보험에관한소송
2017Na115765 Action relating to Insurance
A
KB Non-Life Insurance Corporation
Daejeon District Court Decision 2017Da215718 Decided November 17, 2017
April 12, 2018
May 17, 2018
1. The plaintiff's appeal is dismissed.
2. The costs of appeal shall be borne by the Plaintiff.
The judgment of the court of first instance is revoked. The defendant shall pay to the plaintiff 770,950 won with 15% interest per annum from the day following the delivery of a copy of the complaint of this case to the day of full payment (the plaintiff has withdrawn the part of the defendant's claim to nullify the termination of the insurance contract at this court).
1. Basic facts
A. On November 25, 2015, the Plaintiff entered into an insurance contract with the Defendant for children of B, the Plaintiff’s child, as the insured, as the Plaintiff’s child, as specified in the attached list (UB) and entered into the instant insurance contract (hereinafter “instant insurance contract”).
B. Of the matters to be guaranteed by the insurance contract of this case, the following expenses for surgery of disease, expenses for skin type of disease (outboard), expenses for medical treatment of injured party (outboard), and expenses for medical treatment of injured party (outboard) are included.
* Disease surgery expenses (amount of 300,000 won) - Time of surgery (payment of only one surgery in the case of having undergone two or more types of surgery for a disease during the insurance period (one time of surgery, or one surgery in the case of having undergone one or more types of surgery for the same disease) * Expenses for outpatient treatment for a disease, expenses for surgery for outpatient treatment for a disease (250,000 won) - expenses for outpatient treatment for a disease, expenses for surgery for a outpatient treatment for a disease * expenses for medical treatment for a disease - expenses for medical treatment for a disease - expenses for medical treatment for a disease - 50,000 won for a prescription for a disease
C. "Obligation to notify prior to the conclusion of the insurance contract" attached to the contract of this case states that "the obligation to notify prior to the conclusion of the contract of this case is necessary for the company to take over the subscription of the insurance contract, so the policyholder and the insured (person subject to insurance) will be able to inform the insurance solicitor, etc. of the following matters as they are deemed to have not been notified to the insurance company (in the event of oral notification to the insurance company prior to the contract, the obligation to notify prior to the contract shall be deemed to have been in writing. If the following (1 to 12) is not notified to the truth or is notified differently from the fact, the insurance contract may be refused, and in particular, if the content falls under "material fact", without relation to the will of the policyholder or the insured (person subject to insurance), the contract may be terminated or guarantee may be restricted by the clause, and the plaintiff continued to undergo the following examination or re-examination within 0 years after the examination or re-examination within 10 years prior to the contract."
D. B, on February 3, 2016, upon receiving the diagnosis of absence from (in the left part) C C C in Seo-gu, Seo-gu, Daejeon and received the diagnosis of absence from (in the face), on February 3, 2016; on February 17, 2016; on March 19, 2016; and on March 3, 2016, the Plaintiff spent the treatment costs of KRW 403,40, and medicine costs of KRW 22,200, respectively; and on April 29, 2016, the Plaintiff claimed insurance proceeds under the insurance contract of this case to the Defendant on April 29, 2016.
E. On May 3, 2016, upon receiving the Plaintiff’s claim for insurance proceeds, the Defendant requested a guardian damage adjusting company (hereinafter “guardian”) with the Plaintiff’s consent to the damage adjusting, and around May 16, 2016, the guardian damage adjusting was submitted to the Plaintiff, respectively.
F. On June 7, 2016, based on B’s medical records and relevant data, “The Insured is confirmed to have been diagnosed as Haban Hadan Hadan Hadan Hadan Hadan Hadan Hadan Hadan Hadan Hadan Hadan Hadan Hadan Hadan Hadan Hadan Hadan Hadan, 24 June 24, 2015)” was investigated on June 7, 2016, based on B’s medical records and data, and submitted to the Defendant a report confirming that the Plaintiff violated the Plaintiff’s duty to notify, and that the Defendant received the causal relation between the disease and the disease of this case before the purchase of the instant insurance contract.”
G. On June 3, 2016, the Defendant maintained the contract by providing the Plaintiff with written consent to the conditional maintenance of the instant insurance contract until June 16, 2016 due to the Plaintiff’s breach of duty to notify. If the Defendant does not consent within the said period, he/she sent the “Guidance on the Results of Contract Examination” to the effect that the instant insurance contract will be terminated as of June 17, 2016, and on June 8, 2016, the said instruction reached the Plaintiff.
H. In addition, on June 8, 2017, the Defendant sent the “Guidance on the Results of Contract Examination and Exemption” to the effect that the instant insurance contract is terminated in accordance with the insurance terms and conditions on the grounds of breach of duty to notify to the Plaintiff, and on June 16, 2016, the said instruction reached the Plaintiff.
