logobeta
본 영문본은 리걸엔진의 AI 번역 엔진으로 번역되었습니다. 수정이 필요한 부분이 있는 경우 피드백 부탁드립니다.
텍스트 조절
arrow
arrow
(영문) 서울중앙지방법원 2021.02.16 2020나22215
부당이득금반환
Text

1. The defendant's appeal is dismissed.

2. The costs of appeal shall be borne by the Defendant.

The purport and purport of the appeal [the purport of the appeal]

Reasons

1. Basic facts

A. The Plaintiff entered into a C insurance agreement with the Defendant around October 26, 2001, and entered into D insurance agreement around August 25, 2009. The terms and conditions applicable to this case are as follows:

[Terms and Conditions of Hospitalization in the D Insurance Agreement ] Article 10 [Definition and Place of Hospitalization] of the D Insurance Agreement . The term "Hospitalization" means that a person who is qualified as a doctor, dentist or oriental medical doctor needs to be directly engaged in medical treatment due to a disease or disaster as provided in the list of the insured (person subject to insurance) and it is difficult for him to provide medical treatment at his own home and it is difficult for him to provide medical treatment and concentrate on medical treatment under the control of a doctor by attending a domestic hospital, a member of the National Assembly or a medical institution as provided in the Medical Service Act related to foreign medical treatment.

Article 11 [Types of Insurance Payments and Reasons for Payment] The Company shall pay the amount of hospitalization benefits agreed upon to the beneficiary of insurance (the beneficiary of insurance) if the insured (the beneficiary of insurance) has been hospitalized for at least four consecutive days for the purpose of medical treatment due to diseases or accidents prescribed in the table of classification of diseases and accidents during the insurance period of this special agreement.

In addition, the terms and conditions of the special agreement for hospitalization of a specific disease without a dividend for D insurance provide for the payment of the amount of hospitalization for a specific disease, and the terms and conditions of the special agreement for non-payment of dividends under C Insurance provide for the same purport as above in addition to the number of days of hospitalization more than one day.

B. The Plaintiff paid KRW 25,682,020 to the Defendant in total 34 times from March 3, 2010 to February 24, 2014.

(c)

On February 14, 2019, the Defendant was sentenced to imprisonment with prison labor for one year and six months and three years of suspended execution with the following content as a crime of fraud in the order of the Daejeon District Court Decision 2016 High Order 2453, which became final and conclusive around that time.

The defendant has purchased a large number of insurance policies for the defendant as the insured and then issued a medical certificate.

arrow