[보험금][미간행]
Plaintiff (Attorney Kang-gu, Counsel for the plaintiff-appellant)
East Fire & Marine Insurance Co., Ltd. and one other (Law Firm Vindication, Attorneys Jeon Jae-in et al., Counsel for the plaintiff-appellant)
may 27, 2005
1. The Plaintiff:
A. Defendant East Fire & Marine Insurance Co., Ltd.: 192,450,059 won and its related amount from January 11, 2004:
B. Defendant Twin Fire and Marine Insurance Co., Ltd.: 76,414,302 won and its therefrom from January 1, 2004
By July 1, 2005, 6% per annum and 20% per annum from the next day to the day of full payment.
2. The plaintiff's remaining claims against the defendants are dismissed.
3. Of the costs of lawsuit:
A. The part arising between the Plaintiff and the Defendant East Fire & Marine Insurance Co., Ltd. shall be 4 minutes, and 3 minutes shall be borne by the Plaintiff and the remainder by the above Defendant, respectively.
B. The part arising between the Plaintiff and the Defendant Tranchi Fire Marine Insurance Co., Ltd. shall be five minutes, and its four minutes shall be borne by the Plaintiff, and the remainder by the above Defendant.
4. Paragraph 1 can be provisionally executed.
The plaintiff shall pay 767,027,263 won to the defendant Dongbu Fire Marine Insurance Co., Ltd., and 415,871,643 won to the defendant Tran Fire Marine Co., Ltd., and 6% per annum from December 11, 2003 to the delivery date of a copy of the complaint of this case, and 20% per annum from the next day to the day of complete payment.
1. Facts of recognition;
The following facts are not disputed between the parties, or can be acknowledged by comprehensively taking into account the following facts: Gap evidence 1-1 through 4, Gap evidence 2, 3, Eul evidence 8, 9, Eul evidence 1-3, Eul evidence 4-1, 2, Eul evidence 5-1 through 237, Eul evidence 1-2, Eul evidence 5-2, Eul evidence 2, 3, Eul evidence 8, Eul evidence 9-1, and Eul evidence 2.
(a) Status of parties;
(1) The Plaintiff operated the instant household store (hereinafter “instant household store”) in the name of Nonparty 4 (Plaintiff’s Kenya omitted) in Gyeyang-gu, Incheon. However, the actual owner and the operator of the said household store are Nonparty 2, who is the husband of the Plaintiff.
(2) The Defendant Eastern Fire Marine Insurance Co., Ltd. (hereinafter “Defendant East Fire”) and the Defendant Tchip Fire Marine Insurance Co., Ltd. (hereinafter “Defendant Tchip Fire”) are the companies established with the main purpose of concluding various insurance and reinsurance contracts, collecting insurance premiums under such contracts, and paying insurance proceeds.
(b) Conclusion of insurance contracts;
(1) The Plaintiff and the Defendants entered into four insurance contracts with the policyholder and the insured as follows with respect to the buildings and equipment of the instant furniture store (facilities and fixtures omitted) and movable property (sale expenses and inventory assets) on the ground of Gyeyang-gu, Incheon (detailed number omitted), and paid the first premium on each subscription date (hereinafter “each of the instant insurance contracts”).
