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(영문) 광주지방법원 2018.02.07 2015가단519117
부당이득금
Text

1. The Defendant’s KRW 5,090,000 as well as the Plaintiff’s annual rate of 5% from February 11, 2015 to February 7, 2018.

Reasons

1. Facts without dispute;

A. On January 25, 2008, the Defendant entered into a non-paid franchise insurance contract (hereinafter “instant insurance contract”) with the Plaintiff as the insured and beneficiary, and with the main content of ensuring the expenses for hospitalization of diseases, expenses for sickness of diseases, expenses for hospitalization of diseases, medical expenses for hospitalization of diseases, etc. from January 25, 2037 from the same day to January 25, 2037.

B. According to the instant insurance contract, where the Defendant is hospitalized into a hospital due to a disease, 30,000 won per day of hospitalization shall be paid as the expenses for hospitalization of a disease, and where the period exceeds the above period, 50,000 won shall be paid as the expenses for hospitalization of a disease for at least 31 days, and the additional insurance money shall

On the other hand, while hospitalized medical expenses for hospital diseases are being treated, they are compensated for the expenses equivalent to the principal's charges and non-benefits among the medical care benefits provided in the National Health Insurance Act.

C. On December 24, 2014, including the hospitalization at B Hospital on November 7, 2008 after the conclusion of the instant insurance contract, the Defendant received hospitalized treatment for 823 days in total by 53 medical institutions, such as the detailed unknown diseases in the 53 medical institutions, and the saltss and tensions of the bones, as indicated in the attached Form of Hospitalization.

The Defendant’s insurance money received from the Plaintiff as expenses for hospitalization of a disease, expenses for disease-disease, and expenses for hospitalization of a disease (hereinafter “inpatient insurance money”) on the ground of the above hospitalized treatment (hereinafter “inpatient insurance money”) is the total amount of KRW 24,480,000.

2. Determination

A. The plaintiff asserted 1) The plaintiff asserts that since each of the hospitalizations listed in the separate hospitalization table Nos. 3, 4, 6, 42, 43, 49, and 50 stated in the separate hospitalization list issued by the defendant was conducted in a situation where sufficient treatment is possible solely for hospital treatment, it does not constitute “inpatient” as stipulated in the insurance contract of this case, the defendant must return the above improper hospitalization insurance money received by the defendant to the plaintiff. 2) As to this, the defendant is difficult to completely recover from hospitalization.

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