구상금
1. The plaintiff's appeal is dismissed.
2. The costs of appeal shall be borne by the Plaintiff.
Purport of claim and appeal
The first instance court.
The reasoning for the court’s explanation of this case is as follows, in addition to adding the judgment on the plaintiff’s assertion as follows, and therefore, it is identical to the part on the reasoning of the judgment of the court of first instance pursuant to the main sentence of Article 420 of the CPA.
Even if the Plaintiff’s claim for restitution of unjust enrichment due to unnecessary hospitalization is valid, the Defendant’s hospitalized treatment constitutes excessive treatment beyond the appropriate scope of treatment due to an insured incident, and thus, the Defendant is obligated to return the amount equivalent to the insurance money received in relation to treatment exceeding the period of hospitalization recognized as legitimate to the Plaintiff.
(1) The Plaintiff submitted an application for appraisal on January 19, 2017 for the purpose of confirming that the Defendant’s hospitalization is excessive hospitalization. In full view of the following circumstances revealed by the facts and evidence acknowledged prior to the determination, it is insufficient to recognize that the Defendant received excessive treatment and received unfair insurance proceeds, and there is no other evidence to acknowledge otherwise.
Therefore, there is no reason for the plaintiff's claim on the premise that the defendant received unnecessary hospitalized treatment.
(1) The necessity of hospitalization may vary depending on the patient’s health condition, situation, etc. at the time of hospitalization and it is not uniformly determined depending on the type of disease.
Based on statistical values on the number of patients and the period of hospitalization of the Health Insurance Review and Assessment Service, hospitalization is more than the average number of hospitalization days, and it cannot be concluded that it is excessive treatment.
② The medical treatment and drug treatment and transitional observation following the instant hospitalized treatment are deemed based on the medical judgment of a doctor, who is an expert, and this ought to be respected, barring any special circumstances.
(3) The defendant is false to a doctor to receive insurance proceeds.