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(영문) 대법원 2011. 9. 8. 선고 2010다69360 판결

[보험금][공2011하,2070]

Main Issues

[1] In a case where Party A’s wife concluded traffic safety insurance contracts with Party B as the insured, and Party C concluded the injury insurance contracts with Party B, and thereafter Party A showed symptoms, such as language disorder, etc. due to traffic accidents, and the intelligence also decreased to an average level below the average level, and thus, the case holding that Party A’s disability falls under Grade B of disability grade under the disability Classification Table of the traffic safety insurance terms and conditions

[2] In a case where Party A’s wife concluded traffic safety insurance contracts with Party B as the insured, and Party C concluded the injury insurance contracts with Party B, and thereafter Party A appeared to have symptoms such as language disorder, etc. due to traffic accidents, and the intelligence also reduced to a level much below the average level, thereby making it necessary to assist a guardian in all basic actions, such as taking food, the case holding that Party A’s disability falls under Grade B of disability grade under the disability Classification Table of the above Injury Insurance Terms and Conditions

Summary of Judgment

[1] In a case where Party A’s wife concluded traffic safety insurance contract with Party B with Party B as the insured, and Party C, respectively, and thereafter, Party A shows symptoms such as language disorder, snam power disorder, memory disorder, and judgment disorder due to a traffic accident, etc., which considerably lower level of intelligence than average, and thus, care for guardians was necessary due to all basic actions, such as taking-off of food, taking-off actions, treating her clothes, and bathing, the case holding that the traffic safety insurance contract with Party B concluded with the insurance company constitutes “when the insured is subject to life-rating restrictions on other persons’ life-based basic action” under the premise that the aforementioned insurance contract’s disability grade cannot be seen as an “when the insured is subject to life-rating restrictions on other persons’ life-rating or life-related harm” under the premise that it is difficult to view the aforementioned insurance contract’s life-related condition as an insured event, and that there is an error in law by stipulating that the above insurance contract’s life-related condition or life-related condition of nursing becomes an obstacle to life-related condition.”

[2] In a case where Party A’s wife entered into an insurance contract with Party B as the insured, traffic safety insurance company C, and injury insurance contract with Party C respectively, and thereafter, Party A shows symptoms such as speech disorder, spawn disability, memory disorder, and judgment disorder due to a traffic accident, etc., which considerably lower the average level of intelligence, and the guardian’s assistance was necessary in all basic actions, such as actions taken in food, handling her clothes, treatment of urines, bathing, etc., the case holding that the injury insurance contract entered into with Party C’s insurance company’s injury insurance policy provides that the degree of restriction on the daily life of the insurance company’s injury to the insured’s disability should be determined as stated in the traffic classification table of the traffic safety insurance contract with Party B, and that the provision of the insurance contract with Party C’s injury insurance company’s “where it is obvious that the insured’s injury still remains an insured accident,” including the restriction on the daily life of Party C’s injury or injury grade 1 or 4’s actions necessary for the maintenance of life (i.

[Reference Provisions]

[1] Article 5 (2) of the Regulation of Standardized Contracts Act / [2] Article 5 (2) of the Regulation of Standardized Contracts Act

Plaintiff-Appellant

[Judgment of the court below]

Defendant-Appellee

Young Life Insurance Co., Ltd. and one other (Law Firm White General Law Office, Attorneys Kim Young-young et al., Counsel for the plaintiff-appellant)

Judgment of the lower court

Gwangju High Court Decision 2009Na2526 decided July 16, 2010

Text

The judgment below is reversed, and the case is remanded to the Gwangju High Court.

Reasons

We examine the grounds of appeal.

1. As to the grounds of appeal against Defendant M&C Life Insurance Co., Ltd. (hereinafter “Defendant M&C life”)

According to the reasoning of the judgment below and the records, the insurance terms and conditions of the "I" insurance contract concluded on September 2, 1997 between the plaintiff's wife and the plaintiff as the insured on September 22, 1997 (hereinafter "the life insurance terms and conditions of this case") include class 1, class 2, class 4, and class 3, class 4, class 3, class 3 of the "when the insured is obliged to receive occasional nursing at all times" in the disability grade table, and class 2, class 4, class 3 of the "when he becomes subject to restriction on daily life basic action," and one of the above "where it is necessary to provide care from time to time to time to time to maintain life" and "where it is necessary to ensure that the insured's life or mental disability is seriously damaged by drinking, eating, urineing, or other person's life-related mental or physical disability" in the above life grade table. On the other hand, in the case of "restricted daily life activities" in the above Table 3, it means serious inconvenience that the insured person's life or mental or physical disability.

