2. The term “determination” means that a patient suffers treatment under the observation and management of a medical staff while staying in a hospital for more than six hours in accordance with the following provisions: (a) in cases where continuous observation of a medical staff is necessary with respect to side effects or incidental effects of a patient’s disease, such as the patient’s low resistance ability or the patient’s symptoms, the patient’s symptoms, diagnosis and treatment of the patient, etc. need to be continuously conducted; and (b) in cases where the patient’s conditions are unable to cope with the patient’s disease or where the patient’s risk of infection exists; and (c) the patient suffers from the treatment while staying in the hospital for more than six hours; and (d) as such, the patient’s symptoms, symptoms, diagnosis and treatment of the patient, the patient’s behavior, etc. are determined based on comprehensive consideration of the period of stay in the hospital and the patient’s symptoms, the patient’s treatment details and procedures, and the patient’s actions, etc., and thus, the patient’s treatment is not necessary.

The act of claiming insurance money by asserting that the insurance company satisfies the hospitalization period stipulated in the terms and conditions of the insurance contract without notifying the insurance company of the case of a long-term hospitalization more than necessary for the erroneous payment, constitutes deception in fraud (see Supreme Court Decision 2007Do2941, Jun. 15, 2007). In addition, even if there are any grounds for receiving one insurance money, the insurance money shall be acquired by fraud more than the amount of the insurance money that can be actually paid due to the decline.