부당이득금
1. The Defendant shall pay to the Plaintiff KRW 18,50,000 and the interest rate of KRW 12% per annum from December 4, 2019 to the date of complete payment.
1. Basic facts
A. On September 18, 2009, the Plaintiff entered into an insurance contract with the Defendant as shown in attached Table 1 (hereinafter “instant insurance contract”).
B. On May 31, 2010, the Defendant was hospitalized for 38 days at C Hospital as an insured event from May 31, 2010 to July 7, 2010, as shown in the attached Table 2, from May 31, 2010 to June 7, 2017, and was hospitalized for 572 days as shown in the attached Table 2. Under the instant insurance contract, the Defendant was paid KRW 48,690,360 (the cost of hospitalization for an injury-disease) with the insurance money of KRW 17,130,230 as KRW 16 (the cost of hospitalization for an injury-disease disease of KRW 25,060,00 for nursing expenses for an injury-disease disease of KRW 6,50,130 for nursing expenses for an injury-disease disease of KRW 6,50,130).
[Ground of recognition] Facts without dispute, Gap 1 to 5 evidence, Gap 7-1 to 3 evidence, the purport of the whole pleadings
2. The parties' assertion
A. The Defendant alleged that the Plaintiff’s assertion was possible to provide medical treatment for 146 days during the pertinent period of hospitalization in the attached Table 3. As such, the Defendant is obligated to return 18,550,000 of the insurance money corresponding to the above period of hospitalization without need of medical treatment to the Plaintiff as unjust enrichment.
B. The defendant's assertion that he received hospital treatment for the above 146 days was based on doctor's diagnosis and prescription, and thus, the plaintiff's assertion is without merit.
3. Determination on the cause of the claim
A. In a case where the insured under the relevant legal doctrine was hospitalized in a hospital due to an injury or disease stipulated in the insurance clause, and the insurer paid the insurance money as the insurance money, but it is found that the requirements for the payment of the insurance money were not satisfied later, the insured shall return the insurance money to the unjust enrichment, barring any special circumstance.
At this time, the insurer did not disclose that it failed to meet the requirements for payment of insurance premiums at the stage of examining the payment of insurance premiums based on the data of medical records, opinions, etc. submitted by the insured.