 prepared the part of the “consumer interview report” in the above insurance subscription form delivered by Nonparty 2, stating that “The policyholder and the insured shall have direct interviews, enter “the mandatory matters prior to the contract” and “written signature” in full, explain in detail the goods and the terms and conditions, confirm the customer writing, and accurately prepare a report on the contents of the interview.” The Plaintiff thereafter delivered the insurance clauses and the insurance policy of the instant insurance contract to Nonparty 1 by mail.

⑤ Meanwhile, the Defendant and Nonparty 1 did not notify the Plaintiff of the acquisition of the Defendant’s above motorcycle driver’s license and the above motorcycle driver’s license until the instant accident occurred.

B. Whether an insurance policy is fulfilled with the duty to specify and explain

1) Article 638-3(1) of the Commercial Act provides that the insurer shall deliver the insurance clause to the policyholder and inform the policyholder of the important contents of the insurance clause. In general, the insurer and the person engaged in the conclusion or solicitation of the insurance contract shall, upon entering into the insurance contract, specify and explain the important contents of the insurance contract, such as the content of the insurance contract, the insurance premium rate system, and changes in the entries in the written subscription for the insurance.

The recognition of the duty to specify and explain such insurance terms and conditions is based on the fact that a policyholder would be at an unexpected disadvantage because the important matters of the terms and conditions are the subject of a contract while the policyholder is unaware. Thus, even if the terms and conditions are stipulated in the terms and conditions, if a matter already known or could have been sufficiently anticipated without a separate explanation, or if the matter is merely a matter that has already been determined by the Acts and subordinate statutes, it is not recognized that the duty to specify and explain such matter is not required.

However, the content of the contract cannot be asserted as the content of the contract if the contract was concluded in violation of the duty to specify and explain the terms of the contract, unless the contract is exempt from the duty to explain and explain. Meanwhile, in the insurance contract to which the provision of injured water supply corresponding to the occupation or duty other than driving of a two-wheeled automobile is applied, etc., the contents of the contract, such as "if the two-wheeled automobile is directly used after the conclusion of the contract, the risk of issuing accidents is significantly changed or increased, so it is required to notify the insurer without delay." (see Supreme Court Decision 2009Da91316, 91323, Mar. 25, 2010, etc.).

2) The duty to specify and explain such insurance terms and conditions shall be performed by “insurers and persons engaged in the conclusion or solicitation of insurance contracts”. The Insurance Business Act limits any person entitled to engage in the solicitation of insurance contracts (insurance contracts as a broker or an agent) to insurance solicitors and insurance agencies registered with the Financial Services Commission (Articles 83, 84, 86), and the insurance company prohibits, in principle, insurance solicitors belonging to other insurance companies from entrusting insurance solicitors belonging to them with the solicitation of insurance or for any person other than the insurance company to which they belong (Article 85).

In light of the purport that the Insurance Business Act limits persons eligible for soliciting insurance contracts to persons meeting certain qualifications, and prohibits, in principle, the solicitation of insurance contracts by other insurance companies than the insurance companies under its control, and the fact that only the insurance agencies or insurance solicitors belonging to the relevant insurance company that clearly grasp the contents through appropriate education on the insurance products, terms, etc. of the relevant insurance company can explain the insurance products and terms and conditions of the relevant insurance company properly, barring special circumstances, the above explanation by other persons than the legitimate insurance agencies or insurance solicitors in charge of soliciting the relevant insurance contracts cannot be deemed as having fulfilled their duty to specify and explain the insurance terms and conditions, barring special circumstances.

In light of the above legal principles, Article 26(1) of the Insurance Terms and Conditions of the instant insurance contract provides that “if the insured uses a two-wheeled automobile or a motorcycle directly after the conclusion of the contract, it shall be notified to the Plaintiff.” However, the explanation of the instant insurance contract against Nonparty 1 was made by Nonparty 2, an insurance solicitor belonging to the Plaintiff, not the Plaintiff, and was made by Nonparty 3, the insurance agency of the Plaintiff, and did not contain any explanation by Nonparty 3, the insurance agent of the Plaintiff, and thus, barring any special circumstance, it cannot be deemed that Nonparty 2 performed the duty to specify and explain the insurance terms and conditions of the instant insurance contract with the Plaintiff only with the above explanation of Nonparty 2, barring any special circumstance.