【Comprehensive Business Safety Insurance】
1. Insurer: Defendant Eastern fire;
2. The subscription date for insurance: December 12, 2000;
3. Securities number: 130014632000;
4. Insurance period: From December 12, 2000 to December 16, 2005 (5 years);
5. Object and amount of insurance coverage:
(1) Buildings: 350,000,000 won
(2) Facilities (integrated of facilities and fixtures) - 100,000,000 won
(3) Movable property (all of sold goods and inventory assets), 200,000 won
【Fire Insurance】 2.0
1. Insurer: Defendant Eastern fire;
2. The subscription date for insurance: December 15, 2002;
3. Securities number: 4002035278000
4. Insurance period: From December 15, 2002 to December 16, 2000 to December 15, 2003 (1 year);
5. Object of insurance and amount of insurance coverage: 300,000,000 won in case of inventory assets; and
【New Zealand Comprehensive Insurance】 - 3 insurance
1. Insurer: Defendant pair-use fire;
2. The subscription date for insurance: December 9, 2000;
3. Securities number: 72496000568;
4. Insurance period: From December 9, 2000 to December 9, 2005 (five years); and
5. Object and amount of insurance coverage:
(1) Buildings: 100,000,000 won
(2) Facilities (integrated of facilities and equipment - 50,000,000 won
(3) Movables (sales expenses and inventory assets) - 150,000,000 won
【Fire Insurance】 4 insurance
1. Insurer: Defendant pair-use fire;
2. The subscription date for insurance: December 9, 2002;
3. Securities number: 73101014049;
4. Insurance period: From December 9, 2002 to December 16, 2000, to December 16, 2003 (1 year);
5. Object of insurance and amount of insurance coverage: 200,000 won, in case of inventory assets; and
C. Circumstances and damages of the fire of this case
On November 16, 2003, at around 23:09, the insurance period of each insurance contract of the instant case, the fire presumed to have been electric shocked (hereinafter “the instant fire”) occurred within the instant furniture, and the subject matter of each insurance contract of this case, such as the household store of this case, facilities and inventory assets inside the said house. The amount of damages suffered by the Plaintiff due to the loss of each of the subject matter of insurance due to the instant fire is KRW 118,864,362 in the case of the instant fire, KRW 190,918,896 in the case of the building, KRW 190,918,896 in the case of the facilities, and KRW 534,07,160 in the case of the movable property including inventory assets, KRW 843,8
(d) Terms and conditions;
On the other hand, the main contents of the general terms and conditions incorporated into each of the instant insurance contracts are as follows.
【General Terms and Conditions of Business Safety Insurance】
Article 6 (Compensation for Non-Compensation) A company shall not compensate for any loss for the following reasons:
1. Intention or gross negligence on the part of a policyholder, the insured (in the case of a juristic person, its director or any other institution executing the business of the juristic person), or his legal representative;
2. Intentions on behalf of an employee or a relative living in the same household with the insured in order to have the insured receive insurance proceeds;
Article 23 (Insurance Money to be Paid)
(1) The insurance money to be paid by a company shall be calculated as follows:
1. When the insured amount is equal to or greater than 80% of the insurable value: The full amount of damages within the limit of the insured amount;
2. When the insured amount is less than 80% of the insurable value:
Amount of damage 】 Amount of insurance coverage / value of insurance 80%
However, I do not limit the amount of insurance coverage.
(2) Where there are other contracts under which insurance proceeds are paid for the same accident as the objectives of the same insurance contract and the total amount of their insurance coverage exceeds the insurable value, the insurance proceeds to be paid shall be calculated as follows:
1. Where the other contract provides for the calculation method of the insurance money to be paid;
Damages 】 Amount of insurance coverage under this contract / Total amount of insurance coverage under this contract
2. Where the other contract contains a different calculation method of the insurance money to be paid;
The total amount of damages 】 the amount of insurance proceeds calculated respectively as the absence of the insurance proceeds/other contracts under this contract.
Article 25 (Payment of Insurance Money)
(1) A company shall determine insurance proceeds to be paid without delay after receiving the notice on the occurrence of losses, and where insurance proceeds to be paid are determined, it shall pay them within three days and bed (hereinafter omitted).
(2) When a company has received the claim documents for insurance proceeds under Article 20 above, it shall issue a certificate of receipt, and pay the insurance proceeds within 30 days from the date of issuance of the certificate of receipt: Provided, That where it is evident that the period required for the investigation into and determination of losses exceeds 30 days, it shall notify the insured or beneficiary of the reason thereof, and shall pay the insurance proceeds within 3 days from the date the reason ceases to exist.
