beta
(영문) 전주지방법원 2017.11.29 2015가합2446

보험금

Text

1. All claims filed by the Lessee are dismissed.

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

Reasons

1. Basic facts

A. On May 28, 2004, the Plaintiff entered into each of the above insurance contracts with the Defendant, and around March 7, 2006, a non-distribution agreement agreement insurance contract (hereinafter “each of the instant insurance contracts”) with each of the instant insurance contracts (hereinafter “the instant special terms and conditions”) with respect to the definition, diagnosis, etc. of cerebrovascular diseases.

1) As to “damages to be compensated”, the term “the Defendant shall provide that “if the insured described in the insurance policy (insurance policy) becomes final and conclusive as the first brain-related disease during the insurance period specified in the insurance policy (insurance policy), the insured shall compensate for it in accordance with the terms and conditions.” (ii) As to “the definition and diagnosis of the brain-related disease” in paragraph (1) provides that “The term “the term “the brain-related disease” means a disease classified as the fourth Korean-standard disease classification (attached Table; hereinafter the same shall apply) and “the diagnosis and determination should be made by a domestic or foreign hospital provided for in Article 3 of the Medical Service Act or a foreign medical institution’s certificate of qualification recognized by the company as equal to the above, the diagnosis must be made by a person who holds the first medical license (other than a dentist) of a foreign medical institution (excluding a dentist), and this diagnosis shall be made based on medical history, scientific examination, e.g., e., brain low-rise photocopic ecopic tysis (Electronic) and ecopology).”

3 With respect to “the medical expenses for brain cerebrovascular diseases”, “the Defendant shall pay the following amounts only once in accordance with this special terms and conditions if the insured becomes final and conclusive due to the first diagnosis of the brain cerebrscular diseases,” and the following expenses for the diagnosis of the brain cerebrscular diseases are one year from the date of the insurance contract.