As to this, the Plaintiff asserts that Nonparty 2 may perform the Plaintiff’s duty of explanation because Nonparty 2 lawfully recruited the instant insurance contract through a cross-solicitation under Article 85(3) of the Insurance Business Act. However, the insurance subscription form of the instant insurance contract is indicated as “Sastf franchise 3” or “non-party 3” as the handler of the instant insurance contract, and Nonparty 2 did not entirely indicate it (A evidence 11), and as seen earlier, Nonparty 3 submitted a customer interview with the Plaintiff that “the Plaintiff had interviewed the direct customer and explained the terms and conditions of the contract.” As such, the instant insurance contract can be deemed as having been recruited by well-known franchise or non-party 3, and it cannot be said that Nonparty 2 recruited by a lawful cross-solicitation. Therefore, the Plaintiff’s aforementioned assertion is without merit.

In addition, the plaintiff argues that the validity of the insurance contract of this case should also be denied if the non-party 2 did not lawfully invite the insurance contract of this case. However, as long as the signature and seal of the above insurance subscription of the non-party 1 is valid, and the plaintiff accepted the above insurance subscription as it is and delivered the insurance policy, the insurance contract of this case itself is valid, and even if the non-party 2, who is another insurance solicitor, was involved in the recruitment process, it appears that the non-party 2 was authorized to the degree of the well-dying franchise concerning the conclusion of the insurance contract or the non-party 3's resignation. Thus, the plaintiff's above assertion is not subject to the effect of the insurance contract of this case by the above intervention.

3) Meanwhile, in light of the legal principles as seen earlier, it is difficult to believe that the above explanation by Nonparty 2 was made to the extent that it can be seen that the insurance contract was performed with specific and detailed explanation and explanation as to the important contents of the insurance contract in accordance with the above legal principles. ① The above explanation by Nonparty 2 was made within the vehicle stopped on the street, and the above “matters to be notified prior to the contract” is written in a less than other parts under the reference without distinguishing the part to be notified from the two separate terms and conditions (the above portion was read to Nonparty 1 as it is, and it is difficult to believe that the above part was read and confirmed to be read together with the above part, in light of the circumstances at the time of the above preparation and the whole quantity of the contents to be read, it is difficult to see that the above explanation and explanation were made to the company as to the extent that it is difficult to directly explain the terms and conditions of the insurance contract as well as the above contents of the insurance contract, and in light of Article 26(1) and (2) of the above, it is difficult to directly explain the above content and the above content of the insurance contract.

4) Therefore, the Plaintiff cannot assert Articles 26(1) and 27(1) of the above Insurance Clause, which did not perform his duty to specify and explain, as the content of the instant insurance contract. Accordingly, the Plaintiff’s claim of this case premised on the lawful termination of the instant insurance contract, is without merit.

4. Conclusion

Therefore, the plaintiff's claim is dismissed, and the judgment of the court of first instance is unfair with different conclusions, and the plaintiff's claim is dismissed. It is so decided as per Disposition.

[Attachment] Indication of Insurance Accidents and Insurance Contracts: Omitted

Judges Yoon Jin (Presiding Judge)

(3) Where any insurance solicitor belonging to a life insurance company or an insurance company specialized in Type 3 insurance business performs the insurance solicitation for one non-life insurance company; 2. Where an insurance solicitor belonging to a life insurance company or an insurance company specialized in Type 3 insurance business performs the insurance solicitation for one life insurance company; 3. Where an insurance solicitor belonging to a life insurance company or a non-life insurance company performs the insurance solicitation for one life insurance company;