보험금
1. The plaintiff's appeal is dismissed.
2. The costs of appeal shall be borne by the Plaintiff.
Purport of claim and appeal
1...
1. In the first instance trial, the Plaintiff sought insurance money of KRW 3,850,00 according to a special agreement on the security of medical expenses for hospitalization of a disease, and KRW 6,00,000,00 for the insurance money for the latter disability. The court of first instance accepted the claim for the insurance money for the latter disability, and dismissed the claim for insurance money under a special agreement on the security of medical expenses for hospitalization of a disease.
Therefore, since only the plaintiff appealed against this, the subject of this Court's judgment is limited to the claim of insurance money under the special agreement on the security of medical expenses for hospitalization of the disease.
2. Basic facts
A. On July 8, 2009, the Plaintiff’s mother and B entered into a contract with the Defendant for family loving insurance (hereinafter “instant insurance”) that covers the amount of medical expenses for hospitalization of disease to the extent of KRW 100,000,000.
B. The main contents of the instant insurance agreement on the security of medical expenses for disease patients are as follows.
Article 1 (Compensation for Loss) (1) An insurance company (hereinafter referred to as the "company") shall include hospital or clinic (including herb hospital or clinic) due to reasons for payment of insurance money (excluding where the insured has received diagnosis or treatment due to the disease within the past five years from the date of subscription for insurance) during the insurance period of this Special Terms and Conditions.
(i)In the event of hospitalization and treatment, the following costs of hospitalization and treatment shall be compensated for:
1. Hospitalization fees: Medical examination fees, standard sick room (referring to the standard sick room applied by the relevant hospital or clinic to patients insured by national health insurance), service fees for patients, and food expenses;
2. Expenses for hospitalization: Testing fees, radiation fees, medication and prescription fees, the main feed, medical therapy (physical therapy, rehabilitation treatment), mental therapy, treatment, materials treatment, glocks, and designated medical treatment fees;
3. Expenses for surgery: Expenses for surgery, anesthesia and materials for surgery;
4. Sick difference: An actual sick room: Provided, That a special room or a single person room;