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(영문) 인천지방법원 2015.10.23 2014나1768
보험금
Text

1. Of the judgment of the court of first instance, the part against the defendant in excess of the amount ordered to be paid below shall be cancelled.

Reasons

1. Basic facts

A. On February 26, 2004, the Plaintiff entered into a contract between the Defendant and the policyholder, the insured, the Plaintiff’s insurance period, and the period from February 26, 2004 to February 26, 2050, for a long time as to non-payment of dividends (hereinafter “instant insurance contract”). The details of the insurance coverage related to the instant case and the special terms and conditions are as follows.

(1) In a case where the insured, as stated in the insurance policy, was hospitalized in a hospital or a member under Article 3(2) of the Medical Service Act due to a disease that occurred during the insurance period, the company is bound to compensate for the following expenses for hospitalization and medical treatment.

(1) In the case of hospitalization room fees: Medical examination fees, standard sick room (referring to four to six in-person sick room that shall be applied to the national health insurance patient at the relevant hospital or hospital; hereinafter the same shall apply), patient care fees, meal expenses, etc. ② In the case of hospitalization treatment expenses: examination fees, radiation fees, medication and prescription fees, the main feed, mental therapy, physical therapy, materials treatment, glurgium, designated medical treatment expenses, etc. ③ Medical treatment expenses: 3: 4. In the case of operating expenses, such as operating fees, anesthesia, and expenses for medical treatment. 4. In the case of using the hospital, special room, or one person room, the difference between the medical room and the standard sick room shall be guaranteed by the National Health Insurance Act to the extent of KRW 1,2,300,000 of the expenses to be borne by the insured under the National Health Insurance Act, and KRW 500,000 of the expenses.

However, if the insured is not subject to the national health insurance due to unavoidable circumstances, the amount equivalent to 40% of the total amount of the above-mentioned hospitalization medical expenses shall be compensated for up to 30 million won.

Here, if the number of national health insurance is not applicable, it refers to medical expenses and national health insurance which are compensated in industrial accident insurance.

(2) Security name hospitalization expenses and purchase amount of insurance 10.

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