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(영문) 광주지방법원 2017.07.12 2016가단533714

부당이득금반환

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1. The Plaintiff (Counterclaim Defendant) from December 13, 2016 to the Defendant (Counterclaim Plaintiff) respectively with respect to KRW 11,90,000 and each of the said amounts.

Reasons

1. Basic facts

A. On April 16, 2004, the Plaintiff entered into an insurance contract with the deceased A (hereinafter referred to as the “the Deceased”) and “the Han Han Life Guard” (hereinafter referred to as the “instant insurance contract”).

B. Article 1(1) of the Clause of the Security for Cancer Treatment of the Insurance Contract of this case provides that “When the insured continues to be hospitalized for not less than four days for the purpose of directly treating cancer and received medical treatment from a doctor as stipulated in Article 4(1).” Article 4(1) provides that “involuntary hospitalization” refers to a hospital as stipulated in Article 3(2) due to difficulty in medical treatment at home, etc., or under the control of a doctor as recognized by the company as equal thereto, it is difficult to provide medical treatment at home.”

C. Article 7 of the above Terms and Conditions provides that “The insured shall pay 3 days to 100,000 won per day when he/she has been hospitalized for not less than 4 days consecutively, and the payment days of cancer hospitalization benefits shall be limited to 120 days per time, and where he/she has been hospitalized two times or more during the insurance period, the number of days of each hospitalization shall be considered as continuous hospitalization, and where he/she has been hospitalized two times or more during the insurance period, the number of days of each hospitalization shall

Article 1(3) of the General Terms and Conditions of Security for the Daily Hospitalization provides that "if hospitalized after the lapse of 180 days from the date of the final discharge, it shall be deemed to be a new hospitalization."

From May 9, 2012 to May 9, 2012, the deceased was diagnosed with dysium cancer.

5. From July 19, 2012 to October 3, 2012, the hospital was hospitalized in the Evalescent Hospital (hereinafter “Evalescent Hospital”) for 114 days during the period from July 19, 2012 to October 3, 2012.

The Plaintiff paid the Deceased KRW 12,00,000 per hospitalization day for 120 days after deducting the first three days.

In order of priority, the date of hospitalization of the hospitalization institution during the hospitalization period from November 06, 2012 to November 21, 2012, Evalescent 16 days from the Evalescent 16 days from November 22, 2012 to November 28, 2012. < Amended by Presidential Decree No. 23958, Nov. 22, 2012>