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(영문) 서울중앙지방법원 2016.04.08 2015나71633
보험금
Text

1. The part against the plaintiff falling under the following order of payment among the judgment of the court of first instance shall be revoked:

The defendant.

Reasons

1. Facts of recognition;

A. On March 20, 2013, the Plaintiff entered into an health insurance contract with the Defendant, from March 20, 2013 to March 20, 2061, with the period of insurance, and from March 20, 2013 to March 20, 2061, with the insured and beneficiaries for maturity refund as the Plaintiff. The said insurance contract includes a renewed type of cancer (excluding small-sum cancer), a renewed type of cancer diagnosis cost special agreement (excluding guaranteed amount of KRW 20 million), a renewed type of cancer diagnosis cost special agreement (guarantee amount of KRW 20 million), and a renewed type of high-amount treatment cost diagnosis cost special agreement (guarantee amount of KRW 40 million).

(hereinafter “instant insurance contract”). (b)

On April 14, 2014, the Plaintiff was diagnosed as the type of (Korean Standard Disease Classification Number C61) at the Ondol University Seoul Indol University Hospital, and received insurance money of KRW 20 million under the instant insurance contract from the Defendant, which was subject to the instant contract.

C. Afterward, the Plaintiff received diagnosis of bones cancer, and filed a claim with the Defendant for the total of KRW 60 million (= KRW 20 million (= KRW 40 million) based on the renewed type of cancer diagnosis (excluding small cancer) agreement and the renewed type of high-amount therapy cancer diagnosis expenses under the instant insurance contract, but the Defendant rejected the payment.

On the other hand, on June 15, 2015, after the institution of the instant lawsuit, the Plaintiff was issued a diagnosis of the type of (Korean Standard Disease Classification Number C61), the Daese Daese (Korean Standard Disease Classification Number C79.50) at the Onlam University Seoul National University Hospital.

E. The important terms and conditions of the instant insurance contract are as follows.

Article 1 (Types and Grounds for Payment of Insurance Money) of the Special Terms and Conditions (excluding Small-Scale Cancer) provides that when the insured is diagnosed as a general cancer (excluding small-sum cancer) after the date of commencement of guarantee during the insurance period of the Special Terms and Conditions, the insurance money shall be paid only once for the first time to the beneficiary.

III.(excluding small cancer) 1. Cancer in terms of special terms and conditions, 6.0

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