However, according to the facts found by the court below, the plaintiff, which is an insurance accident of this case, showed symptoms such as language disorder, spatitual disorder, spatitual disorder, memory disorder, memory disorder, judgment disorder, shock disorder, aggressive and sensitive disorder, aggressive behavior, social degradation, old disorder, mental exercise disorder, delay in spatitual disorder, hair 69, man 68, total intelligence 68, and 68, which are much less than the average, thereby contributing to the guardian's care in all basic actions such as food intake behavior, actions to get off clothes, treatment of backs/urines, bathing, bathing, etc. Thus, the plaintiff's disability grade falls under the category of disability in attached Table 3 (Attachment Table 3) of this case, since it is difficult for the plaintiff to nurse from time to time in order to maintain his/her life, such as intake behavior, etc. of food remaining in the above accident. Thus, it constitutes a disability grade in attached Table 3) of this case.

Nevertheless, the court below acknowledged the contents of the disability classification theory applicable to the above insurance contract as above, while the first instance court maintained the judgment of the first instance court that the plaintiff's disability did not fall under the disability grade No. 2 under the School Life Insurance Clause (Attached Table 3) of this case, because it is difficult to see that the plaintiff's disability cannot be seen as "the situation where the plaintiff's disability does not fall under the disability grade No. 2 of the School Life Insurance Clause of this case, because it is difficult to see that the plaintiff's disability is restricted to movement action because it goes beyond the invasion and it is like the insurance clause of the 1/200 accident insurance as of December 27, 200 and December 28, 200. Thus, the court below erred in the misapprehension of legal principles as to the interpretation of the terms and conditions.

2. As to the ground of appeal against the defendant's life

The interpretation of a standardized contract shall be interpreted fairly and reasonably in light of the purpose and purpose of the standardized contract in question in accordance with the principle of trust and good faith, but it shall be objectively and uniformly interpreted based on the average customer's interests, without taking into account the intended purpose or intent of the parties to the contract. Even after the above interpretation, in cases where the meaning of the standardized contract is not clear, such as where the standardized contract provisions are objectively and objectively interpreted and their respective interpretations are reasonable, it shall be interpreted favorably to customers (see, e.g., Supreme Court Decisions 2008Da81633, May 28, 2009; 2009Da51318, Sept. 30, 2010).

According to the reasoning of the judgment of the court below, the life insurance contract of this case refers to the case where the number of others from time to time is restricted by one or more of the items of life insurance, and the extent of restriction on the movement of others from time to time to time to time to time to time to time to determine whether there is a need to be restricted by 1 or more of the items of life insurance (2) the time to determine whether there is any need to be restricted by 5 or more of the items of mental illness from time to time to time to time to time to time to time due to dementia or mental illness, etc. (1) the condition of the school life insurance contract of this case (attached Table 3) as in the table of disability classification of this case is divided into two cases under the table of disability classification, and (2) one of them includes the restriction on the movement of others from time to time to time to time to time to time to time to determine whether there is any need to permit the movement of others from time to time to time to time to time to exceed the extent of the restriction on the movement of others.

(3) In light of the above legal principles and records, it is necessary to interpret the snow rules of this case in harmony with other snow rules of the disability classification table and the theory of disability grade. The above disability grade table is "when the insured has to undergo long-term nursing at all times" with regard to disability grade 1; and the above disability grade 2 is "when they have to undergo long-term nursing" with regard to "when they have to undergo long-term nursing" and the above grade 1, 2 and 4 are categorized by the necessity of "intermediacy" and the above grade of disability 1, 2 and 4 are to be separated from the above grade of disability in cases where the above disability grade is to be restricted to the extent that the above grade of the insured's life or the above grade of disability is to be restricted to the extent that the above grade of disability is to be restricted to the extent that the above grade of disability is to be restricted to the extent that it is not necessary to maintain the daily life of the insured, and the above grade of disability grade is to be restricted to the extent that the above grade of disability is not necessary to the above grade of the daily life grade of the above."

Nevertheless, the court below held otherwise based on the premise that even if there is a case where it is strictly necessary for others from time to time due to dementia, mental illness, etc. on the ground of its stated reasoning, if it fails to meet the requirements of “(i) restriction on movement movement during the basic daily life for the maintenance of life,” it does not constitute a case of “number of hours” as prescribed by the snow provision of this case, and in the case of the plaintiff, it did not meet the requirements of “restriction on movement during the basic daily life for the maintenance of life,” and thus, it does not constitute a case where “number of hours” as prescribed by the disability Classification Table 2 of the Korea Life Insurance Terms and Conditions and the snow Provisions of this case. In so determining, the court below erred by misapprehending the legal principles on the interpretation of the

3. Conclusion

Therefore, the lower judgment is reversed, and the case is remanded to the lower court for further proceedings consistent with this Opinion. It is so decided as per Disposition by the assent of all participating Justices on the bench.

Justices Min Il-young (Presiding Justice)