2012 Ghana 22521 Insurance proceeds

2. The defendant (Counterclaim plaintiff)'s counterclaim is dismissed.

3. The costs of lawsuit are assessed against the Defendant-Counterclaim Plaintiff by aggregating the principal lawsuit and counterclaims.

Counterclaim: The Plaintiff (Counterclaim Defendant; hereinafter referred to as the “Plaintiff”) pays 42,176,658 won to the Defendant (Counterclaim Plaintiff; hereinafter referred to as the “Defendant”) and 5% per annum from November 24, 2011 to the service date of a duplicate of the instant counterclaim, and 20% per annum from the next day to the full payment date.

A. On July 30, 2008, the Defendant concluded an insurance contract (hereinafter referred to as “instant insurance contract”) with the Plaintiff as shown in the attached Table No. 2 of Insurance Table No. 2.

B. On November 24, 201, around 11:42, the Defendant was subject to an accident listed in paragraph (1) of the attached Table of Insurance Contract (hereinafter “instant accident”), and the rate of payment of disability benefits therefrom reaches 37%. On August 30, 2012, the Defendant was paid KRW 18,500,000 as the general injury injury injury insurance money under the General Terms and Conditions of the instant insurance contract (basic contract) and KRW 18,50,000 as the general injury injury injury insurance money under the General Injury Ex Post Facto Injury Clause of the instant insurance contract. The Defendant was subject to an insurance payment rate of KRW 6% on March 9, 2009, KRW 11% on March 19, 2010, and both of the instant insurance accidents were different from the instant insurance accidents.

D. As the insurance clauses included in the instant insurance contract, there are general terms and conditions of non-dividend C well-being insurance and special terms and conditions of non-dividend C well-being insurance, and the contents relating to the instant insurance accident are as follows.

Article 17 of the General Terms and Conditions for Distribution C wellpy Insurance (Insurance Money for Climate Injury)

(2) Ordinary disability insurance money: If the insured suffers from injury due to an accident as provided for in Article 14 (Compensation for Damages), and the insured loses part of his body within two years from the date of the accident as a direct result, or his function has been permanently lost as a result of the accident, and the payment rate as provided for in [Attachment 1] (Classification of Disability) falls short of 80%, and the latter disability (hereinafter referred to as "general after disability") remains, the company will pay it to the beneficiary as general after receiving the injury.

(6) If two or more subsequent disabilities are created for the same accident, the payment shall be made by summing up the rate of payment of the subsequent disability.

(8) If the residual disability occurs two or more times due to any other accident under paragraph (2), the rate of the payment of such disability shall be determined every time.

Article 3 (Insurance Money for Climate Disability)

(2) An insurance proceeds of advanced disability: In cases where the insured was injured by an accident as prescribed in Article 2 (Compensation for Damages), and the insured has lost part of his body within two years from the date of the accident as a direct result, or his/her function has been permanently lost as a result of the accident, and the payment rate as prescribed in [Attachment Table 1] (Disability Classification) falls short of 80%, and the latter disability (hereinafter referred to as "general after disability") remains, the company will pay it to the beneficiary as the insurance proceeds of advanced disability.

(6) If two or more subsequent disabilities are created for the same accident, the payment shall be made by summing up the rate of payment of the subsequent disability.

(8) If the disability referred to in paragraph (2) has occurred twice or more due to any other accident, the rate of the payment of the disability shall be determined every time.

Article 3 (Disability Pension)

(8) If a company suffered from an injury caused by an accident as provided for in Article 2 (Compensation for Damages) and loses part of the body within two years from the date of the accident as a direct result, or has lost its function permanently as a result of the accident, and the payment rate as provided for in attached Table 1 (Classification of Disability) reaches or exceeds 50% of the payment rate as provided for in attached Table 1 (hereinafter referred to as "general residual disability"), it shall pay it to the beneficiary as a disability pension for the future.

