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(영문) 서울중앙지방법원 2020.08.21 2019나66066

부당이득금

Text

1. Revocation of the first instance judgment.

2. The instant lawsuit shall be dismissed.

3. All costs of the lawsuit shall be borne by the Plaintiff.

Reasons

1. Basic facts

A. The Plaintiff, a company running an insurance business, entered into an insurance contract for guaranteeing lost medical expenses (hereinafter “instant insurance contract”) with the insured as indicated in the attached Table “insured” or the company to which the insured belongs, with the content that, in the event that the above insured (hereinafter “insured”) is hospitalized or treated as a patient due to disease, 80% or 10% of the sum of the personal charges and the non-paid benefits prescribed in the National Health Insurance Act among the medical benefits prescribed in the Medical Care Assistance Act and the medical benefits prescribed in the Medical Care Assistance Act.

B. Under the National Health Insurance Act, the Defendant, who operates D’s medical care institution, was paid medical expenses indicated in the attached Table “Materials / Smar-to-satom” column from the above insured, after performing an satom-to-saton-sat-sat-sat-sat-sat-satat-sat-sat-sat-sat-sat-sat-sat-sat-sat-sat-sat-sat-sat-sat

C. Meanwhile, the insured received the insurance money indicated in the “insurance money” column in the annexed sheet from the Plaintiff on the ground that the insured paid medical expenses such as the above Mamomomo-mom pom cat.

[Ground for Recognition: Facts without dispute, Gap evidence 1, Gap evidence 2-1 to 107, and the purport of the whole pleadings]

2. The plaintiff's assertion

A. Although the Mamomo-mom’s surgery can be performed in medical practice, it does not constitute medical care benefits or non-benefit items, and even if medical practice is performed, it cannot be received from the patient’s individual, it does not include non-benefit items guaranteed by the instant insurance contract.

B. Therefore, the Plaintiff has a claim for return of unjust enrichment equivalent to the above insurance money that was unjustly paid to the insured, the insured has a claim for return of unjust enrichment equivalent to the medical expenses paid to the Defendant, or a claim for damages arising from tort.