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(영문) 광주지방법원순천지원 2016.06.30 2014가단72306
보험금
Text

1. With respect to the insured events listed in attached Form 1, the plaintiff is the defendant based on the insurance contract listed in attached Form 2.

Reasons

1. Basic facts

A. On April 10, 2001, the Plaintiff entered into an insurance contract in attached Form 2 (hereinafter “instant insurance contract”) with the Defendant as the insured. The instant insurance contract contains security to guarantee cancer hospitalization expenses (payment of KRW 100,000 per day more than three days and up to 120 days per day when hospitalization is continued for at least four consecutive days, and payment of KRW 10 million per day) and cancer medical care expenses (up to 121 days after the continuous hospitalization).

B. On March 16, 2012, the Defendant was diagnosed with Domam, and was hospitalized on May 16, 2012 at Samsung Seoul Hospital for 17 days, and was hospitalized until May 27, 2012. After receiving aviation cancer treatment by January 5, 2013, the Defendant continued hospitalized treatment, etc. at C convalescent hospitals, D clinics, E Hospital, etc.

Plaintiff

On May 29, 2013, the Company paid 39,560,000 won of insurance money, such as cancer hospitalization and medical care, to the Defendant in relation to the above treatment.

C. As shown in attached Form 1, the Defendant received hospitalized treatment for 68 days from March 26, 2013 to June 1, 2013, and for 125 days from June 3, 2013 to October 5, 2013, after receiving a diagnosis of sexual intercourse, hydropathy infection, chronic hydropathy infection, and re-treatment;

(hereinafter “each of the instant hospital treatment”). D.

On February 19, 2014, the Defendant: (a) filed a new claim with the Plaintiff for reimbursement of cancer hospitalization expenses and medical care expenses according to the instant hospital treatment; (b) however, the Plaintiff Company rejected the said payment.

[Ground of recognition] Facts without dispute, Gap evidence Nos. 1 through 6, Eul evidence No. 1, the purport of the whole pleadings

2. The Plaintiff asserted by the parties concerned, not directly aiming at cancer treatment, but with the purpose of reducing side effects, restoring physical functions, and strengthening immunity, and thus, the Plaintiff’s assertion that each of the instant hospitalized treatment is not subject to insurance money under the insurance contract of this case. On the other hand, the Defendant’s assertion that the result of the examination conducted on March 27, 2013 does not lead to a recurrence.

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