2011Na54340 Insurance proceeds, etc.

A

1. A stock company B;

2. C organization:

Seoul Central District Court Decision 2011Gadan191576 Decided November 2, 2011

July 18, 2012

August 22, 2012

1. Revocation of a judgment of the first instance;

2. The plaintiff's claims against the defendants are all dismissed.

3. All costs of the lawsuit shall be borne by the Plaintiff.

1. Purport of claim

Defendant B Co., Ltd. shall pay 30,700,000 won to the Plaintiff, the Defendant Co., Ltd. shall pay 3,500,000 won with 20% interest per annum from the day following the delivery of a copy of the instant complaint to the day of full payment.

2. Purport of appeal

The same shall apply to the order.

1. Basic facts

A. The Plaintiff concluded each of the following insurance contracts with the Defendants.

A person shall be appointed.

B. Details of the insurance terms of this case

1) The instant 1 and 2 insurance

Article 11 [Definition and Determination of "Cr.m." and Other Bl.m.】

(1) In this Special Agreement, "Cance" means a disease specified in attached Table 2 [excluding Maternal Life Classification (other Maternal Life Classification Table) which is subject to the Korean Standard Disease Classification: Provided, That the classification number C44 and Maternal Disease Classification (other Maternal Life Classification Table) shall be excluded.

③ 암 및 기타피부암의 진단확정은 해부병리 또는 임상병리의 전문의사 자격증을 가진 자에 의하여 내려져야 하며, 이 진단은 조직(fixed tissue)검사, 미세침흡인검사(fine needle aspiration biospy) 또는 혈액(hemic system)검사에 대한 현미경 소견을 기초로 하여야 합니다. (중략)

Article 13 [Definition and Diagnosis Confirmation of ‘Written Kind of Boundary']

(1) For the purpose of this special agreement, the term "finite species" means the diseases as specified in the attached Table 4 (Finite Identification of Action or Non-Formal Identification Table) in the Korean Standard Disease Classification.

(2) The diagnosis and confirmation of the specifications of boundaries shall be made by a person with a professional doctor's license of the autopsy pathology, and this diagnosis shall be based on the present opinion on the organizational inspection.

[Attachment 2] Malinio Classification Table

In the third Korean Standard Industrial Classification of Diseases as defined in the terms and conditions, diseases classified as malicious organisms mean the following diseases among the National Standard Industrial Disease Classification (Notice No. 1993-3 of the Statistics Korea) revised by the third amendment:

A person shall be appointed.

[Attachment 4] Actional Classification Table 4

The following diseases, which are classified as "inception of behavior style or unknown life," as prescribed by the terms and conditions, refer to the third revised Korean Standard Disease Disease Classification (Public Notice No. 1993-3 of the Statistics Korea).

A person shall be appointed.

2) The instant 3 insurance

Article 10 [Definition and Confirmation of “Crance” and “Tropical Cancer”]

(1) In this Special Agreement, "Cr." means a disease specified in the Medical Organism Classification Table (except for other skin cancers) (see attached Table 3) which is the subject of the Korean Standard Disease Classification in the fourth Korean Classification of Patients: Provided, That the foregoing shall not apply to C44 (Other Amal Organisms of the skin and Emal Maternal Maliomomomomant.

3. The diagnosis and confirmation of cancer and other skin cancer shall be conducted by a person who holds a professional doctor's license of autopsy pathology or clinical pathology, and this diagnosis shall be based on organizational examination, non-subsurination test, or opinion of fact-finding on blood examination (component).

Article 12 [Definition and Diagnosis Confirmation of ‘Batch Species']

(1) For the purpose of this special agreement, the term "dominary species" means the diseases specified in the 4th Korean Standard Disease Classification (See attached Table 5) that are not known in behavior patterns or in the 4th Korean Standard Disease Classification.

② 경계성종양의 진단확정은 해부병리 또는 임상병리의 전문의사 자격증을 가진 자에 의하여 내려져야 하며, 이 진단은 조직(Fixed tissue)검사, 미세침흡인검사(Fine needle aspiration biospy) 또는 혈액(Hemic system)검사에 대한 현미경 소견을 기초로 하여야 합니다. (중략)

[Attachment 3] Aquatic Organisms Classification Table (other skin cancers excluded)

The following diseases are the Korean Standard Disease Classification (Statistics Notice No. 2002-1, January 1, 2003) which is classified as malicious life as prescribed in the terms and conditions, and are the following diseases:

A person shall be appointed.