(5) If two or more subsequent disabilities are caused by the same accident, the payment shall be made by summing up the rate of payment of the subsequent disability.

(8) Where the residual disability has occurred at least twice due to any other accident under paragraph (2), the rate of payment of the disability shall be determined every time such accident occurs.

[Grounds for Recognition] Unsatisfy, each entry (including each number), the whole purport of pleading, and the purport of the whole pleading

2. Both claims;

A. The defendant's assertion

Of the insurance period of the instant insurance contract, three insurance accidents, including the instant insurance accident, were included in the insurance payment rate of each of the instant insurance accidents, and correspond to 54% if the insurance proceeds were to be added. Considering the interpretation of the terms and conditions, the instant insurance accident constitutes an insurance accident stipulated in Article 3(1) of the General Disability Pension Clause (hereinafter “Special Clause”), which is included in the instant insurance contract, and thus, the Defendant should additionally pay the insurance proceeds stated in the counterclaim claim to the Plaintiff pursuant to the aforementioned provision.

B. The plaintiff's assertion

This case’s special contract also applies when the insurance payment rate due to a single insurance accident exceeds 50%, and it is clear that the insurance payment rate for all the insurance accidents during the insurance period is not to be added up. However, the insurance payment rate due to the instant insurance accident is merely 37%, and there is no obligation to pay the insurance money under Article 3(1) of the instant special contract.

3. Determination

According to the above facts, it is clear that all of the general terms and conditions, the general terms and conditions, and the special terms and conditions of general injury, high-speed disability, incorporated into the insurance contract of this case, stipulate that the payment rate of disability shall be determined for each individual insurance accident, and that the amount of the insurance money stipulated in the pertinent special terms and conditions shall be paid (see Articles 17(8) and 17-2 of the General Terms and Conditions, Article 8, 1-2 of the Special Terms and Conditions, and Article 8 of the Special Terms and Conditions). Since the insurance payment rate of the insurance money due to the accident of this case is 37% as seen earlier, there is no insurance money under the insurance contract of this case (Article 3 of the General Terms and Conditions of Injury, High-speed Disability, High-Pressure Disability Pension, etc.) in relation to the insurance accident of this case premised on the payment rate of the insurance money due to the

Supplementaryly, the defendant asserts that the above provision (the provision that sets the rate of payment of insurance money per individual accident) cannot be incorporated into the insurance contract of this case on the ground that he violated the duty to explain and explain Article 3(8) of the 1-3 Special Terms and Conditions in the briefs submitted after the closing of argument of this case.

The term "important contents of the terms and conditions" subject to the duty to explain and explain refers to the contents that a policyholder would not enter into an insurance contract with the same content, i.e., whether to enter into a contract or not, directly affect the price (insurance premium) (see, e.g., Supreme Court Decisions 95Da11344, Dec. 12, 1995; 2007Ma1328, Jan. 26, 2008). According to the reference documents submitted by the Plaintiff after the closing of argument, the general injury high-risk disability pension of the insurance contract of this case in which the Defendant was a party is a special contract which is not a main contract, and its insurance premium is only part of KRW 2,500,00, total insurance premium is only part of KRW 128,511, and even if the payment rate of insurance premium is more than 50% based on a single insurance accident, the defendant still has an interest to enter into such insurance contract.

Furthermore, even if important contents are also important, in a case where a policyholder could have sufficiently predicted without a separate explanation because they are general and common in transactions, the content of the insurance system is not acknowledged (see, e.g., Supreme Court Decision 98Da32564, Nov. 27, 1998).

The term "insurance accident" refers to the insurance accident in question, unless there are special circumstances, so Article 3(8) of the 1-3 Special Terms and Conditions is not subject to the duty of explanation and explanation. Therefore, the defendant's assertion of violation of the duty of explanation and explanation cannot be accepted.

4. Conclusion

Therefore, the plaintiff's claim of this case is justified, and the defendant's claim of this case is dismissed as it is without merit. It is so decided as per Disposition.