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(영문) 부산지방법원 2015.3.19.선고 2013가단232158 판결

보험금

Cases

2013 Ghana 232158 Insurance proceeds

Plaintiff

A person shall be appointed.

Defendant

Hansung Life Insurance Co., Ltd.

Conclusion of Pleadings

January 15, 2015

Imposition of Judgment

March 19, 2015

Text

1. The defendant shall pay to the plaintiff 75, 659, 902 won with 5% interest per annum from November 26, 2013 to March 19, 2015, and 20% interest per annum from the next day to the day of complete payment.

2. The plaintiff's remaining claims are dismissed.

3. 1/4 of the costs of lawsuit shall be borne by the Plaintiff, the remainder of 3/4 by the Defendant, respectively.

4. Paragraph 1 can be provisionally executed.

Purport of claim

The defendant shall pay to the plaintiff KRW 100 million and a copy of the complaint of this case from the day following the delivery date of the copy thereof.

By the day, 20% interest per annum shall be paid.

Reasons

1. Basic facts

A. On July 30, 2007, the Plaintiff entered into a contract with the Defendant (the Korea Life Insurance Co., Ltd. prior to the change) under which the insured was the Plaintiff’s husband B (hereinafter “instant contract”). According to the instant contract, the Defendant would pay KRW 100 million upon the Plaintiff’s death, and the Defendant would pay KRW 100 million per annum for nursing funds (10 million limited to 10 times) in the event that the Plaintiff is diagnosed as a daily disability or diagnosed as a dementia condition. A beneficiary is the Plaintiff upon the maturity or death of B and is at the time of hospitalization or injury. Insurance premium is KRW 343,40,00 ( discounted insurance premium KRW 339,966) per month, and the payment period is 20 years per month, and the payment method is automatic (10th day of each month).

B. B was hospitalized at the Ulsan National University Hospital on January 22, 2009 after undergoing a liver cancer diagnosis, and on February 2, 2009

26. He/she was hospitalized in the above hospital and undergone the chronology surgery, and received a chronology surgery at the above hospital on January 18, 2010.

C. At the time when the Plaintiff entered into the instant contract with the Defendant, the Defendant’s insurance solicitor was C, and thereafter, C managed the instant contract. On May 1, 2009, C discontinued the Defendant’s insurance solicitor’s work, and D, an insurance solicitor of the Defendant, was in charge of the instant contract.

D. The Plaintiff entered into four insurance contracts including the instant contract with the Defendant, and the total amount of the premium was KRW 1,091,660. The Plaintiff paid each insurance premium by means of the total transfer (the total amount of the insurance premium transferred at one time) and was not paid by transfer from around 2010 due to the shortage of the balance in the insurance premium payment account, and was paid by automatic transfer.

E. The Plaintiff paid out of the instant insurance premium up to the part on November 201, 2010. However, on December 201, 2010, the installment premium was not paid as the balance short on December 10, 201, and thereafter, on January 31, 201, the Plaintiff attempted to transfer the premium at a intervals of five days pursuant to the terms and conditions, but did not pay the total amount of the installment premium and the amount of the premium on January 201.

F. On March 31, 201, the Plaintiff and the Defendant concluded a restoration contract of the instant contract (hereinafter “instant restoration contract”) on the premise that the instant contract was invalidated on the grounds of unpaid insurance premium. From December 12, 2010 to March 2011, the Plaintiff paid KRW 1,364,054,000 as the restitution insurance premium for four-minutes of insurance premium and overdue interest as the aforementioned date.

G. B died on April 23, 2013. On May 14, 2013, the Plaintiff filed a claim against the Defendant for the payment of insurance proceeds on the ground of an insured incident that occurred due to the death of B. However, on June 18, 2013, the Defendant sent to the Plaintiff a notice to the effect that B terminated the instant restitution contract on the ground that B did not notify the Plaintiff of his/her disease and treatment as described in Paragraph (b) at the time of the instant restitution contract. The said notice was served on the Plaintiff on June 19, 2013 (Evidence 4-1, 40, 098). The Defendant returned KRW 10,781,653, which deducted the principal and interest of the standardized contract loans from KRW 24,340,09,000,000 for the said temporary cancellation refund at KRW 13,58,445.

