2. Determination

A. In a case where continuous observation by a medical personnel is required with respect to side effects or incidental effects of drugs which have low resistance power to, or are administered by, a patient’s disease, the patient’s pains need to be continuously controlled, and thus, the patient’s pains are in a situation where the patient’s condition is unable to cope with pains or where the patient’s risk of infection exists, etc., and the patient suffers from treatment while staying in the hospital. As such, the patient’s treatment is being provided under the observation and management of the medical personnel while staying in the hospital for more than 6 hours pursuant to all the provisions of the “detaileds on the criteria and method for applying medical care benefits” as publicly notified by the Ministry of Health and Welfare, such as “the criteria for and method of medical care benefits” should be determined based only on symptoms, diagnosis and treatment of the patient, and the patient’s actions. However, the determination should be made by comprehensively taking account of symptoms, diagnosis and treatment of the patient

In addition, in the case of exercise of rights by means of deception, if such deception is to the extent that it is not acceptable as a means of exercise of rights by social norms, the exercise of rights constitutes fraud, and there is a reason to receive insurance money.

Even if this is done, if excessive insurance money is paid through long-term hospitalization, etc. with intent to acquire a large amount of insurance money than the actual insurance money, a crime of fraud is established against the whole insurance money received.

Supreme Court Decision 209.