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(영문) 울산지방법원 2018.08.16 2017나24342

보험금

Text

1. The plaintiff's appeal is dismissed.

2. The costs of appeal shall be borne by the Plaintiff.

The purport of the claim and appeal is the purport of the appeal.

Reasons

1. Basic facts

A. On October 31, 2008, B, the husband of the Plaintiff, entered into a contract with the Defendant, an insurance company, under which: (a) the Plaintiff and B, the insured; and (b) C, the insurance period from October 31, 2008 to October 31, 2026, under which the Plaintiff and B, were the children of non-dividend Samsung F&C (hereinafter “instant insurance contract”).

B. The instant insurance contract’s guarantee includes a special agreement on medical expenses for hospital diseases (hereinafter “instant special agreement”). The relevant special agreement is as follows.

16.(Renewal) The company is bound to compensate for any loss caused by a disease during the insurance period specified in the insurance policy of this Special Terms and Conditions for Medical Expenses (A1) in accordance with this Special Terms and Conditions.

Article 2 (A) ① Where the insured has received medical treatment by being hospitalized in a hospital or clinic due to a disease prescribed in Article 1 during the insurance period, the company shall pay the following expenses for hospitalization and medical treatment (A) to the beneficiary (if the beneficiary is not designated, the insured).

1. Hospitalization fees: Medical examination fees, fees for the use of a standard sick room, fees for patient management, and food expenses;

2. Expenses for hospitalization: Testing fees, radiation fees, medication and prescription fees, the main feed, secondary feed, medical treatment fees, mental therapy fees, materials for treatment, glocks, and designated medical treatment fees;

3. Expenses for hospitalization operation: Expenses for surgery, anesthesia and materials for surgery;

4. The difference between the difference between the actual user's disease room and the standard disease room: (2) The company shall pay the full amount of the expenses under paragraph (1) 1, 2, and 3 that are borne by the insured under the National Health Insurance Act (referring to the part of the medical care benefits provided for in the National Health Insurance Act and the part of the non-benefit) and 50% of the expenses under paragraph (1) 4 within the limit of 30 million won.

However, if the insured is not subject to the national health insurance, the health care benefit procedure prescribed by the national health insurance.