logobeta
본 영문본은 리걸엔진의 AI 번역 엔진으로 번역되었습니다. 수정이 필요한 부분이 있는 경우 피드백 부탁드립니다.
텍스트 조절
arrow
arrow
(영문) 서울중앙지방법원 2017.08.16 2016나83626
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. Facts of recognition;

A. On March 4, 2015, the Plaintiff entered into an insurance contract for multi-use franchise with the Plaintiff and the insurance period as the Defendant (hereinafter “instant insurance contract”). The main terms and conditions of the said insurance contract are as follows: (a) the agreement for non-payment of dividends; (b) the agreement for non-payment of damages and medical expenses (hereinafter “instant special agreement”).

Article 3 (Guarantees by Type of Security) (1) A company shall compensate for medical expenses for hospitalization within the limit of the amount of insurance coverage (50 million won) for each of the following cases, where the insured was hospitalized in a hospital due to an injury:

Of the medical benefits prescribed in the National Health Insurance Act or the Medical Care Assistance Act, the amount of compensation classified by multiple-choice hospitalization, expenses for hospitalization, and expenses for medical care under the National Health Insurance Act, an amount equivalent to 90% of the sum (excluding the difference between the actual user's room and the standard sick room at time of hospitalization) of the amount of non-payment (However, if the amount equivalent to 10% exceeds 2 million won a year from the date when the contract is entered into or the date when the contract falls on a yearly basis, the amount in excess shall be compensated) after deducting 50% of the difference between the actual user's room and the standard sick room at the time of hospitalization (Provided, That the average amount per day shall be limited to 100,000 won, and the difference between the average patient's room's room and the standard sick room during the period of hospitalization shall be calculated by dividing the total number of days of hospitalization) of theO (non-compensation) Article 4 (Non-compensation Matters) of the Medical Care Assistance Act) [3] No compensation shall be provided for the following expenses for hospitalization.

9. Medical expenses paid in automobile insurance (including mutual aid) or industrial accident insurance: Provided, That the principal's medical expenses shall be compensated in accordance with Article 3;

B. On August 25, 2015, the Plaintiff was involved in a traffic accident at Geyang-sidong, and on October 26 of the same year from the date of the accident.

arrow