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(영문) 대구지방법원 2015.06.12 2014가단116049

1. In relation to the accidents described in paragraph 2 of the attached list, intent of the source of the insurance contract listed in paragraph 1 of the attached list.


1. Basic facts

A. On October 31, 2012, Defendant A concluded an insurance contract between the Plaintiff Company and Defendant B as the insured under the attached Table No. 1.

B. On February 14, 2013, Defendant A gave birth to Defendant B; Defendant B was hospitalized in the Daegu Movables Medical Center on February 15, 2013; Defendant A transferred to the Samsung Seoul Hospital on March 8, 2013; and was diagnosed with congenital typhrosis and congenital malutism; and on May 7, 2013, Defendant A received an institutional surgery because of the need for a long-term artificial absorption treatment.

C. Defendant A purchased the instant medical device from C (D) on July 29, 2013 to receive education on the method of its management and use, and Defendant B discharged it from the Samsungnam Hospital on August 9, 2013, according to the doctor’s prescription that the use of the artificial absorption and oxygen absorption measuring instrument among the water surface at Defendant B’s house, and the medical smoking and ultra-frequency smoking machine (hereinafter “the instant medical device”).

The terms and conditions of the instant insurance contract relating to the instant claim are as follows.

(1) Article 1 (Types and Grounds for Payment of Insurance Money) of the Special Terms and Conditions for Guarantee of Disease, In the event that the insured (person subject to insurance) is hospitalized in a hospital due to disease and received treatment, the company is bound to compensate for the expenses for hospitalization medical treatment up to the amount of insurance coverage (the maximum amount of KRW 50 million as determined by the contractor) per disease as follows:

Article 3 of the Medical Care Assistance Act provides that the amount equivalent to 90% of the total sum of the amount of “self-payment” and “non-payment (excluding the difference of difference of injury and disease compensation)” among the medical care benefits prescribed in the National Health Insurance Act and the amount of hospitalization expenses for hospitalization of hospitalization as classified amount of compensation (Provided, That where the amount equivalent to 10% exceeds two million won a year from the date on which the contract is concluded or from the date on which the contract falls each year, such excess amount shall be compensated).