[Ground of recognition] A without dispute, Gap evidence 1 through 10, Eul evidence 1 through 7, 10, 11, 14, 15 (including numbers, hereinafter the same shall apply)

2. The parties' assertion

A. The Plaintiff’s claim 1) Claim for insurance money under the instant contract

Since the Plaintiff entered into the instant contract with the Defendant, and the occurrence of an insured incident (B’s death) therefrom, the Defendant is obligated to pay the insurance proceeds to the Plaintiff.

The Defendant asserts that the instant contract was terminated due to the delay in the payment of the Plaintiff’s insurance premium. However, the delayed payment of the Plaintiff’s insurance premium was significant due to the Defendant’s negligence that the changed insurance solicitor was not in charge of contract management or did not timely withdrawal. Around February 1, 2011, the Defendant’s notice of termination issued to the Plaintiff was inappropriate due to the lack of the payment demand procedure that should be pre-paid, and the payment demand notice and the notice of termination (verification) sent by registered mail around March 1, 201 did not receive the Plaintiff (the Plaintiff received the notification of invalidation around March 4, 2011 in the warden, but it appears that the Plaintiff changed the assertion that the registered mail was not received from the preparatory document from January 6, 2014). In addition, the Defendant did not notify the beneficiary B of the overdue payment of the insurance premium in order to be valid. Therefore, the instant contract was not terminated, and the instant notice was still valid, and the instant notice was concluded only for the settlement of the insurance premium in arrears.

Therefore, the instant contract still remains valid despite the Plaintiff’s delinquency in the payment of the insurance premium, and since it cannot be deemed that the duty of disclosure of B arises at the time of the instant restoration contract, the Defendant shall pay the Plaintiff insurance amounting to KRW 100 million according to the instant contract. 2) When the instant restoration contract is executed, the Defendant breached the Defendant’s

The instant contract was terminated, and the instant restoration contract was a separate contract from the instant contract, and thus, even if the duty of disclosure newly created B at the time of the terms and conditions, the Defendant did not explain the duty of disclosure or the nature of the restoration contract. Therefore, the Defendant cannot be held liable for the non-performance of the duty of disclosure under B.

In addition, since the plaintiff notified C, an insurance solicitor of the defendant when B was diagnosed as liver cancer around January 2009, it is difficult to deem that the defendant failed to comply with the duty of disclosure, and therefore, the defendant should pay 100 million won insurance money under the restoration contract of this case to the plaintiff. If the defendant's obligation to pay insurance money under the restoration contract of this case is not recognized, the plaintiff should claim damages equivalent to the plaintiff's insurance money due to the defendant's breach of duty of explanation.

B. Defendant’s assertion 1) Termination of the instant contract

Of the insurance premium under the instant contract, the Defendant did not pay the premium for the portion on December 2010 and January 9, 2011. On January 9, 2011, the Defendant sent to the Plaintiff a confirmation of the unpaid insurance premium and a written guidance on payment that the insurance contract will be terminated if the overdue insurance premium is not paid by the day immediately preceding the same month. The instant contract was terminated on February 1, 201, the following day.

Even if the above mail is sent by ordinary mail and the arrival of the Plaintiff is not confirmed, on March 1, 201, the notice of demand for payment of the premium and the notice of cancellation (verification) by registered mail was sent to the address of the Plaintiff, the representative director of the E-company, Ulsan-gu F4th (which is the address of the Plaintiff under an insurance contract subscription). G, an employee of the Plaintiff company, received on March 4, 201. Accordingly, on March 3, 2011, when the notice was served, 15 days after the delivery of the notice.

19. The instant contract was terminated around 19.

The Plaintiff asserted that, as the instant contract was for another person’s insurance contract, in order for the Defendant to terminate the instant contract on the grounds of delinquency in the payment of the Plaintiff’s insurance premium, B, a beneficiary of the instant contract, should be notified of delinquency in the payment of the insurance premium, but the beneficiary of the insurance money paid at the time of death and the time of maturity of the insured, who is a major benefit under the instant contract, cannot be deemed an insurance for another person, as the policyholder, as the insured.

In particular, the Plaintiff’s assertion that the Plaintiff had subscribed for a reinstatement contract on the premise that the instant contract was terminated, but again changed its position to the assertion that the insurance contract was not terminated cannot be allowed against the good faith principle.