(3) If the company fails to pay insurance money within the due date for payment stipulated under the provisions of paragraph (2), it shall pay interest calculated by the interest rate on the loan of terms and conditions for the period from the following day to the date of payment plus insurance money: Provided, That if the payment is delayed due to a cause attributable to a policyholder or an insured (or an insured), it shall not add any interest
Article 28 (Loss of Claim for Insurance Money) In the following cases, the Insured loses the claim for insurance money for damages.
1. Where the policyholder or the insured has intentionally entered matters different from the facts in the documents pertaining to the notification of losses or the claim for insurance proceeds, or has forged or altered such documents or evidence;
【Fire Insurance General Terms and Conditions】
Article 6 (Compensation for Non-Compensation) The Company shall not pay for any of the following damages:
(1) A loss resulting from the intentional or gross negligence of a policyholder, the insured (in cases of a corporation, its director or any other institution executing the business of the corporation), or their legal representatives.
(2) A loss caused intentionally by any relative or employee in the same household with the insured in order to have the insured receive insurance proceeds.
Article 19 (Loss of Claim for Insurance Money) In the following cases, the Insured loses the claim for insurance money for the damage.
1. Where the policyholder or the insured has intentionally entered matters different from the fact in the documents relating to the notification of damage or the claim for insurance proceeds, or has forged or altered such documents or evidence;
【New Zealand Comprehensive Insurance (Terms and Conditions of Type 3 Insurance)
Article 6 (Compensation for Non-Compensation) The Company shall not pay any compensation for any loss under Article 3 caused by the following reasons:
1. Intention or gross negligence of a policyholder, the insured (in the case of a corporation, the director or any other institution executing the business of the corporation or its legal representative;
2. Intentions on behalf of an employee or a relative living in the same household with the insured in order to have the insured receive insurance proceeds;
Article 25 (Calculation of Insurance Money to be Paid)
(1) The insurance money to be paid by a company shall be calculated as follows:
1. When the insured amount is equal to or greater than 80% of the insurable value: The full amount of damages within the limit of the insured amount;
2. When the insured amount is less than 80% of the insurable value:
Amount of damage 】 Amount of insurance coverage / value of insurance 80%
However, I do not limit the amount of insurance coverage.
(2) Where there are other contracts under which insurance proceeds are paid for the same accident as the objectives of the same insurance contract and the total amount of their insurance coverage exceeds the insurable value, the insurance proceeds to be paid shall be calculated as follows:
1. Where the other contract provides for the calculation method of the insurance money to be paid;
Damages 】 Amount of insurance coverage under this contract / Total amount of insurance coverage under this contract
2. Where the other contract contains a different calculation method of the insurance money to be paid;
The total amount of damages 】 the amount of insurance proceeds calculated respectively as the absence of the insurance proceeds/other contracts under this contract.
Article 26 (Payment of Insurance Money)
(1) When a company receives a notice of the occurrence of damage and a claim for insurance proceeds under Article 22, it shall issue a certificate of receipt, and shall pay the same within 20 days from the date of receipt of the document
(2) Where the company is clearly expected to exceed the due date under paragraph (1) in order to investigate and confirm the causes for payment of insurance proceeds, it shall notify the insured or beneficiary of the detailed reasons and the scheduled date for payment in writing.
(4) If the company fails to pay insurance proceeds within the due date prescribed in the provisions of paragraph (1) or (2), it shall pay interest calculated by the rate of interest rates on the terms and conditions loan for the period from the following day to the date of payment plus insurance proceeds: Provided, That if the payment is delayed due to any cause attributable to the contractor, the insured, or the beneficiary, it shall not add any interest for
Article 29 (Loss of Claim for Insurance Money) In the following cases, the Insured loses the claim for the insurance money for the damage.
1. Where the policyholder or the insured has intentionally entered matters different from the fact in the documents concerning the notification of damage or the claim for insurance proceeds, or has forged or altered such documents or evidence;
【Fire Insurance General Terms and Conditions】
Article 20 (Loss of Claim for Insurance Money) In the following cases, the Insured loses the claim for insurance money for damages.