[Attachment Table 5] Actional Identification or Non-living Identification List

The following diseases are included in the Korean Standard Disease Disease Classification (No. 2002-1, January 1, 2003, the Statistics Korea Notice No. 2002-1, January 2003, 2003), which is classified as "the behavioral pattern is unknown or unregistered" as prescribed in the terms and conditions:

A person shall be appointed.

(c) Details of the Korean Standard Disease Disease Classification;

1) Summary

Korean Standard Disease Classification is governed by the International Disease Classification System of the World Health Organization(WHO) under the United Nations, and in Chapter 2 of Part 3, a comprehensive form classification number is presented in Part 4 for the people who wish to be classified as a systematic form of new organisms.

2) Part 3 Extraordinary Schedule and No. 4-unit item classification table.

The malicious life of a fire extinguishing agency is classified into C15-C26 categories as above. Among them, "work bad faith" is classified into C20. "Saides" is classified into Category D37-D48 categories as above. These new lifes provide / 1 of behavior pattern classification in Part 4. The former and fire extinguishing agency's behavior patterns are classified as D37, and among them, it is classified as D37.5.

(iii) the classification of the types of new organisms in Part 4;

The classification number of forms is composed of five units. The first four units indicate the organizational form of a new life and indicate the fiveth class after the shooting, and the behavior pattern classification number is as listed below [in accordance with the above classification of types, if the organizational behavior is a type or a group cancer, it shall be classified as M8240/1, and the Kanood Kaod Kaod Kaod Kaod Ma8240/3, if the organizational behavior is a type or a group cancer, it shall be classified as M8240/3).

A person shall be appointed.

4) The corresponding relationship between each classification and classification

A person shall be appointed.

D. Progress of the Plaintiff’s diagnosis

1) On November 5, 2010, the medical personnel of G Hospital conducted an internal inspection of the history of the Plaintiff on the basis of the internal inspection of the medical personnel. On November 8, 2010, the physician of the Halinology examination center entrusted by the medical personnel of G Hospital prepared an organizational pathology report to the effect that the 0.3§¯ of the Plaintiff’s workplace is the crocid crocid crocid cl. Based on this report, the doctor 1 of G Hospital was diagnosed as the crocid crocos around November 20, 2010, and transferred the Plaintiff to the J hospital.

2) On November 24, 2010, J Hospital’s doctor K performed the crypt removal surgery to the Plaintiff, and then entered the Plaintiff’s final diagnosis name as “new life (workplace cancer) in the workplace” and issued a medical certificate that assigned an international disease classification number to D37.5.

3) On January 24, 2011, a medical adviser of the Lacademic Conference is about the medical advice of the Plaintiff on the part of the Plaintiff on January 24, 201. ① The Plaintiff’s pattern is mix 1 of high molecule molecule molecule mar mar (www marrode). ② The size is small (0.3 mc), no similar division is likely to be high, but it can be predicted that the possibility of cultivation is high due to the lack of blood erosion, but it can be difficult to completely exclude the possibility of marity, and the form of 3rdra mar 240/1 of Mau International Emar mar mar mar 300/1 of Mademar mar mar mar mar mar mar mar mar mar 30/7 of Mau mar mar mar mar mar mar mar 3.

4) On March 28, 2011, J Hospital’s doctor K drafted a statement of opinion that the Plaintiff’s diagnosis name is workplace cancer, d37.5, d37.5, d37.5, dump for organizational inspection, and eump for the Plaintiff’s disease under the TNM Classification Act of M and N, constitutes Tis2 (a).

5) As to the fact finding by the court of the first instance, the above doctor K sent to the fact finding by the court of the first instance: (1) workplace cancer is different in the size, and in the size of less than 1cm, it is relatively good and almost less than another long-term. (2) The workplace cancer of this size is classified according to the doctor's supervision; (3) it gives a code by classifying it into an intermediate fatal (fatal fatal fating) by taking into account the characteristics and examples of the fatal; and (3) in the case of a very small size of workplace cancer, only the organizational examination conducted during the internal fatal examination is the case of the Plaintiff, and there was no residual fatal cell in the organizational examination of the J hospital, but it was specified in the G hospital's written request for medical examination as workplace cancer, and thus, it was diagnosed as workplace cancer only limited to the fatal fatal fat.

E. Details of the Defendants’ payment of insurance money

The Defendants paid only KRW 1,00,000 for medical expenses, surgery expenses of KRW 300,000 for insurance under the insurance policy, and KRW 1,000 for cancer diagnosis under the insurance policy, and KRW 1,50,000 for cancer diagnosis under the insurance policy, on the ground that the Plaintiff’s disease constitutes a type of diversity.

