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(영문) 광주지방법원 2017.10.25 2017나53698
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. Basic facts

A. On June 10, 2010, the Plaintiff entered into a non-dividend C insurance contract (a contract number: D; hereinafter “instant insurance contract”) with the purchase price of KRW 100 million as its heir at the time of injury to the Defendant, the Plaintiff, the beneficiary, and the heir at the time of death.

B. The main contents of the instant insurance contract relating to the instant case are as follows.

[Terms and Conditions of the Special Agreement for Involuntary Hospitalization of Specific Diseases] Article 14 [Definition and Confirmation of Diagnosis] (1) The term "fourth-person disease" in this Special Agreement refers to a disease specified in attached Table 4 (The Four-person Disease Classification) of the Korean Standard Disease Classification.

(2) The diagnosis and confirmation of four major diseases shall be based on a written diagnosis by a person qualified as a medical doctor (excluding dentists) of a domestic hospital or a medical institution prescribed by the Medical Service Act related to medical treatment outside the country under Article 3 (Medical Institutions) of the Medical Service Act.

Article 17 (Definition and Place of “Hospitalization”) In this special agreement, the term “hospitalize” means that a person qualified as a doctor, dentist or oriental medical doctor (hereinafter referred to as “doctor”) deems it necessary for the direct purpose of medical treatment due to an insured’s disease or disaster, and it is difficult to provide medical treatment at his own home, etc., and is committed by him to a domestic hospital or clinic as prescribed by Article 3 (Medical Institution) of the Medical Service Act, or a medical institution as prescribed by the Medical Service Act related to foreign medical treatment, and to concentrate on medical treatment

Article 18 [Types and Grounds for Payment of Insurance Money] If the insured during the insurance period of this Special Agreement falls under any of the following subparagraphs, the Company shall pay the beneficiary the “specified Hospital Benefits” as follows:

If the insured under a special contract for the cause of payment has been hospitalized for at least four consecutive days for the purpose of directly treating such cancer during the period of insurance under this special contract, or the insured has continued to be hospitalized during the period of insurance under this special agreement.

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