(1) Where the contractor or the insured intentionally enters documents concerning the notice of damage or the claim for insurance proceeds in a false manner, or forges or alters such documents or evidence.
2. Judgment on the plaintiff's assertion
A. Summary of the assertion
The Plaintiff, due to the instant fire, is obligated to pay the Plaintiff insurance proceeds, as stipulated in each of the insurance clauses of this case, the amount of KRW 437,595,217 for the building, KRW 153,729,00 for the facilities, KRW 46,682,00 for the movable property, KRW 536,98,560 for the movable property, KRW 1,175,04,77 for the inventory assets, and KRW 1,175,07 for the total amount of KRW 1,777,00 for the inventory assets, KRW 767,027,263 for the Plaintiff, and KRW 415,871,643 for the Defendant joint-use fire, as well as damages for delay.
B. Determination
In light of the facts as seen earlier, the Plaintiff’s total amount of damages caused by the instant fire was 843,860,418, and barring any special circumstance, the Defendants are liable to pay the Plaintiff insurance money calculated in accordance with the respective insurance terms and conditions for the said damages.
3. Judgment on the defendants' assertion
A. Determination on the assertion of immunity due to intentional fire-prevention
(1) Summary of the defendants' assertion
① At the time of the occurrence of the instant fire, the management status of the instant furniture, which was operated by the Plaintiff, has considerably deteriorated, ② The cause of the instant fire, such as electricity, has not been discovered as a result of the examination by the National Investigation Agency of Korea, ③ there is no source of fire-proof, ④ The point of fire-proof is presumed to be the front part of the instant fire-proof engine, ④ The point of fire-proof is presumed to be the front part of the fire-proof engine, and it is not possible to present the situation where it is not artificial fire-prevention. ⑤ Nonparty 2’s behavior, who is the Plaintiff’s husband and the actual owner of the instant household store, is doubtful, is doubtful, and the Plaintiff’s husband and the instant household store’s actual owner, completed the instant fire-fighting business two hours more than normal, without any particular circumstance on the day of the fire, and Nonparty 2 received insurance money or insurance money from the instant fire-prevention with the intention of receiving insurance money from the instant fire-prevention. In full view of these circumstances, Nonparty 2 did not have any obligation to pay insurance money from each of this case.
(2) Determination
It is insufficient to conclude that the instant fire was fire by Nonparty 2’s intentional fire, solely on the basis of the descriptions of the evidence Nos. 2, 3, and 4 through 8 of A, and there is no other evidence to acknowledge it. Thus, the Defendants’ above assertion is without merit.
B. Determination on the invalidity of an insurance contract under excess insurance
(1) Summary of the allegation of Defendant B-use fire
Since each of the instant insurance contracts is an excessive insurance contract concluded due to the Plaintiff’s fraud, it is null and void pursuant to Article 669(2) of the Commercial Act, Defendant B&M did not have an obligation to pay the Plaintiff insurance proceeds.
(2) Determination
The insurance amount under each of the insurance contracts of this case is 1,450,000 won in total (450,000,000 won in buildings, 150,000,000,000 in movable property, and 850,000,000 won in movable property, and 843,860,418 in total for damages suffered by the plaintiff due to the fire of this case. As seen earlier, the estimated insurance value of each of the insurance objects of this case can be deemed 843,860,418 won inasmuch as the insurance amount of each of the insurance contracts of this case is 843,860,418 won in total at the time of the conclusion of each of the insurance contracts of this case or at the time of the fire of this case does not reach the insurance amount, but merely on the basis of this, it cannot be concluded that each of the insurance contracts of this case falls under excess insurance concluded by the plaintiff's deception, and there is no other evidence to support this.
C. Determination on the assertion that the insurance claim is lost due to submission of false documents
(1) Summary of the defendants' assertion
Since the Plaintiff claimed insurance money from the instant fire and entered false facts in the documents regarding the claim for insurance money, each insurance claim against the instant fire was lost in accordance with each of the insurance clauses of the instant case.
