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(영문) 의정부지방법원 2016.08.31 2015가합53381

보험금

Text

1. The plaintiff's obligation to pay insurance money for diagnosis expenses for brain-cerebrovascular diseases based on the insurance contract as shown in the attached Form.

Reasons

1. Basic facts

A. On February 22, 2013, B entered into an insurance contract with the Plaintiff on the attached list that the Plaintiff shall pay insurance proceeds, such as expenses for diagnosis of cerebrovascular diseases (hereinafter “instant insurance contract”). The special terms and conditions of the instant insurance contract include the definition of cerebrovascular diseases and the confirmation of diagnosis as follows.

1. The term "cerebrovascular disease" in this Special Terms and Conditions refers to a disease specified in [Attached Table 12] (Classification Table of cerebrscular Diseases) in the 6th Korean Standard Medical Disease Classification.

(2) The diagnosis and confirmation of cerebrovascular disease should be made by a person with a certificate of qualification (other than dentists) of a hospital under Article 3(2) of the Medical Service Act or of a medical institution deemed equivalent thereto, and this diagnosis shall be based on Computerization, e-mail, self-official image, cerebrovascular e-e-e-mail, e-mail release e-mail, etc. along with the medical and neological examination.

(3) If the insured (person insured) is diagnosed as "cerebrovascular disease" during the insurance period, the company shall pay the following amount only once for the first time to the beneficiary (if the beneficiary is not designated as the beneficiary of the insurance), at the cost of diagnosis for cerebrovascular disease:

(Article 2). [Attachment 12] The diseases classified as cerebrovascular diseases as specified in the Terms and Conditions of the Classification Schedule for Brain Diseases refer to the diseases listed below in the sixth revised Korean Standard Korean Classification for Brain Diseases:

B. From January 12, 2015, the Defendant complained of symptoms, such as two pains, and was hospitalized until January 29, 2015, upon request from the D Hospital located in Namyang-si, Nam-si, and received hospitalized treatment by January 29, 2015. On January 30, 2015, D Hospital E diagnosed the Defendant’s name on the following grounds: (a) “the brain death symptoms, and the detailed unknown high blood pressure” (hereinafter “the instant diagnosis”); and (b) “the deceased patient is the principal patient under the name of the disease.”