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(영문) 서울중앙지방법원 2020.10.28 2020나23089 (1)

보험금

Text

The defendant's appeal is dismissed.

Expenses for appeal shall be borne by the defendant.

Purport of claim and appeal

1. Purport of the claim.

Reasons

1. Basic facts

A. On June 29, 2016, the Plaintiff entered into an insurance contract with the Defendant (i.e., the “Insurance Contract” (hereinafter “Insurance Contract”) and (ii) DNA “Insurance Contract” (hereinafter “Insurance Contract”) and “Case 2 Insurance Contract” on July 15, 2016.

B. According to the terms and conditions of each of the instant insurance contracts, where the insured Plaintiff received medical treatment from the hospital due to a disease, the medical treatment expenses and outpatient treatment expenses (other than contract 1), and the diagnosis has become final and conclusive as cancer (other than part of the nursing cancer, etc.), the specific cancer diagnosis fund 20,000,000 won (the second insurance contract) shall be paid within three business days from the date of receipt of the claim for insurance money.

C. On June 18, 2018, the Plaintiff was diagnosed with the Zasia cancer at E Hospital and was treated by the pertinent hospital until July 31, 2018.

On August 2018, the Plaintiff filed a claim with the Defendant for insurance proceeds from the aforementioned diagnosis and treatment, and the Defendant, on September 5, 2018, notified the termination of each of the instant insurance contracts on the ground of the Plaintiff’s breach of duty of disclosure.

[Ground of recognition] Unsatisfy, Gap evidence Nos. 1-8, the purport of the whole pleadings

2. Determination

A. Inasmuch as there is no particular dispute as to whether the Plaintiff violated the duty of disclosure and received medical care, it constitutes an insurance accident stipulated in each insurance contract of this case, we examine whether the Defendant may refuse the payment of insurance money by cancelling each insurance contract of this case on the ground that the Plaintiff violated the duty of disclosure, such as the Defendant’s assertion.

The Defendant’s notice of termination on September 5, 2018 stated that “The Plaintiff did not notify the Plaintiff of the diagnosis of the gymnasium increase certificate, the epidemitis and the epidemitis before entering into each of the instant insurance contracts, even after receiving the diagnosis of the gymnasium infection, constitutes a violation of the duty of disclosure.”

However, the epidemic hepatitis and the stimulic hepatitis are diagnosed.