부당이득금
1. Of the judgment of the court of first instance, the part against the defendant exceeding the following amount ordered to be paid shall be revoked.
1. Basic facts
A. On January 29, 2010, the Plaintiff, an insurer, concluded an insurance contract with the Defendant listed in the separate sheet No. 1 (hereinafter “instant insurance contract”).
B. As indicated in attached Table 2, the Defendant received hospitalized treatment for a total of 150 days from December 8, 201 to April 5, 2016, as shown in attached Table 2.
(hereinafter referred to as “each of the instant hospitalization” in the sequence Nos. 1 above shall be deemed to be “instant hospitalization” and “each of the instant hospitalization” in total.
The Defendant claimed insurance money to the Plaintiff upon receiving the above hospitalized treatment, and the Plaintiff paid the Defendant the total of KRW 12,690,647 in accordance with the instant insurance contract terms and conditions, as shown in attached Table 2.
In each of the special terms and conditions of the instant insurance contract, the term “in the case where it is deemed necessary to treat a disease by a doctor, dentist, or oriental medical doctor (hereinafter “doctor”)”, and where it is difficult to treat at home, etc., it is difficult to attend a hospital, clinic, or medical institution recognized by the company as equal to the hospital under Article 3(2) of the Medical Service Act, and concentrate on treatment under the control of a doctor.”
【Ground of recognition】 The fact that there has been no dispute, entry of Gap's 1 through 4 (if there is an additional number, including a branch number; hereinafter the same shall apply) and the purport of whole pleadings
2. The defendant alleged by the plaintiff had received excessive hospitalized treatment in the absence of the necessity of hospitalized treatment. Thus, the defendant must return the insurance proceeds for the period exceeding the appropriate hospitalization treatment period as unjust enrichment.
However, the pertinent period of hospitalization by each sequence Nos. 1 of annexed Table 2 is 14 days each, and the insurance proceeds therefrom are 4,240,000 won in total. Thus, the defendant is 8,450,647 won in excess of the above amount among the insurance proceeds received from the plaintiff.