(2) Determination
㈎ 인정사실
The following facts may be acknowledged in full view of the statements in Gap's evidence 9, Eul's evidence 1-1 through 3, Eul's evidence 3, Eul's evidence 5-1 through 237, Eul's evidence 5-1, 2, Eul's evidence 1-2, Eul's evidence 4, Eul's evidence 8, and the purport of the whole pleadings:
① On December 11, 2003, Nonparty 2, the husband of the Plaintiff, submitted the documents claiming insurance proceeds from the instant fire to the International Accident Adjustment Co., Ltd., which represented the instant damage assessment. The Plaintiff and Nonparty 2 claimed insurance proceeds from the instant fire at KRW 1,414,367,431 (the amount of damages for the building was KRW 263,478,00, the amount of damages for the facility was KRW 251,621,971, and the amount of damages for the movable property was KRW 89,268,560).
② However, Nonparty 2, on behalf of the Plaintiff, requested the payment of insurance money as above, and the fact is that the actual purchase amount of the inventory asset (household) destroyed by the fire of this case is not more than KRW 534,077,160 from the 65 transaction parties, but submitted a false statement of transaction, etc., which was entered excessively from the above 49 transaction parties and received by the above 898,070,460 won from the above 65 transaction parties, and entered the false statement in the document claiming insurance money as if the fire of this case was destroyed by fire of this case.
③ Nonparty 2 was indicted of attempted fraud due to the fact that the Defendants claimed insurance money based on the false statement of trading details as above. On June 15, 2005, the Incheon District Court sentenced Nonparty 2 to a suspended sentence of three years of imprisonment with prison labor for a year and June, 2005, and the said judgment became final and conclusive around that time.
㈏ 판단
The general terms and conditions of each of the instant insurance provide that “the policyholder or the insured intentionally stated false facts in the documents concerning notification of damages or claim for insurance proceeds, or forged or altered such documents or evidence,” and that the amount of damages suffered by the Plaintiff due to the loss of each of the subject matter of the instant insurance due to the fire is KRW 118,864,362 in the case of a building, KRW 190,918,896 in the case of a facility, KRW 190,07,160 in the case of a movable property, KRW 534,860,418 in the case of a movable property, and KRW 843,860,418 in the case of the foregoing facts. As seen above, the initial insurance amount claimed by the Plaintiff in relation to movable property is KRW 899,267,460 in the above documents, or KRW 534,077,169 in the case of a fire and KRW 400 in the case of a fire and KRW 57080 in the above documents.
However, in light of the fact that the subject matter of each insurance contract of this case is distinguished from buildings, facilities, and movables, and that the amount of each insurance contract of this case is specified separately, and that the plaintiff (or non-party 2) has not claimed insurance money against the defendants with respect to damage to buildings and facilities, it is reasonable to deem that the plaintiff lost only the claim for insurance money under the 2, 4, the subject matter of insurance contract of which the inventory assets are the subject matter of insurance, and only the claim for insurance money related to movable property (sale and inventory assets) under the 1, 3, and the 1, and the 3 insurance contract. Therefore, the above assertion by the defendants is justified within the above scope.
Therefore, the plaintiff can be said to have only the insurance claim related to buildings and facilities among the 1st insurance contract, and the 3rd insurance contract against the defendant bridge fire.
(3) Judgment on the Plaintiff’s assertion of violation of the duty to deliver terms and conditions
The plaintiff asserts that each of the insurance clauses of this case cannot be the content of each of the insurance contracts of this case in violation of the duty to explain the terms and conditions, since the plaintiff did not have any explanation from the defendants at the time of entering into each of the insurance contracts of this case.
