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(영문) 서울중앙지방법원 2021.02.18 2020나27630

보험금

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The plaintiff's appeal is dismissed.

Expenses for appeal shall be borne by the plaintiff.

The purport of the claim and the purport of the appeal are the judgment of the first instance.

Reasons

1. Basic facts

A. On November 24, 2010, the Plaintiff entered into a D contract (hereinafter “instant insurance contract”) with the Defendant and the insured on November 24, 2010, setting the contract term from November 24, 201 to November 24, 204 as follows:

If an insured person who has been diagnosed and confirmed as having cerebrovascular or acute fluorial fluorlosis (if the insured person has been at least one year's coverage period) after the commencement date of the insured period during which the insured person was eligible for the examination of the second-time adult disease payment due to an insured person (if the insured person was at least one year's coverage period), 20 million won (if the insured person was at least one year's coverage period), has undergone an operation for a direct purpose of treating the major adult disease after the commencement date of the coverage period (if the insured person was at least one year's coverage period), 3 million won per operation (if the insured person was at least one year's coverage period), and has been hospitalized for at least four consecutive days for the purpose of directly treating the major adult disease after the commencement date of the coverage period (at least one day more than three days but up to 120 days per day

B. The terms and conditions applicable to the instant insurance contract (hereinafter “instant terms and conditions”) include the following:

Sub-Section 3 Payment of Insurance Proceeds, etc. (Main Obligations of Company) 16 [Definition and Determination of “cerebral cerebrovascular” and “cerebral cerebral tymosis” in this contract] ① The term “cerebral cerebral tymosis” and “cerebral tymosis” means diseases classified in the basic classification of the type of Korean standard diseases in the fifth Korean standard diseases (see, e.g. “cerebral tymosis” and “mal tymopical tymosis classification”).

(hereinafter referred to as "cerebral blood" and "hymar flafymosis".

(2) The diagnosis of "cerebrovascular" shall be conducted by a domestic hospital or a medical institution prescribed by Acts related to overseas medical services (hereinafter referred to as "medical institution") under Article 3 (Medical Institutions) of the Medical Service Act.

Medical doctors (excluding dental doctors) shall be conducted by a person with a physician's license, and this diagnosis shall be conducted with a medical history and neological examination, and computerized single-story photography (brain CT.

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