2) The cancellation of the instant restitution contract due to the breach of B’s duty of disclosure does not significantly differ from the duty of disclosure and the terms and conditions on the breach of such duty of disclosure as stipulated in Article 651 of the Commercial Act regarding the effect of the breach, and is common and common in the transaction, so it is possible for the contractor to sufficiently expect without a separate explanation. Thus, the above provision is not subject to the insurer’s duty of disclosure and explanation.

In addition, D, an insurance solicitor of the defendant at the time of entering into the instant restitution contract, is 2011.

3. 31. At the time of the conclusion of the instant restitution contract, the Plaintiff visited the Plaintiff’s company and explained to the Plaintiff and B about the duty to know prior to the contract and the effect of the breach.

The plaintiff argued to the effect that around January 2009, the plaintiff performed the duty of disclosure when informing C of the fact of liver cancer diagnosis. However, even if the plaintiff knew of the above fact, it cannot be deemed that the plaintiff notified C of the fact to the defendant.

Therefore, B did not notify the fact of medical history of liver cancer at the time of subscription for the instant restoration contract, and since this was due to an obvious intention of fraud, the Defendant could cancel the instant restoration contract at the time of the terms and conditions, and as the Defendant expressed an intention of cancellation around June 18, 2013, the instant restoration contract lost its validity. Therefore, the Plaintiff’s claim premised on the existence of the instant restoration contract is without merit.

3) Mutual-aid grounds

Even if the Defendant’s obligation to pay insurance proceeds is recognized, the Defendant returned the cancellation refund of KRW 10,781,653 calculated by subtracting the principal and interest on the loan of a standardized contract from KRW 13,58,445 on June 18, 2013, to the Plaintiff. As such, the Defendant’s repayment of KRW 24,340,098 ( = 13,558,445 + + 10,781,653) ought to be deducted from the insurance proceeds to be paid by the Defendant.

3. Determination;

A. Determination on the claim for insurance money under the instant contract

1) The fact that the instant contract was concluded between the Plaintiff and the Defendant, and the occurrence of the insurance accident stipulated in the instant contract due to the death on April 23, 2013 is as seen earlier. Therefore, barring any special circumstance, the Defendant is obligated to pay 100 million won insurance money under the instant contract to the Plaintiff, on the other hand, the Plaintiff did not pay four-minute insurance premium from December 12, 201 to March 31, 201 among the insurance premium under the instant contract, and the Defendant attempted to transfer the insurance premium at an interval of about five days from December 10 to January 31, 201, but did not pay the insurance premium due to the shortage of the balance in the automatic transfer account. The Defendant asserted that the instant contract was terminated on the ground that the Plaintiff’s delayed payment of the insurance premium was due to the cancellation of the instant contract.

2) Relevant laws and regulations and terms and conditions

Pursuant to Article 650 (2) of the Commercial Act, if the continued premium is not paid at the time agreed upon, the insurer may terminate the contract if it gives a peremptory notice to the policyholder within a reasonable fixed period and if it is not paid within such specified period, and according to Article 650 (3) of the Commercial Act, if the policyholder delays the payment of the premium, the insurer shall not cancel or terminate the contract unless it gives a peremptory notice to the other party to pay the premium within a reasonable period specified

On the other hand, Article 13 of the Terms and Conditions of the instant contract provides for the procedure of termination at the time of delayed payment of the premium, and the details thereof are as shown in the separate sheet. In other words, in the case of insurance for a contractor and a third party, the Defendant must pay the delayed premium to the beneficiary within the period of the demand notice for payment, and in the case of insurance for a third party, if the premium is not paid by the date after the expiration of the period of the demand notice for payment, it must be notified in writing or by telephone (recording) not later than 15 days before the expiration of the period from the day after the expiration of the above period. 3) In the case of insurance for a third party as to whether the insurance contract related to the instant insurance accident is an insurance contract for a third party, "insurance for a third party" under Articles 639 and 650 (3) of the Commercial Act refers to cases where the policyholder and the beneficiary are different from each other. In addition, if a single insurance contract consists of a principal contract and an individual special agreement, whether it constitutes "insurance for a third party" should be separately determined based on individual contract.

