(영문) 대전지방법원 2015.8.21.선고 2014나106449 판결

The insurance contract between the plaintiff and the defendant is invalid. The defendant pays to the plaintiff 26,580,00 won with 5% interest per annum from September 2, 2013 to the delivery date of a copy of the complaint of this case, and 20% interest per annum from the next day to the day of complete payment.

2. Purport of appeal

The order is as set forth in the text.

Reasons

1. Basic facts

A. On December 24, 2003, the Plaintiff, an insurer, entered into a mutual aid agreement with the Defendant from December 24, 2003 to December 24, 203, 203, with the period of mutual aid, and the Defendant, the Jeju Mutual Aider from December 24, 2003, to December 24, 2037, under the main contract, KRW 10,00,00 in the purchase price of insurance, KRW 10,00 in the cancer diagnosis agreement, KRW 5,00 in the death agreement, KRW 5,00 in the death agreement, KRW 00 in the monthly payment, KRW 47,250 in accordance with the terms and conditions of the instant insurance contract and the special terms and conditions of the cancer diagnosis agreement, to pay the insurance benefits as follows:

- Seven disease hospitalization benefits: when the beneficiary has been hospitalized for at least four consecutive days for the direct purpose of the diagnosis after the date of commencing the liability, for which the diagnosis has become final and conclusive for seven diseases;

- The amount of hospitalization for other diseases: when the person has been hospitalized for not less than 4 consecutive days for the direct purpose of the treatment due to diseases other than the seven major diseases.

- The disaster operating benefit or the disaster hospitalization benefit: when the Insured has been hospitalized for more than four consecutive days after the date of commencement of liability for the direct purpose of the treatment due to a disaster after the date of commencement of liability;

- Cancer diagnosis benefits: by a special agreement, when the Insured first diagnosis becomes final and conclusive after the date of commencement of the liability for cancer security during the period of the deduction;

B. The Defendant received mutual aid money from the Plaintiff for the period from April 13, 2004 to June 30, 2013 at 18, and filed a claim for mutual aid money from the Plaintiff for the amount of KRW 400,00, general hospitalization allowances, KRW 5,760,00, and other hospital hospitalization allowances, KRW 8,860,00, KRW 5,000, and KRW 5,60, and KRW 5,60, and KRW 5,00, and KRW 6,00,00, and KRW 26,580, and KRW 00, in total, for the period from April 13, 2004 to June 30, 2013.

C. As shown in the attached list 3, the Defendant purchased monthly insurance premiums of 29,200 won on July 12, 2002, monthly insurance premiums of 79,600 won on August 8, 2003, monthly insurance premiums of 89,600 won on October 16, 2003, monthly insurance premiums of 80,000 won on December 23, 2003, monthly insurance premiums of 105,220 won on December 23, 200, and 100 won on December 24, 203, and 208, excluding the monthly insurance premiums of 47,250 won on May 30, 205, and 200 won on May 16, 2005, respectively.

D. The Defendant, as indicated in the attached Table 3, additionally subscribed to the monthly insurance premium of 43,00 won on September 18, 2007, the monthly insurance premium of 51,000 won on June 11, 2009, the monthly insurance premium of 51,000 won on December 4, 2009, the monthly insurance premium of 30,000 won on March 17, 201, the monthly insurance premium of 30,000 won on July 17, 201, the monthly insurance premium of 30,000 won on July 17, 201, and the insurance premium of 30,000 won was collected by the Defendant in relation to each of the above insurance contracts terminated on September 18, 207.

[Ground of recognition] In the absence of dispute, Gap evidence Nos. 1 through 30 (including branch numbers), the National Health Insurance Corporation of the first instance court, Libyan damage insurance company, Libyan Life Insurance Co., Ltd., Samsung Fire and Marine Insurance Co., Ltd., Samsung Fire and Marine Insurance Co., Ltd., new life insurance company, Dongbu Fire and Marine Insurance Co., Ltd., Hyundai Marine Fire and Marine Insurance Co., Ltd., and the purport of the entire arguments as a result of each inquiry about the whole arguments

2. Determination as to the cause of action

A. The plaintiff's assertion

1) The instant insurance contract was concluded for the purpose of unfairly acquiring mutual aid money by pretending to a mutual aid accident or exaggerationing the degree of the accident, rather than against the risk to life, body, etc., and thus, is null and void in violation of good morals and other social order under Article 103 of the Civil Act. Thus, the Defendant’s unjust enrichment of KRW 26,580,000 paid to the Plaintiff.

have the obligation to return.

