Text
1. From February 4, 2014 to February 21, 2014, the Defendant’s 18 days and 51 days from March 14, 2014 to May 3, 2014 respectively.
Reasons
1. Facts of recognition;
A. On November 30, 2005, the Plaintiff, a corporation established for the purpose of insurance business, etc., concluded each insurance contract with the Defendant, the insurance type of which is “non-distribution OK wwk Health Insurance,” and “non-distribution OK wk wk walk insurance” as indicated in (attached Form 1) insurance contract statement.
(hereinafter referred to as the "Sawal Health Insurance Contract" and "Sawal Cancer Insurance Contract", and each of the above contracts shall be referred to as the "each of the instant insurance contracts".
Among the terms and conditions of the well-dying Health Insurance Contract, the main contents related to the payment of hospitalization expenses shall be as follows:
(1) Adult specific diseases include virus infection and alcohol liver diseases in the end of the diseases listed in Table 8 of the Terms and Conditions of the Health Insurance Agreement among the Korean Standard Industrial Classification for the Fourth Amendment (National Statistical Office Notice No. 2002-1, January 1, 2003).
(2) When the insured was hospitalized for at least four consecutive days for the purpose of directly treating a certain adult disease after the commencement date of guarantee during the insurance period, expenses for adult disease hospitalization of KRW 30,000 per day of more than three days of hospitalization shall be paid.
[See Article 28 subparag. 8 of the above Terms and Conditions, and Article 28 subparag. 8 of the Insurance Money Payment Schedule of the attached Table 1, see item 8). (3) When the insured was hospitalized for at least four consecutive days for the purpose of directly treating any disease or accident other than an adult specific disease after the commencement date of guarantee during the insurance period, the amount of hospitalization of KRW 10,000 per day for more than three
Provided, That in the case of hospitalization due to mental disorder (including mental or physical weakness), and in the case of hospitalization due to alcohol addiction, it shall be excluded from the subject of the payment.
(See Item 9 of Article 28 and attached Table 11 diseases and disaster classification table). (C)
On the other hand, each insurance contract of this case includes a non-paid special agreement for admission, and its main contents are as follows.
(1) In this special agreement, hospitalization means a person who is qualified as a doctor, dentist, or herb doctor, is annexed to the said special agreement.