보험에관한 소송
The appeal is dismissed.
The costs of appeal are assessed against the defendant.
The grounds of appeal are examined.
1. The insurance contract is a continuous contract that survives for a long time during the insurance period and is likely to cause moral hazard, and thus there is a strong fiduciary relationship between the parties.
Therefore, when the trust relationship, which forms the basis of the contract, is destroyed due to unfair acts of one of the parties during the existence of the contract, and the other party is unable to expect the continued existence of the contract, the other party can terminate the contract by terminating it to the future.
In a case where the policyholder claimed or paid the insurance money for the cause of the payment of the hospitalized treatment, but it is found that the whole or part of the hospitalized treatment is not necessary, the insurer may terminate its effect in the future by cancelling the insurance contract, provided that the trust relationship, which forms the basis of the insurance contract, is destroyed due to the policyholder’s unreasonable claim for the insurance money or the receipt of the insurance money, and that there is a serious reason for not expecting the existence of the insurance contract, considering the following: (a) circumstances leading up to receiving the hospitalized treatment; (b) whether hospitalized was hospitalized with knowledge that there was no need for the hospitalized treatment; (c) the number of days of hospitalization without the necessity of the hospitalized treatment or the amount of the insurance money claimed or received; (d)
On the other hand, this right of termination is based on Article 2 of the Civil Code which provides the principle of good faith and is naturally premised on the relationship of insurance contract.
The insurer's exercise of the right to terminate the contract is not in violation of Article 663 of the Commercial Act or Article 9 (2) of the Regulation of Standardized Contracts Act.
The insurer fails to meet the requirements for payment at the stage of examining the payment of insurance proceeds.