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(영문) 서울중앙지방법원 2019.09.26 2017가합537867

보험에관한 소송

Text

1. All of the plaintiff's claims are dismissed.

2. The costs of lawsuit shall be borne by the Plaintiff.

Reasons

1. Basic facts

A. On July 25, 2008, C Co., Ltd. (hereinafter “C”) concluded an insurance contract with the Defendant and the insured as the Defendant and entered into an insurance contract with the same content as the attached list that guarantees general injury, temporary living expenses, hospitalization expenses, etc. (hereinafter “instant insurance contract”).

B. On May 3, 2013, the Plaintiff (D Co., Ltd.) acquired the insurer status of the instant insurance contract from C pursuant to a decision to transfer a contract under Article 14(2) of the Act on the Structural Improvement of the Financial Industry.

C. From August 23, 2009 to November 5, 2016 after the conclusion of the instant insurance contract, the Defendant was hospitalized for a total of KRW 23,456,404 (general injury, temporary living expenses, disease hospitalization expenses, etc.) as shown in the attached Table on the ground of the instant insurance accident under the instant insurance contract, and received insurance proceeds from the Plaintiff in total of KRW 33,456,404.

[Reasons for Recognition] The absence of dispute, Gap evidence Nos. 1 through 5 and 7 (including the number of each branch office in the case of additional notes), the result of the response of the submission of each document to the I Hospital by the National Health Insurance Corporation, E hospital, F hospital, G hospital, H hospital, G hospital, and I Hospital, the purport of the whole pleadings

2. As a result of the Plaintiff’s appraisal of medical records on 186 days during which the Defendant received hospital treatment, the Defendant received hospital treatment for at least 79 days, as shown in the attached Table.

Since the trust relationship, which forms the basis of the instant insurance contract, has been destroyed due to such falsity and excessive hospitalization, and thus, it was difficult for the Plaintiff to maintain the instant contract as it is. Accordingly, the Plaintiff’s delivery of the application for modification of the purport of the claim and the cause of the claim on October 16, 2017 to cancel the instant insurance contract and seek confirmation therefrom.

In addition, the defendant received 79 days of unnecessary hospitalization and received 2,110,000 won as stated in the above table as insurance money (general injury, temporary living expenses, hospitalization expenses, etc.) from the plaintiff.