2) Preliminaryly, in light of the Defendant’s medical condition and degree of injury, etc., the Defendant intentionally committed long-term hospitalization in the insurance that the Defendant subscribed to, even though there is no need for long-term hospitalization, for the Defendant to receive the expenses and daily allowances. Therefore, this constitutes a case where the Plaintiff was not obligated to pay insurance money due to intentional exemption or lack of proximate causal relation between the disease and the hospitalized treatment pursuant to Article 659 of the Commercial Act. Therefore, the Defendant is obligated to return KRW 26,580,000 to the Plaintiff as unjust enrichment.

B. Whether the instant insurance contract constitutes an anti-social legal act

1) Relevant legal principles

In a case where an insurance contract is concluded for the purpose of unfairly acquiring insurance proceeds through a large number of insurance contracts, the payment of insurance proceeds would go beyond social feasibility by encouraging the insured to obtain unjust benefits through abuse of the insurance contract and thereby impairing the purpose of the insurance system, destroying the risk, causing the sacrifice of many subscribers, and thus impairing the basis of the insurance system, even if the content of the insurance contract is not contrary to good morals and other social order, or the motive of the legal act indicated or known to the other party is contrary to social order. In a case where the insured concludes the insurance contract with the aim of unfairly obtaining insurance proceeds through a large number of insurance contracts, it is difficult to conclude that the insurance proceeds would be paid to the Defendant for 20 years after the conclusion of the insurance contract, including the fact that the insured did not receive unjust benefits. It is difficult to conclude the insurance contract for 20 years after the conclusion of the insurance contract with the lower court’s judgment on the ground that the purpose of the insurance contract would be 05 days after the conclusion of the insurance contract and other circumstances under Article 103 of the Civil Act.

2) Determination

In full view of the following circumstances, it is insufficient to acknowledge that the Defendant concluded the instant insurance contract for the purpose of unlawfully acquiring insurance proceeds, and there is no other evidence to determine the recognition thereof. The Plaintiff’s assertion in this part is without merit. The Plaintiff’s assertion is without merit.

A) Even if the Defendant excluded from the automobile insurance contract concluded on June 27, 2005, the Defendant entered into 12 examination contracts including the instant insurance contract from July 12, 2002 to March 17, 201 as listed in the attached Table 3, but it is difficult to readily conclude that the Defendant entered into the insurance contract concluded on July 12, 201, as of July 12, 201, with a total of 12 examination contracts executed on July 12, 2012, as of March 7, 2005; and September 18, 2007; and each insurance contract concluded on June 11, 2009, with nine years earlier.

B) It is difficult to conclude that each insurance contract that the Defendant entered into as shown in the separate sheet No. 3 is identical to four motor vehicle-related insurance contracts, and health-related insurance contracts overlap with the content of coverage as eight cases, and it is difficult to eliminate the possibility that the Defendant entered into another insurance contract in 2002 with a view to preparing more thoroughly against future uncertainty and diseases.

C) Even if the Defendant received hospitalized treatment over 35 occasions at a hospital in the 18 location during the period from April 13, 2004 to June 20, 2013 as shown in the separate sheet No. 2 list, the Defendant received medical treatment on the following occasions: (a) once in 2004; (b) once in 2005; (c) twice in 2006; (d) March in 2008; (b) five times in 2009; (c) twice in 2010; and (d) once in one year in 2011; and (c) the instant insurance contract requires the payment of insurance benefits in cases of illness, disaster, cancer diagnosis, etc.; and (d) the Defendant cannot be deemed to have received insurance benefits during the daily life for more than nine years, traffic accidents; and (d) in light of the number of times the Defendant claimed for insurance benefits due to being hospitalized or claimed for insurance diseases.