[Ground of recognition] A without dispute, Gap evidence Nos. 1 through 13, Eul evidence Nos. 1, 2, Eul evidence Nos. 1, 1 and 2, fact-finding with respect to the chief of the hospital at the court of the trial, the fact-finding with respect to the chief of the hospital at the trial court

chapter 6

2. The allegations and judgment of the parties

A. The assertion

The plaintiff was diagnosed by the plaintiff that the plaintiff was deprived of the workplace's occupied malod class or workplace malod class. While this malods correspond to "cam" in light of various disease classification standards, the defendants are liable to pay the insurance money corresponding to the boundaryal malods. Thus, the defendants are liable to pay the plaintiff the remainder after deducting the insurance money already paid from the "malods" insurance money stipulated in the insurance contract.

In regard to this, the Defendants asserted that the Kazin Kazin (R37.5) diagnosed by the Plaintiff merely falls under the category of boundary but does not fall under cancer according to the Korean Standard Disease Death Classification stipulated in each insurance contract of this case.

B. Determination

1) If the Plaintiff’s claim for insurance money is reasonable, it should be able to regard the workplace cancer, which is the Plaintiff’s disease, as the malicious life of C20 of the Korean Standard Disease Death Classification C20 according to the terms and conditions of the instant insurance, and further, the diagnosis should be determined by the doctor’s license holder of the autopsy pathology or clinical pathology.

2) According to each description of Gap evidence Nos. 14 through 16, WHO species classification in 2010 shall be divided into G1 [8240/3] out of the species of molecule decentralization, and the classification number of "8240/3" shall be assigned to the workplace cirth class, the cirth class of the cirth class, the cirth class, the cirth class, the cirth class, the cirth class, or the cirth class of the cirth class (in the case of the plaintiff, the cirth class, the cirth class, the cirth class, the cirth class of the cirth class, the size of the cirth class, the size of the cirth class of the cirth class and the fact that the cirth class of the cirth class, the cirth class of the cirth class, the cirth class code of the court, the new doctor's.

However, in light of the Plaintiff’s 22 evidence, 1, 24 each of the above 3-year Macambal 1, i.e., the following circumstances that are recognized as being by adding the results of fact-finding to 3-year Macambal 1, 2000, the terms of each of the insurance contracts of this case were classified as 3-year Macambal 1, 201, Macambal 2, Macambal 3, Macambal 2, Macambal 3, not ICD 20, Macambal 2, Macambal 3, Macambal 4, Macambal 1, Macambal 3, Macambal 4, Macambal, Macambal 1, Macambal 3, Macambal.

3) Furthermore, the standard terms and conditions indicate that the diagnosis and determination of cancer, etc. should be made by a person with a professional doctor's license of autopsy pathology or clinical pathology, and gender-sensitive boundaries, including workplace cancer, are areas where the doctor has high professional knowledge and experience in light of various specific circumstances, such as size, blood ties, transfer, and decentralization, and that the plaintiff's final sick name was diagnosed as falling under d37.5 of disease classification as a non-life in the workplace, and there is no evidence to find that the diagnosis lacks rationality, or that it was erroneous application of the Korean Standard Disease Classification, and thus, the above diagnosis cannot be easily rejected (the plaintiff submitted a majority of the lower court's rulings in other similar cases related to workplace cancer, but most of the above cases are diagnosed as "C20" other than "D37.5" under disease classification, or the size of the insurance policy and the degree of the opinion or the opinion of the court in charge of the examination of the organization of the above case, etc. is not different from the above case's conclusion.

4) Ultimately, the Plaintiff cannot be deemed to have been confirmed by intention under the Korean Standard Disease Disease Classification, which is defined as cancer in each of the instant insurance contracts, under the name of a doctor, who is a "malicious (C20)" (C20), and therefore, the Plaintiff’s claim of this case is without merit without further review.

3. Conclusion

Therefore, the plaintiff's claim against the defendants of this case is dismissed in its entirety as it is without merit, and the judgment of the court of first instance with different conclusions is unfair, and all of the plaintiff's claim is dismissed. It is so decided as per Disposition.

Judges Lee Jin-jin

Judge Lee Jae-in

Judges Esung Young-young

1) The commander’s wall is classified into braille floors, braille layers, inner layers, and studios, depending on their depth. Of these, the studios are composed of upper cell layers, potents, ocosive layers, ocosive layers, and mosive layers.

2) According to the evidence No. 15, since Tis applies only to the stomach as a weapon corresponding to the Stage0, it seems that the doctor K appears to have expressed that it is the phase prior to the Stage I.