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(영문) 서울중앙지방법원 2020.09.25 2019가합547929

손해배상(기)

Text

The plaintiff's claim is dismissed.

Litigation costs shall be borne by the plaintiff.

Reasons

1. Facts of recognition;

A. 1) The Plaintiff is a company running non-life insurance business, etc., and the Defendant, as a doctor of Ansan-gu, is in charge of treating and surgery in the country as a representative director of the Dental Institute located in Gangnam-gu Seoul as the insured. 2) The Plaintiff concluded an indemnity medical expenses insurance contract (hereinafter “each of the instant insurance contracts”) with the content that the amount of the medical expenses is paid in case where the Plaintiff and the insured are hospitalized in the sick Institute and received treatment between each policyholder and the insured, as the insured.

B. The Defendant’s implementation of artificial insemination inserted in a multi-point artificial insemination, and the Plaintiff’s payment of insurance proceeds, were hospitalized between the Plaintiff and the Plaintiff from January 2018 to April 23, 2019, and the Defendant was conducted with multiple-point artificial insemination inserted in a foreign-use artificial insemination injection for treatment in a white paper (hereinafter “the instant surgery”), and the Defendant was paid medical fees to the Defendant. Accordingly, upon receiving insurance claims from the Plaintiff under each of the instant insurance contracts, the Plaintiff was paid insurance proceeds for the items of personal charges and non-paid items among the medical benefits under the National Health Insurance Act or the Medical Care Assistance Act under the instant veterinary Act.

C. On the other hand, the standard terms and conditions of each insurance contract of this case were amended on December 29, 2015 as follows.

[Revised standard terms and conditions] Matters not compensated by a third company, which are not compensated by a company under Article 4 (Matters not compensated) are as follows for each type of guarantee.

(3) Hospitalization of disease;

8. Medical expenses incurred by treatment for the purpose of improving appearance, which is not for improving physical essential functions, for non-benefits of national health insurance, as follows:

(c)the part that is not in use of surgery methods or materials for medical care benefits for national health insurance in order to cope with climatics, contact lensess, etc.