D) Furthermore, according to the written confirmation and diagnosis against the Defendant, it is reasonable to view that the Defendant was hospitalized at a hospital due to the relevant injury and quality disease through a doctor’s diagnosis. The Defendant’s hospitalization days or insurance proceeds received from the Plaintiff in relation to the above disease after receiving the diagnosis of the dysleuk-mar cellosis cellosis, which is a kind of the dyspine cancer, on April 13, 2009. Since 2009, the Defendant’s cancer diagnosis expenses and insurance proceeds related to other disease-related expenses received from the Plaintiff were 26,580,00 won out of 14,640,000 won. In addition, the above disease is not a disease that may cause the Defendant to artificially artificially cause insurance fraud, but it is not suspected that the Defendant was hospitalized at a hospital with the largest content of the insurance accident, or that the Defendant was subject to a punishment for an insurance fraud for a long time after receiving the medical treatment for more than an injury.

E) Although the Defendant’s total amount of insurance proceeds received through an insurance contract concluded with insurers other than the Plaintiff is also large amount of KRW 209, 512, and 808, the Defendant appears to have caused a sudden increase in the amount of insurance proceeds received in relation to the disease that was diagnosed after 2009.

F) With respect to the Defendant’s income during the instant insurance contract period, the fact that the Defendant did not pay the value-added tax, global income tax, and Class A labor income tax by 2009 up to 2014. However, it is difficult to conclude that the Defendant was engaged in the instant insurance contract around 2003, which was the time of entering into the instant insurance contract. It is difficult to conclude that the Defendant had no income to enter into the instant insurance contract since 2005. While the Defendant was unable to submit financial transaction details around 2005, G, who was intentionally son, began to receive wages of 1,100,000 won or less as an occupational soldier from around January 2005, it is difficult to conclude that the Defendant’s denied L, which was the Defendant’s wife, was an excessive restaurant business from July 4, 2008 to 00,000 won, and that the Defendant’s wife, who was the Defendant’s mother, did not receive more than 00,000 won since 000 won.

G) The Defendant’s avoidance of risk resulting from an insurance accident in the future can be naturally permitted due to the nature of the insurance contract. Thus, it is difficult to accept the Plaintiff’s assertion to nullify the instant insurance contract at the expiration of 10 years from the date of conclusion of the instant insurance contract on the ground that the Defendant was paid a large amount of insurance money, even though the Plaintiff did not ask whether the available supplies, etc. are the same as or similar to the instant insurance prior to the conclusion of the instant insurance contract, and received monthly insurance premium from the Defendant from 2002 to the Defendant in a normal manner.

H) On January 15, 2013, LIG non-life insurance companies that concluded an insurance contract with the Defendant filed a lawsuit to confirm the existence of an obligation with the Incheon District Court 2013da20531, but the lawsuit was withdrawn on April 25, 2014, and the other insurance companies that concluded the insurance contract with the Defendant did not take measures such as claiming the return of the insurance amount already paid against the Defendant.

C. Whether the Defendant intentionally hospitalized the Defendant for a long time to receive insurance proceeds

With respect to whether the defendant was intentionally hospitalized for a long time in the absence of a need for long-term hospitalization, it is insufficient to acknowledge the above assertion solely on the basis of each fact inquiry into the National Health Insurance Corporation of the first instance court on the details of Gap evidence Nos. 3 through 29, or on the details of the insurance money supplied to the defendant by other insurance companies, and each fact inquiry into the defendant with respect to the defendant's insurance company, ELA damage insurance company of Alanean Life Insurance Co., Ltd., Samsung Fire Maritime Insurance Co., Ltd., Samsung Fire Maritime Insurance Co., Ltd., Samsung Fire Maritime Insurance Co., Ltd., new life insurance company, and Dongbu Marine Insurance Co., Ltd., Ltd., and there is no other evidence to acknowledge it. Thus, there

4. Conclusion

Thus, all of the plaintiff's claims of this case shall be dismissed as it is without merit. Since the judgment of the court of first instance is unfair with different conclusions, it is revoked and all of the plaintiff's claims are dismissed. It is so decided as per Disposition by the court below.