In light of the above, the insurer and the person engaged in the conclusion or solicitation of the insurance contract are obliged to provide the policyholder or the insured with specific and detailed explanation and explanation of the important contents of the insurance contract, such as the contents of the insurance contract, the insurance premium rate system, and changes in the entries in the application form, etc., which are contained in the insurance contract, so if the insurer concludes the insurance contract in violation of such duty to specify and explain the terms and conditions, the insurer cannot claim the contents of the terms and conditions as the content of the insurance contract. However, although the insurer's explanation and explanation of the terms and conditions are acknowledged as the contents of the contract while the policyholder is unaware of, it is reasonable to avoid unexpected disadvantages to the policyholder as they are the contents of the contract. Thus, even if the terms and conditions are stipulated in the insurance contract, if the matters that the policyholder could have sufficiently predicted without any separate explanation, or are merely about the extent to which the contents already stipulated in the Acts and subordinate statutes, it cannot be said that the insurer has indicated and explanation and explanation duty to the insurer up to such matters.
In this case, although it is unclear whether there was an explanation about each of the above terms and conditions at the time of entering into each of the insurance contracts in this case, it is difficult to view that there was such explanation as an important content of the terms and conditions with the duty to explain. Furthermore, the reason for loss of insurance claims stipulated in each of the terms and conditions in this case cannot be allowed as an act of fraudulent insurance claim against the principle of trust and good faith in an insurance contract. Thus, in the case of an insurance accident caused intentionally to prevent the insured from speculation and gambling of insurance under the Commercial Act, and to prevent the insured from acquiring any unfair benefits above the actual damage (Article 659 of the Commercial Act), the insurer's exemption is acknowledged (Article 659 of the Commercial Act). In light of the fact that the insurance contract is an excess insurance due to fraud, it is not subject to the duty to explain as a matter of course, which can be predicted by the general transaction parties without the insurer's explanation (see Article 69 (4) of the Commercial Act).
4. Scope of payment of insurance money.
A. Furthermore, with respect to the amount of insurance money that the Defendants are liable to pay to the Plaintiff, the following facts are as follows: the amount of insurance coverage for the buildings and facilities of the instant household store, the estimated amount of insurance, and the amount of damages.
Type 1 insurance of 350,00,000 won 118,864,362 won 118,864,362 won 118,864,362 won 362 won: 100,000 won 190,918,896 won 190,918,896 won 3 insurance of 50,000 won ;
B. However, Article 23(2)1 and Article 25(2)1 of the Terms and Conditions of the instant 1 Insurance Contract provide that “Where there are other contracts under which insurance proceeds are paid for the same accident as the purpose of the same insurance contract, and their total purchase amount exceeds the insurable value, the amount of damages 】 the total purchase amount of the insurance under this contract / the purchase amount of the insurance under this contract / the purchase amount of the insurance under this contract / the purchase amount of the insurance under this contract.” Accordingly, the insurance amount to be paid by the Defendants to the Plaintiff is calculated as follows (if less than
본문내 포함된 표 ? 건물 시설 합계 피고 동부화재 92,450,059원(118,864,362원×35/45) 보험가입금액 한도인 100,000,000원 192,450,059원 피고 쌍용화재 26,414,302원(118,864,362원×10/45) 보험가입금액 한도인 50,000,000원 76,414,302원
C. Therefore, the Plaintiff is liable to pay the Plaintiff the amount of KRW 192,450,059 insurance money and KRW 30 days from January 11, 2001 after the lapse of 30 days from the date on which the documents claiming insurance money was received ( December 11, 2003); ② from January 1, 2004 after the lapse of 20 days from the date on which the documents claiming insurance money were received ( December 11, 2003), and from January 1, 2004 after the lapse of 20 days from the date on which the documents claiming insurance money was received ( December 111, 2003), to raise disputes as to the existence and scope of the Defendants’ respective obligations. As the Plaintiff seeks from July 1, 2005, the amount of damages for delay shall be paid at a rate of 6% per annum under the Commercial Act and 20% per annum under the Act on Special Cases Concerning the Promotion, etc. of Legal Proceedings from the following day to the day of full payment.
5. Conclusion
Therefore, each claim against the Defendants against the Plaintiff is justified within the scope of the above recognition, and each remaining claim is dismissed as it is without merit.
Judges Park Jong-jin (Presiding Judge)