Seoul Central Central District Court Decision 3 (Seoul Newdong)

Representative Director Kim Jong-soo

Law Firm Dool (Law Firm Shin, Counsel for defendant-appellant)

Attorney Kim Young-hwan

2. The costs of lawsuit are assessed against the defendant.

A. On June 12, 2013, the Plaintiff entered into a “accident insurance contract (hereinafter “instant insurance contract”) with the Defendant on the following terms and conditions.”

- The instant insurance contract -

A person shall be appointed.

B. Of the special terms and conditions of disability pension II (10 years each year) with 50% or more of the disease of the insurance contract of this case (hereinafter “the special terms and conditions of this case”), the contents of this case are as follows.

- The instant special terms and conditions -

A person shall be appointed.

C. On November 14, 2014, the Defendant: (a) was diagnosed by the result of the examination of the symptoms to Acheon-ro Hospital; (b) was diagnosed as flat fluoral and yellow body bags (hereinafter “the instant disease”); and (c) was conducted on November 19, 2014, with glusiums and both brusiums.

D. On January 8, 2015, the Defendant: (a) lost all of the Defendant’s difficulties due to the instant surgery to the Plaintiff; (b) thus, on the ground that the instant insurance contract’s disability under the Disability Classification Table falls under “when there is an obvious obstacle to the chest organs or parthenogenesis function; and (c) claimed insurance proceeds based on the instant special terms and conditions (hereinafter “the instant insurance proceeds”).

[Reasons for Recognition] Uncontentious Facts, Gap evidence Nos. 1 through 4, Eul evidence Nos. 1, 2, and 3, oral argument

The purport of the whole

2. Determination

A. The claimant bears the burden of proving the contingency of an accident, which is the requirement of an insurance accident under an insurance contract, and the causal relationship between the accident and the result of injury (see, e.g., Supreme Court Decisions 2001Da5549, 5505, Nov. 9, 2001; 2003Da35215, 3522, Nov. 28, 2003).

According to the above facts, the state of disability stipulated in the special terms and conditions of this case does not mean the state of disability caused by all treatment, but means only the state of disability caused by ‘the disease with the diagnosis determined' during the insurance period.

However, each statement of evidence Nos. 1 through 4 alone is insufficient to view the causal relationship between the disease of this case and the disability condition in which the defendant lost both sides of the disease of this case, and there is no evidence to acknowledge it otherwise.

The reason is that evidence Nos. 1 through 4, and No. 2 can be recognized by integrating the overall purport of the pleadings in the statement of evidence No. 1 and No. 2, the plaintiff cannot be deemed to have been implemented for the purpose of direct treatment of the disease of this case due to the following circumstances.

② As to “the reasons why a doctor had to refrain from the difficulties of both the Defendant and the reasons therefor,” the Defendant was 49 years of age in close vicinity to the closed games, and immediately was expected to suspend the function of scambling. In order to prevent the scambling of scams after the closed games, I suggest that the other scambling should be removed in principle. According to the above opinion, the reason why the Defendant removed the other scambling of the scam of the Defendant, which did not directly treat the instant disease, seems to be aimed at preventing the Defendant’s scambling after the closure of the scambling.

③ Even if an indeption for the foregoing prevention purpose can be included in the category of comprehensive treatment, it is difficult to view it as an act of treating “a diagnosed disease” as defined in the instant special treatment terms and conditions (see Seoul High Court Decision 2014Na203776, Jun. 16, 2015).

④ The case of Seoul High Court Decision 2012Na22770 Decided October 26, 2012, which the Defendant cited as the ground for the Defendant’s argument, is a medical decision that: (a) there is a possibility that new organisms presumed to be malicious in the left-hand damaged area of the insured; and (b) there is a possibility that the form might be transferred to the right-hand damaged area; (c) it is difficult to apply the instant case as it is in the absence of any evidence to acknowledge that the instant surgery was performed in the instant case, under a medical judgment that there is a possibility that the instant case would have been transferred to the other scar in the Defendant’s other scar in which the yellow field was not generated at the time of the instant surgery.

B. Therefore, the Plaintiff and the Defendant did not have a duty to pay insurance money to the Defendant under the instant special terms and conditions, and there is a benefit to seek confirmation as the original order insofar as the Defendant asserted and contests the existence of the said obligation.

3. Conclusion

Therefore, the plaintiff's claim is reasonable, and it is decided as per Disposition.

Judges Park Jin-han

Judges Yellow Jin-Jin

List

Insurance contracts

Insurance Types: Serious personal accident insurance (1,304) in the lot of undividend dividend

Securities Number: 205F2013003200

A medical person: The defendant

Insured: Defendant

Insurance period: June 12, 2013 to June 12, 2065

2. An insured incident:

Accidents: Impacting on each side of the diversitys

The date and time of outbreak: November 19, 2014.