부당이득금
1. The part of the judgment of the court of first instance against the plaintiff corresponding to the amount ordered to be paid below shall be revoked.
The defendant.
1. Basic facts
A. On April 24, 2007, the Plaintiff entered into an insurance contract with the Defendant (hereinafter “this hour insurance contract”) with the same content as indicated in the attached Table 1 insurance contract.
B. From June 7, 2007 to March 4, 2016, the Defendant received hospitalization (hereinafter “instant hospitalization”) over a total of 29 days from 29 days as indicated in the attached Table 2, as shown in the treatment statement.
C. The Plaintiff paid KRW 53,086,835 on the ground of the instant hospitalization to the Defendant from July 3, 2007 to April 8, 2016, as indicated in the attached Table 3 of the Payment Statement.
(hereinafter referred to as “the instant insurance proceeds”). [Grounds for recognition] The entry in Gap’s Evidence Nos. 1, 2, 4, 6, and 7 (including branch numbers) and the purport of the whole pleadings.
2. During the Plaintiff’s assertion, the sum of 122 days of hospitalizations, 5, 23, 24, 26, 27, and 15, e.g., the entire hospitalizations in the annexed Table 2, 5, 23, 24, 26, and 27, including the entire hospitalizations, was excessive or false. As such, the Defendant should return 16,73,046 won of the insurance money received from the Plaintiff as an insured event for excessive or false hospitalizations as unjust enrichment.
3. Determination
A. In a case where it is found that the insured under the relevant legal doctrine 1 was hospitalized in a hospital due to an injury or disease stipulated in the insurance clauses, and thus claiming expenses for hospitalization and medical treatment as insurance proceeds, the insurer paid the insurance proceeds, but it later is found that the requirements for the payment of the insurance proceeds have not been satisfied, the insured shall return the insurance proceeds to unjust enrichment, barr
At this time, the insurer fails to fulfill the requirements for payment of insurance premiums at the stage of examining the payment of insurance premiums based on the data of medical records, opinions, etc. submitted by the insured.