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(영문) 광주지방법원목포지원 2020.04.29 2019가단56563
보험금
Text

1. As to KRW 1,800,000 and KRW 600,000 among the Plaintiff (Counterclaim Defendant), the Defendant (Counterclaim Plaintiff) from August 1, 2018.

Reasons

A principal lawsuit and a counterclaim shall be deemed simultaneously.

Basic Facts

On December 27, 2016, the Plaintiff entered into an insurance contract between the Defendant, an insurance company, and the Plaintiff, the insured, as the Plaintiff’s child, and Nonparty D, who was scheduled to be born as the Plaintiff’s child, and the insurance period from December 27, 2016 to December 27, 2016 (hereinafter “instant insurance contract”).

D The treatment and insurance payment of D had a congenital disease called the left-hand neck, shoulder, the upper part part of Q82.5) and the upper part of Q82. The two shoulders and the upper part of D had a astronomical congenital disease (the disease code: Q82.5).

D From October 2017, 2017, at L4VO Radic care and Doisre care (hereinafter “each of the instant Radic care”) for each of the instant diseases at the Furdic care center located in Daegu.

Under the insurance contract of this case, the Plaintiff received insurance money totaling KRW 87,465,224 [the Plaintiff’s insurance money = KRW 5,103,596 9,402,881 ray and abnormal surgery expenses of KRW 61,118,887, 11,887, 11,839,860] from the Defendant.

The defendant's insurance contract of this case provides that the defendant shall pay 300,000 won per time of the disease surgery of the insured, and the main contents of the defendant's insurance contract related to the expenses of the disease surgery are as follows.

In relation to the Defendant’s special insurance terms and conditions related to “in a vessel or an emergency,” the following are the same in relation to the operation part:

Article 1 (Grounds for Payment of Insurance Money) of the Special Terms and Conditions for Disease Operation Expenses (Liability for Payment of Insurance Money) If the insured has undergone an operation for the direct purpose of treating a disease diagnosed during the insurance period of this Special Terms and Conditions, he/she shall pay the amount of insurance coverage of this Special Terms and Conditions to the beneficiary (the insured if the beneficiary is not designated) once

Notwithstanding paragraph (1), Article 4 shall be operated.

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