6. Supreme Court Decision 2012Da25562 Decided 28, 2010

The main benefit of the instant contract is to pay KRW 100,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000

Therefore, the termination of the contract related to the special agreement on the guarantee of hospitalization or injury should be set aside, and at least, in relation to the principal contract, the defendant must demand the plaintiff to pay the insurance premium only to the plaintiff in order to terminate the contract on the ground of delinquency in the plaintiff's insurance premium.

4) Whether there exists a defendant's liability concerning the delay of the plaintiff's insurance premium

The Plaintiff asserts to the effect that there is a cause attributable to the Defendant as to delinquency in the payment of the Plaintiff’s insurance premium, since the changed insurance solicitor D was not well in managing the instant contract or the Defendant was not in arrears due to the failure to transfer the insurance premium from the account (if the Defendant’s cause attributable is acknowledged, the period of demand) under Article 13(2) of the Terms and Conditions of the instant contract is extended to three months from the due date of payment. However, the Plaintiff’s delinquency in the payment of the insurance premium is due to the lack of balance in the Plaintiff’s automatic transfer account. There is no evidence to prove that the Defendant erred in the course of attempting to withdraw money from the said account for a certain period of time after the payment date of the insurance premium or after telephone communications. Furthermore, even if the changed insurance solicitor did not timely inform the Plaintiff of the unpaid insurance premium, it cannot be deemed that the Plaintiff’s failure to deliver the insurance premium to the Plaintiff due to the reasons attributable to the Defendant under Article 13(2) of the said Terms and Conditions constitutes a case where the Plaintiff was unable to receive the Plaintiff’s insurance premium from the Defendant’s domicile (2).

Therefore, even if the defendant sent the insurance premium to the plaintiff on January 9, 201, the previous owner of the insurance premium, and the notice of the highest payment and the notice of the termination (the confirmation) delivered on March 4, 2011, which was delivered by the defendant on February 2 and 1, 2011, was presented to the plaintiff, even if the notice was not served on the plaintiff (the plaintiff asserted that the insurance was invalidated at the complaint, but it is unclear whether it is identical to the above notice claimed by the defendant), and it appears that the defendant lawfully notified the plaintiff of the highest payment of the insurance premium and the notice of the termination (the confirmation). It is reasonable to view that the contract in this case was legally invalidated by the defendant's declaration of termination on March 20, 2011.

6) Therefore, as the instant contract was terminated on March 20, 201, the Defendant’s defense of termination is reasonable, and the Plaintiff’s claim for this part of the contract, premised on the existence of the instant contract lawfully, is without merit.

B. Determination on the claim for insurance money based on the instant restitution contract

1) Determination on the cause of the claim

The facts that the instant restitution contract was concluded between the Plaintiff and the Defendant; the Plaintiff paid KRW 1,364,054 according to the instant restitution contract; and the fact that the insured events stipulated in the instant restitution contract died on April 23, 2013 are as seen earlier. Therefore, barring special circumstances, the Defendant is obliged to pay KRW 100 million of the insurance proceeds stipulated in the instant restitution contract to the Plaintiff.

2) Determination on revocation defenses due to breach of duty of disclosure

The terms and conditions of the restoration contract of this case relating to the duty of disclosure are Articles 24 through 26, and the detailed contents are as shown in the attached sheet. The above provisions also apply mutatis mutandis to the restoration contract in accordance with Article 14(2) of the above terms and conditions. Therefore, the plaintiff and B, who is the insured, shall inform the fact that they are aware of the matters asked in the subscription form even at the time of the application for the restoration contract of this case, and if they are violated, the defendant may exercise his right under the above

B On January 22, 2009, he was hospitalized in the Ulsan National University Hospital after undergoing a cancer diagnosis. < Amended by Presidential Decree No. 21354, Jan. 22, 2009>

2. Around 26. Around January 18, 2010, the fact that he/she received the liver surgery at the above hospital as a part of the liver cell cancer surgery at the above hospital was as seen earlier. In addition, when considering the overall purport of oral arguments in the descriptions of evidence No. 3 and No. 14, the Plaintiff and B’s offer for reinstatement (Evidence No. 3, No. 14) in the 10-year period of “the 10-year period of diagnosis, treatment, hospitalization, medication, etc. through a diagnosis or examination from the doctor of 10-year disease, such as cancer, liver, etc., and the fact that he/she received the 10-year period of diagnosis or examination, it cannot be acknowledged that the Plaintiff did not inform the Defendant of the fact that he/she did not comply with the duty of disclosure, such as the Plaintiff’s testimony, even if he/she did not notify the Defendant of the fact that he/she did not notify the 30-year diagnosis.

