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(영문) 서울중앙지방법원 2017.11.29 2017나1010
보험금
Text

The judgment of the first instance court, including the plaintiff's claim extended by this court, shall be modified as follows 2.

2.(a)

Reasons

1. Facts of recognition;

A. On March 18, 2011, the Plaintiff purchased medical insurance goods sold by the Defendant (hereinafter “instant insurance contract”) and paid the insurance premium (hereinafter “instant insurance contract”).

The terms and conditions of the special agreement on non-payment of dividends, losses, and medical expenses (Renewal) applicable at the time of the instant insurance contract stipulate “the amount equivalent to 90% of the total amount of the amount of the principal’s charges and non-payment of the medical benefits prescribed in the National Health Insurance Act (excluding the difference between the actual user’s disease room and the standard sick room at the time of hospitalization)” as damages.

C. Meanwhile, Article 4 of the said Terms and Conditions provides that “scopic correction methods, etc. to replace massages, contact lensess, etc. among the medical expenses incurred due to treatment for the purpose of improving the appearance” shall not be compensated.

On November 5, 2015, the Plaintiff was diagnosed as “instigious lebane instigious lebane,” etc. in two eyes from the National Assembly members, and was hospitalized from November 6, 2015 to November 7, 2015 and received instigious leb and modified body surgery (instigious emulmatization) and artificial insemination inserted.

E. The Plaintiff spent KRW 7,00,000, including KRW 6,400,000, for multi-point artificial insemination (with respect to the treatment of the foregoing surgery) that is not covered by health insurance or that the patient himself/herself bears, and claimed for insurance payment under the insurance contract of this case with respect to the above expenses.

[Reasons for Recognition] Unsatisfy, Gap evidence 1 to 5, Eul evidence 1 to 3, the purport of the whole pleadings

2. The parties' assertion

A. Since the standard terms and conditions have not been specified or explained as to the fact that artificial insemination surgery using the plaintiff Daz is not subject to the payment of insurance proceeds, it cannot be deemed that the artificial insemination surgery is not subject to the payment of insurance proceeds, and even if not, it is not subject to the payment of insurance proceeds, the defendant's total medical expenses and the amount

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