[2] Whether to bear the burden of proving the violation of duty of disclosure under an insurance contract and the existence of causation (= policyholder's side)

[3] The purpose and the method of interpreting the fire insurance clause which provides that "where the contractor or the insured intentionally enters false matters in the documents concerning the notification of damage or the claim for insurance money, or forges or alters documents or evidence, he/she shall lose his/her right to claim insurance money"

1. Regarding ground of appeal No. 1

"Important matters" under Article 651 of the Commercial Act, which is required to notify the insurer at the time of the insurance contract, means the standard matters for the insurer to determine whether to conclude the insurance contract or the contents of the insurance contract such as the addition of premium or special exemption clause by measuring the occurrence of the insurance accident and the estimated rate of liability arising therefrom, and objectively, if the insurer knows the fact, it refers to the matters that should not conclude the contract, regardless of whether to conclude the contract, or at least the same condition, if it is objectively known that the insurer knows the fact. Any fact-finding problem, which must vary depending on the type of insurance, must be objectively observed and determined in light of the technology of the insurance. However, the matters asked in writing by the insurer, can be presumed to fall under important matters in the insurance contract (Article 651-2 of the Commercial Act), and the written subscription of the insurer can be included in the insurance contract (see, e.g., Supreme Court Decision 651Da1849, Jun. 13, 2004).

In a case where the contract of insurance violates the duty of disclosure of important matters in the contract, it is proved that the violation of the duty of disclosure did not affect the occurrence of the insurance accident. In other words, when it is proved that the occurrence of the insurance accident was not by the policyholder's non-disclosure or by the false notification, the insurer cannot terminate the insurance contract on the ground of the non-disclosure notification. However, in accordance with the proviso of Article 655 of the Commercial Act, the burden of proving that the occurrence of the insurance accident and the absence of the causation is on the part of the policyholder. Thus, if there is room to determine the existence of the causation even if it is possible, the above proviso should not be applied (see Supreme Court Decision 92Da28259 delivered on October 23, 192).

Based on its stated reasoning, the court below determined that since the Plaintiff (Counterclaim Defendant; hereinafter “Plaintiff”) asked the Defendant (Counterclaim Plaintiff; hereinafter “Defendant”) about whether visual impairment occurred in each of the instant insurance contracts in writing, the issue of visual impairment is presumed to be an important matter in each of the instant insurance contracts. However, the Defendant stated the fact that the Plaintiff was treated at the right time in the process of amending the instant first insurance contract on August 17, 2009, but confirmed that there was no visual impairment, the Plaintiff could terminate the instant first insurance contract in violation of the Defendant’s duty of disclosure, and the Defendant’s visual impairment can be deemed to have contributed to 10% of the occurrence of the instant accident, and thus, it cannot be concluded that there was no causation between the Defendant’s breach of duty of disclosure and the instant accident.

In light of the above legal principles and records, the above judgment of the court below is just, and there is no violation of the rules of evidence or misapprehension of legal principles as to causation with the violation of duty of disclosure as alleged in the

2. Regarding ground of appeal No. 2

The purpose of the fire insurance clause, which provides that "if the contractor or the insured intentionally states false facts in the documents concerning notification of damage or claim for insurance money, or if such documents or evidence are forged or altered, the insured shall lose the right to claim insurance payment against the damage, the insured shall lose the right to claim insurance payment against the damage." Although the insurer needs to be aware of the cause and situation of the insurance accident, and the degree of damage for the determination of the amount of compensation, etc., in most cases, materials related thereto are located in the area of control and management over the contractor or the insured, it is highly necessary to provide accurate information about such fact. Accordingly, if the insured claims excessive insurance money in a fraudulent manner contrary to the principle of trust and good faith by forging documents or manipulating evidence against this request, it is necessary to impose sanctions against the insured's loss of the right to claim insurance money: Provided, That deeming the insurer exempted from liability only if it violates the terms and conditions of the above contract by strictly interpreting the terms and conditions, it would be in conflict with the social utility and economic functions of the insurance that intends to protect the multiple victims, and would unfairly be unfairly unfavorable to the customer.

For reasons indicated in its holding, the lower court determined that, under Article 22 of the General Insurance Contract Clause of this case, the Defendant lost its right to claim against the Plaintiff, on the ground that the Defendant intentionally stated in the documents concerning claims for insurance money in order to receive excessive payment of insurance money, although the Defendant could only claim the insurance money reduced according to the premium rate to be applied after a change in duties due to the change

In light of the above legal principles and records, the above determination by the court below is just, and there is no error in the misapprehension of legal principles as to the loss of insurance claim.

3. Conclusion

Therefore, the appeal is dismissed, and the costs of appeal are assessed against the losing party. It is so decided as per Disposition by the assent of all participating Justices.

Justices Kim Chang-suk (Presiding Justice)