Therefore, barring any special circumstance, the defendant may cancel the contract within five years from the date of guarantee on the ground that the contract was made by hiding it after having been confirmed prior to the subscription pursuant to Article 26 of the above Terms and Conditions and by joining the insurance contract, and that the contract was concluded by fraud. The defendant sent a notice to the plaintiff to the effect that the contract of this case is cancelled based on the circumstances on June 18, 2013, and the defendant (Article 4-1 of the above Terms and Conditions, however, it is reasonable to see that the above notice is "cancellation", but its purport is "cancellation", which is served on the plaintiff on June 19, 2013, which is the next day after the above notice was served on the plaintiff on June 19, 2013. Thus, the restoration contract of this case became retroactively null and void by the defendant's above expression of intent. 3) The insurer's duty to explain in the insurance contract

In accordance with Article 638-3(1) of the Commercial Act and Article 3 of the Regulation of Standardized Contracts Act, when an insurer concludes an insurance contract, the insurer is obligated to provide the policyholder with specific and detailed explanation and explanation of the important contents of the insurance contract, such as the content of the insurance product, the insurance premium rate system, changes in the terms and conditions of the insurance application, and reasons for the exemption of the insurer's liability. Thus, if the insurer concludes an insurance contract in violation of such duty to specify and explain the terms and conditions, it cannot be asserted as the content of the insurance contract as the content of the insurance contract: Provided, That even if matters falling under the important contents of the insurance contract are included in the general and common terms and conditions in the transaction, if the policyholder or its agent was sufficiently anticipated without any separate explanation, or if the content of the contract is sufficiently known to the policyholder or its agent, it is not necessary for the insurer to provide separate explanation of the contents of the contract (see, e.g., Supreme Court Decision 2004Da26164, Dec. 9, 2005).

Meanwhile, according to Article 650-2 of the Commercial Act, where an insurance contract is terminated pursuant to Article 650(2) of the Commercial Act due to the continued insurance premium of a policyholder, and the refund for termination is not paid, the policyholder may demand the insurer to recover the contract by paying to the insurer delayed insurance premium together with the agreed interest within a given period. In this case, Article 638-2 of the Commercial Act on the formation of the insurance contract applies mutatis mutandis. It is determined that the instant reinstatement contract is a reinstatement contract under Article 650-2 of the Commercial

When concluding a reinstatement contract, it is a question of which the insurer must explain about any scope.The scope of guarantee or contract terms are not different from the contract before the reinstatement, and as to such content, the insurer's duty to explain the above contents is exempted or mitigated.

However, since the restoration contract is not a form of a contract that is ordinarily concluded, it is difficult for the general public to understand the meaning and effect of the contract, the ordinary usage of the term of restoration is extinguished or invalidated as before and after the payment of the insurance premium in arrears, it is easy for the general public to misunderstand that if only a restoration contract is concluded after paying the insurance premium in arrears, it would be the same legal situation as the previous contract is not invalidated, but its accurate meaning is not stated. The provisions of Article 650-2 of the Commercial Act are applied mutatis mutandis but Article 651 of the Commercial Act is not applied mutatis mutandis, but Article 650-2 of the Commercial Act is not applied mutatis mutandis. In particular, if the insurance period is considerably long time in the case of the insurance contract, the insurance contract, especially in the case of the personal insurance, is considerably long time, it seems that there is a considerable change from the time of the conclusion of the previous contract, and if the contract is concluded again based on the previous contract's health condition, it seems reasonable to clearly explain the effect of the disclosure contract to the insured.

