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The judgment of the first instance shall be revoked.
The plaintiff's claim is dismissed.
All costs of litigation shall be borne by the plaintiff.
purport.
Reasons
1. The reasoning for this part of the judgment of the court is the same as that of the corresponding part of the judgment of the court of first instance, and thus, this part is cited by the main text of Article 420 of the Civil Procedure Act
2. Determination
A. The Defendant asserted that the number of hospitalization days of E and G exceeds the reasonable number of hospitalization days, and knowingly acquired KRW 20,930,000, by claiming insurance money with knowledge that there is no ground for the payment of insurance money.
Therefore, the defendant is obligated to pay the plaintiff damages amounting to 20,930,000 won and damages for delay caused by tort.
B. The following facts and circumstances that can be acknowledged by comprehensively considering the purport of the entire argument as to Gap evidence 3, namely, ① the necessity and reasonableness of hospitalization is acknowledged by the doctor, who is an expert, individually ascertains the patient's disease, health condition, etc., and thus, the discretionary nature of medical practice is recognized. However, it is difficult to readily conclude that the decision of the doctor directly treated the patient was erroneous only by the post-determination of the Health Insurance Review and Assessment Service based on the medical records and medical records. ② Even if the Health Review and Assessment Service determines that the necessity or reasonableness of hospitalization is not recognized for part of the days of hospitalization E and G, the evaluation by the Health Assessment and Assessment Service is not absolute, nor does there is no reasonable ground or proof as to special circumstances that are difficult to trust the decision of the doctor who actually provided medical treatment. ③ Even according to the response of the Health Assessment and Assessment Service, it is difficult to deem the relevant days of hospitalization as excessive hospitalization immediately if there is no reasonable ground or proof as to the special circumstances that it is difficult to trust the decision of the doctor who actually provided medical treatment.