보험금
The judgment of the court below is reversed, and the case is remanded to the Jeonju District Court Panel Division.
The grounds of appeal are examined.
1. The procedure for determining the amount of insurance accidents or the amount of insurance proceeds, which are a major part of the insurance contract, is usually determined by the contents of the insurance policy or the terms and conditions. However, if the contents of the insurance policy or the terms and conditions are unclear, it shall be determined by taking into account various circumstances, such as the progress and process of concluding the insurance contract by the parties concerned
(see, e.g., Supreme Court Decisions 99Da5786, Jun. 29, 2001; 2007Da19624, Nov. 13, 2008). Furthermore, the burden of proving the occurrence of an insurance accident stipulated in an insurance contract lies on the insured, etc. who claims insurance proceeds.
(See Supreme Court Decision 2001Da27579 delivered on August 21, 2001, etc.). According to the reasoning of the lower judgment and the record including the duly admitted evidence, the following circumstances are revealed. A.
On December 30, 2005, the Plaintiff entered into a non-distribution agreement (hereinafter “instant insurance contract”) with the Defendant on the basis of the medical expensesA for the diagnosis of the hovascular disease, daily allowances for hospitalization of the hovascular disease, and the instant insurance contract (hereinafter “instant special terms and conditions”) provides for the definition, confirmation, etc. of the hovascular disease as follows.
(1) Article 1 of the Special Terms and Conditions of this case provides, “Where the insured, as stated in the insurance policy (insurance policy) of this case, entered in the insurance policy of this case, has been diagnosed as the first her chronic disease during the insurance period of this Special Terms and Conditions, the insured shall be compensated for in accordance with the terms and conditions of this case.”
(2) Under the title of Article 2 of the instant Special Clause, “the definition and confirmation of diagnosis of the Hemovascular disease” (1) of the instant Special Clause, “The Hemovascular disease is the stimulism, acute stimulism, and acute stimulism in the 4th Korean Standard Industrial Classification.”