C) Whether the Defendant fulfilled his duty to explain in the instant case

In light of the following circumstances acknowledged by adding the whole purport of arguments to each of the above evidence and evidence Nos. 3 and 14 and 16, the facts that D, an insurance solicitor of the defendant, around March 31, 2011, at the time when the offer of the instant restoration contract was prepared, clearly stated and explained to the plaintiff or B about the legal nature of the restoration contract, the fact that the duty of disclosure takes place based on the time of the offer of the restoration contract, cannot be acknowledged, and there is no other evidence to acknowledge it otherwise.

① The Plaintiff asserts that the Plaintiff was unable to accurately memory the preparation process of the instant restoration contract, but that there was no fact that D had been found. The mere descriptions of No. 3, No. 14, and No. 16 of the Plaintiff’s Certificate No. 14, and No. 16 of the instant restoration contract are insufficient to deem that D visited the Plaintiff’s office. (D was subject to a fine for negligence due to the Defendant’s absence in this court, even if duly summoned upon the Defendant’s application for witness, and even if so, the Defendant was not present as

② Even based on the statement in the evidence No. 16 (Evidence of Fact) written by D, only D was signed with a detailed explanation as to whether D was open within 5 years, and solely on such circumstance alone, it is difficult to view that: (a) a new duty of disclosure arises as at the time of the offer of the instant restoration contract; and (b) a specific explanation is given that if it is violated, it would be at a disadvantage such as cancellation of the contract under the terms and conditions.

③ On the other hand, the customer confirmation column (No. 3, No. 2, No. 15) of the insurance subscription form of this case (Evidence No. 6) provides that the customer confirmation column of the insurance subscription form of this case must verify whether the customer has been explained about the important matters of the insurance contract. On the other hand, the customer confirmation column of the instant restoration contract is stated only in the period of restoration, overdue premium, overdue interest, and insurance premium, etc. at the bottom of this case. Therefore, the contractor does not have any explicit explanation on the fact that the customer’s confirmation in the instant restoration contract is likely to think that the said monetary matters are the main contents, and that the duty of disclosure takes place again at the time of the offer of the restoration contract, which can be the most important contents.

④ In addition, regarding the meaning of the 'recoverage' in the subscription form of the above restoration contract, it is highly likely that the plaintiff would be the same situation as the 'recoverage' in which the effect of the previous restoration contract (the instant contract) is not restored if the restoration contract and the previous contract are concluded instead of a separate contract.

⑤ The Defendant’s breach of duty of disclosure does not stipulate the purport that the duty of disclosure takes place again on the basis of the time of application for a restoration contract, even on three pages of the application for a restoration contract of this case.

D) Sub-decisions

Therefore, since the Defendant violated the duty of disclosure and explanation as to the legal nature of the restoration contract and the fact that the new obligation of disclosure arises as of the time of application for the restoration contract, the Defendant cannot assert the terms and conditions provisions (Articles 14(2), 24 through 26) as the contents of the restoration contract of this case. Therefore, the above terms and conditions provisions cannot be asserted as the contents of the restoration contract of this case.

The defendant's defense on the premise that the above cancellation is incorporated is no longer reasonable. Therefore, the defendant is liable to pay to the plaintiff the insurance money of KRW 100 million under the restoration contract of this case due to the death of B and the damages for delay.

C. Determination on the grounds of the claim for deduction

Meanwhile, around June 18, 2013, the Defendant returned the cancellation refund of KRW 10,781,653 calculated by subtracting the principal and interest of a standardized contract loan from KRW 13,58,445, and KRW 10,781,653 as seen earlier. Therefore, the Defendant’s return of the said money returned by the Defendant and the total amount of principal and interest of a standardized contract loan that was deducted from KRW 24,340,098 ( = 13,558,445 + + 10,781,653) should be deducted from the insurance amount that the Defendant should pay.

D. Therefore, the Defendant is obligated to pay damages for delay at each rate of 75,659,902 won ( = 100 million won - 24,340,098 won) and 20% per annum under the Civil Act until March 19, 2015, which is the date when the Defendant rendered a substantial judgment, as to the existence and scope of performance obligations, from the date following the delivery date of a copy of the complaint of this case to the date when the copy of the complaint of this case is served.

4. Conclusion

Thus, the plaintiff's claim of this case is justified within the above scope of recognition, and the remaining claim is dismissed as it is without merit. It is so decided as per Disposition.

Judges

Effective quantity of judge

Site of separate sheet

A person shall be appointed.