[Ground of recognition] Facts without dispute, Gap evidence Nos. 1 through 6, Eul evidence Nos. 1 through 5 (including paper numbers), the purport of the whole pleadings
2. The plaintiff's assertion
According to Article 651 of the Commercial Act, the termination of a contract due to breach of duty of disclosure must be made within one month from the date the insurer becomes aware of the breach of duty of disclosure. However, if the Defendant became aware of the past manpower of B at the time of issuance of a copy of the medical records of B, the insured on May 16, 2016, and was able to exercise the right of termination, and notified the termination of the insurance contract of this case on June 17, 2016 after one month from the date when the termination of the contract of this case was terminated, the limitation period for exercising the right of termination is invalid. Therefore, the Defendant is obliged to pay to the Plaintiff the insurance money of this case and its delay damages totaling KRW 70,950 (40,00 for the amount of the insurance money of this case and its delay damages totaling KRW 403,40,00 for the loss treatment expenses of the disease patients + KRW 22,200 for the loss treatment expenses of the disease patients + KRW 300,00).
3. Determination
A. Relevant legal principles
According to the Commercial Act, when a policyholder or the insured fails to notify important matters intentionally or by gross negligence at the time of an insurance contract, or makes a false notification, the insurer may terminate the contract within one month from the date of becoming aware of such fact (Article 651) and within three years from the date of conclusion of the contract (Article 651). Even after the occurrence of an insured event, if the insurer terminates the contract pursuant to Article 651 of the Commercial Act even after the occurrence of an insured event, the insurer is not liable to pay the insurance proceeds (main sentence of Article 655). In this case, when the insurer intends to terminate the contract for the reason of breach of duty of disclosure, the insurer must first prove the fact of breach of duty of disclosure. In light of the above, the period of exercise of the right of termination as the starting date of the right of disclosure, "the date when the insurer becomes aware of the fact of violation of duty of disclosure" as the date when it is believed that there is a ground to suspect the fact of violation of duty of disclosure, but it should be determined at the time of securing the evidence of the fact of violation of duty of duty of disclosure.
On the other hand, the fact that an insurer asked in writing is presumed to constitute an important matter in an insurance contract (Article 651-2 of the Commercial Act), and the written subscription may also be included in an insurance subscription. Thus, if the purport of seeking an answer regarding a certain matter is included in the written subscription, such matter is presumed to be “material fact” under Article 651 of the Commercial Act (see, e.g., Supreme Court Decisions 2003Da18494, Jun. 11, 2004; 2013Da91405, Mar. 13, 2014).
B. Whether the termination of the instant insurance contract is lawful
1) First, around June 24, 2015, before the conclusion of the instant insurance contract, B was diagnosed by the emergency department of the E Hospital as a leave of absence on the left-hand side. Based on the records of his/her CT photographic image on June 25, 2015, B was diagnosed by the aforementioned member of the E Hospital as a leave of absence on the basis of the records of his/her CT photographic image, and he/she was re-employed by the same member on July 2, 2015 and July 16, 2015. Meanwhile, in full view of the descriptions and arguments in subparagraph 3-3 and the purport of the entire arguments in subparagraph 3, B can be recognized as having been determined by the above member of the E Hospital on June 25, 2015. < Amended by Presidential Decree No. 26303, Jul. 2, 2015>
However, on November 25, 2015, the Plaintiff did not notify the Plaintiff of the additional inspection (re-inspection) and the fact of medication by indicating that the Plaintiff received the following medical practice through a medical examination or examination within the latest five years from among the matters to be notified of the entire contract of the subscription written in the course of entering into the instant insurance contract. Thus, the Defendant may terminate the instant insurance contract on the grounds of violation of the Plaintiff’s duty of disclosure, barring special circumstances.
2) Furthermore, based on the above legal principle, if the Defendant’s exercise of the Defendant’s right to terminate the contract was based on the limitation period under Article 651 of the Commercial Act, it is reasonable to determine that the Defendant was aware of the Plaintiff’s breach of duty of disclosure at the time when the Defendant submitted a damage evaluation report to the effect that “the insured was treated with the same disease or disease as that prior to the purchase of the insurance” was confirmed on June 7, 2016, and that “the insured was treated with the disease or disease with a causal relationship.” It cannot be said that the limitation period for exercising the right to terminate the contract under Article 651 of the Commercial Act is run immediately on the ground that the Defendant received the copy of the record of the obligation of the insured. Ultimately, the Defendant terminated the instant insurance contract as of June 17, 2016, the Defendant’s termination of the contract is lawful and effective.
C. Sub-committee
Therefore, the plaintiff's claim for insurance money based on the insurance contract of this case is without merit.
3. Conclusion
Thus, the plaintiff's claim of this case shall be dismissed as it is without merit. Since the judgment of the court of first instance is just in conclusion, the plaintiff's appeal is dismissed as it is without merit.
Judges of the presiding judge
Judges fixed-type
Judges Kim Jong-soo
A person shall be appointed.