부당이득금
1. The judgment of the first instance court, including a claim that has been reduced and expanded in the trial, shall be modified as follows:
The defendant.
1. Basic facts
A. The Plaintiff is an insurer who has concluded an insurance contract with each insured person under C, D, F, E, G, H, I, J, K, L, M, N, andO (hereinafter referred to as “insured person”) as stated in the attached Table 1 (hereinafter referred to as “instant insurance contract”).
B. The Defendant is a doctor in the ordinary course, who operates a PPS medical clinic (hereinafter “Defendant hospital”).
C. The insured hospitalized the Defendant Hospital on the ground of injury, etc., and accordingly, claimed insurance money to the Plaintiff.
The Plaintiff paid insurance proceeds of KRW 12,411,367 in total, as stated in the details of payment of attached insurance proceeds to the insured.
[Ground of recognition] Facts without dispute, Gap evidence Nos. 8-1 through 17, Gap evidence Nos. 9 and 10-1 through 15, the purport of the whole pleadings
2. The plaintiff's assertion
A. In collusion with the insured, the Defendant committed an unfair medical practice, such as hospitalizing the insured without a need to be hospitalized and manipulating the medical records, and thereby, the Plaintiff became entitled to receive insurance proceeds even if the Plaintiff did not pay to the insured. Even if the Defendant did not conspired with the insured, the Defendant heard a publicity or a lawsuit that “after hospitalized a patient who does not need to be hospitalized at a hospital, prepares and provides necessary documents, such as a written confirmation of hospitalization and discharge, so that the patient can receive insurance proceeds,” and issued a direction of hospitalization and necessary documents to the insured, and the Defendant’s act constitutes an act of aiding and abetting insurance fraud at least.
B. Therefore, due to the tort committed by the Defendant in collusion with, or aiding and abetting the insured's insurance fraud, the Plaintiff was suffering from damages that the Plaintiff would pay to the insured amount of KRW 12,411,367.