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(영문) 서울북부지방법원 2016.10.12 2014가합26839
손해배상(기)
Text

1. The plaintiff's claim is dismissed.

2. The costs of lawsuit shall be borne by the Plaintiff.

Reasons

1. Basic facts

A. The Plaintiff entered into an insurance contract with B, etc. with the insured as 64 persons, such as B, etc. indicated in the “insured” list of damages in the attached list of the insured (hereinafter “B, etc.”), with the content of paying medical expenses within the scope of security coverage in the event the insured was hospitalized in a hospital, etc. due to disease during the insurance period.

B. From December 17, 2011 to August 10, 2014, the Defendant issued to B, etc. a certificate of entry and discharge to B, etc. that, during the period from the Seongbuk-gu Seoul Metropolitan Government’s “D foreign medical clinic,” the Defendant had been engaged in the training type removal of an embankment using a womanmomotom (hereinafter “mmomomom surgery”). At that time, the Defendant issued to B, etc. a certificate of entry and discharge to B, etc., for hospitalized treatment after the mmomomom surgery.

C. B, etc. claimed insurance money against the Plaintiff on the ground of the certificate of discharge from admission issued as above, and received each corresponding money indicated in the “Plaintiff’s Payment” column in the attached Form List of Damages.

According to the "Detailed matters concerning the criteria and methods for the application of medical care benefits" publicly notified by the Ministry of Health and Welfare, the standard for calculating daily admission fees means a case where the maximum time is at least six hours in the "inpatient".

[Reasons for Recognition] Evidence Nos. 1 through 64, Evidence Nos. 1 and 2, and the purport of the whole pleadings

2. Determination as to the cause of action

A. The Plaintiff asserted that he did not need to receive hospitalized treatment after the Maom surgery and that he was actually hospitalized. Although there was no fact that he had received hospital treatment, the Defendant committed an illegal act to issue a false certificate of entrance and discharge as if he had received hospital treatment, even though he did not have received hospital treatment. As a result, the Plaintiff suffered damages totaling KRW 136,377,84 as stated in the “amount of damages claim” column in the “amount of damages claim” table in the annexed sheet, and thus, the Defendant is obligated to pay to the Plaintiff the above 136,377,844 won and damages for delay.

B. Determination 1 means the resistance to the disease of the patient.

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