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(영문) 광주고등법원 2019.07.12 2018나21707
보험금
Text

1. Revocation of the first instance judgment.

2. The plaintiff's claim is dismissed.

3. All costs of the lawsuit shall be borne by the Plaintiff.

Reasons

1. Basic facts

A. On February 25, 2010, the Plaintiff entered into an insurance contract with the Defendant, the insured Party C, the beneficiary, the Defendant, and the insurance period from February 25, 2010 to February 25, 2045 (hereinafter “instant insurance contract”).

B. The term “the instant special terms and conditions” contained in the instant insurance contract (hereinafter “the instant special terms and conditions”) provides that the Plaintiff shall pay KRW 5 million to the Defendant where the first diagnosis is finalized due to cerebrovascular diseases stipulated in the instant special terms and conditions between February 25, 2010 and February 25, 2035.

The main contents are as follows:

Article 2(Definition and Confirmation of cerebrovascular Diseases)(1) of the Special Terms and Conditions for the Examination of Brain Diseases (Renewal No. 4, B)(Definition and Confirmation of cerebrscular Diseases)(1) of this Special Terms and Conditions refers to the diseases specified in attached Table 12 (Classification of Brain Diseases) in the Korean Standard Classification of 5th Medical Patients.

(2) The diagnosis and determination of a brain-related disease shall be conducted by a hospital prescribed in Article 3 (2) of the Medical Service Act or by a person with a certificate of qualification of a medical institution recognized as equivalent thereto (excluding dentists), and such diagnosis shall be conducted based on the brain-related calcology shooting, self-official image, MFI, brain-related calcology surgery, double-electronic emission calcology (PET), computerized calcology (SPECT), and calcology testing, etc.

However, only if the insured dies and cannot be based on the above method of inspection, it can be based on the documentized records or evidence verifying that the insured was under diagnosis or treatment due to cerebrovascular disease.

Article 3 (Compensation for Loss) (1) The insured period of this Special Terms and Conditions stated in an insurance policy shall be the cover period of this Special Terms and Conditions.

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