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(영문) 의정부지방법원 2018.12.14 2018가단115276

보험금

Text

1. Insurance proceeds for the plaintiff's medical examination expenses for brain cerebrovascular diseases (e.g., renewal) based on an insurance contract indicated in the attached Form.

Reasons

1. Basic facts

A. The Plaintiff, an insurance company running non-life insurance business, etc., concluded an insurance contract with the Defendant on October 25, 2010 (hereinafter “instant insurance contract”).

B. The main contents of the special terms and conditions applicable to the instant insurance contract (hereinafter “instant special terms and conditions”) are as follows.

Article 1 (Definition and Determination of Brain Diseases) The term "cerebrovascular diseases" in this Special Terms and Conditions refers to diseases specified in [Attachment Table 15] in the 5th Korean Standard Disease Disease Classification.

The diagnosis and confirmation of cerebrovascular diseases must be conducted by a person with a medical license (other than dentists) of a hospital prescribed in Article 3(2) of the Medical Service Act or of a medical institution recognized as equivalent thereto, and this diagnosis shall be based on brain computer-oriented layer shooting, self-official image, MFI, cerebrovascular surgery, double-electronic emission layer(PET), ESPECT, and brain diversology testing.

Article 2 (Types and Grounds for Payment of Insurance Money) If an insured person (person subject to insurance) is diagnosed as "cerebrovascular disease" during the insurance period, the company shall pay the following amount only once for the first time to the beneficiary (person who receives the insurance money) at the expense of diagnosis of brain-related diseases, and if there is no designation of the beneficiary (person who receives the insurance money), the insured (person subject to insurance).

When examining brain cerebrovascular diseases for less than one year after entering into an initial contract to renew the contract for diagnosis expenses for brain cerebrovascular diseases for less than one year, the amount of insurance covered by this Special Terms and Conditions 0.5 times the amount of insurance covered by this Special Terms and Conditions / [Attachment 15] of the insurance covered by this Special Terms and Conditions / the amount of insurance covered by this Special Terms and Conditions / [Attachment 15] shall be classified as brain cerebrscular diseases under the 5th revised Korean Standard Industrial Classification Agency notification.