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(영문) 서울동부지방법원 2016.12.14 2016나22372

보험금

Text

1. The part of the judgment of the court of first instance against the defendant shall be revoked.

2. All of the plaintiff's claims corresponding to the above revocations.

Reasons

1. Basic facts

A. On December 12, 2008, the Plaintiff, as the insured, subscribed to the Defendant’s non-payment of dividends (hereinafter “instant insurance”). The details of the instant insurance terms and conditions are as follows.

1) Expenses for diagnosis of cerebrovascular diseases: Insurance proceeds of KRW 5 million includes cerebrovascularis and other specified cerebrscular diseases; ii) hospitalization expenses for the 16th hospitalization of cerebrscular diseases: insurance proceeds exceeding 3 days (120 days ceiling) 70,000 won per day (120 days ceiling) shall include cerebrscular diseases.

B. On April 21, 2014, the Plaintiff was hospitalized in B Hospital located in Namyang-si, and received treatment for 22 days until May 12, 2014. The Plaintiff was diagnosed as brain death and thirrosis on April 26, 2014 while hospitalized.

[Reasons for Recognition] Unsatisfy, each entry of Gap evidence 1 to 6 (including virtual numbers) and the purport of the whole pleadings

2. Assertion and determination

A. The Plaintiff’s assertion was diagnosed with the cerebral cerebral typhism, and the Plaintiff’s disease constitutes at least chronic cerebral typhism, which constitutes both a chronic cerebral typhism disease under the insurance terms and conditions of the instant case.

Therefore, the defendant has a duty to pay insurance money of KRW 5 million and KRW 1.33 million in total (=70,000 x 19 days) of the 16th hospitalization expenses for cerebrovascular diseases and delay damages.

B. According to the statement in Gap evidence No. 5 (Insurance Contract), the defendant stipulates that the insured shall compensate for expenses for diagnosis of cerebrovascular diseases and expenses for hospitalization of 16 diseases in the event that the diagnosis becomes final and conclusive due to cerebrovascular diseases. The determination of diagnosis of cerebrscular diseases must be made by a person with a certificate of doctor (excluding dentists) of a domestic hospital as defined in Article 3 (Medical Institution) of the Medical Service Act or a foreign medical institution recognized by the defendant as equivalent thereto, and this diagnosis must be made by a person with a certificate of qualification of a medical doctor (excluding dentists) of a foreign medical institution (excluding dentists). This diagnosis, along with a medical and pathic examination, shall be computerized single-story photographs of cerebrs (brain Cssect), a cirral typology (MRI), a pET and a double-electronic emitting ion