2016Da3034 Insurance proceeds

2016Da3041 (Consolidated Insurance Proceeds)

1. A;

2. B

3. C.

4. D;

Samsung Life Insurance Co.

Seoul Central District Court Decision 2015Na13644, 2015Na13651 Decided December 15, 2015

(Consolidated) Judgment

June 28, 2016

The judgment of the court below is reversed, and the case is remanded to the Seoul Central District Court Panel Division.

The grounds of appeal are examined.

1. The term “overgoing accident” among the “overgoing accident,” which is the requirement of the instant insurance accident under the instant insurance clause means that the cause of injury or death means all the physical defects of the insured, i.e., disease or physical physical factors, and the causal relationship between the external nature of the accident and the result of injury or death, and the claimant for insurance bears the burden of proof (see, e.g., Supreme Court Decision 2013Da210466, Jul. 10, 2014).

2. The lower court, citing the judgment of the first instance, determined that the deceased’s death was caused by an unexpected unexpected accident during the operation and a contingent ex post facto accident due to the occurrence of post facto death.

① The medical team of the instant case additionally implemented an open-to-under-under-the-counter brain resistant surgery when performing a back-to-under-the-under-face wing surgery to the deceased, and thus, additionally implemented an open-to-under-the-under-face divers and diversary surgery.

(2) The Deceased was unable to find his consciousness continuously after the reciting reciting.

③ The Deceased was hospitalized for a long time with non-explosion brain, and thereafter, a series of long-term complosion occurred, resulting in the death of the deceased with a multi-plosion organ.

3. However, it is difficult to accept such a determination by the lower court for the following reasons.

A. Review of the reasoning of the first instance judgment as cited by the lower court and the record reveals the following circumstances.

① As stated by the lower court, it is difficult to readily conclude that the wing recognism, which is the treatment of the deceased’s wing regrhesion, is an accident caused by high blood pressure or is related to cerebral blood, and thus, it is difficult to readily conclude that the non-cerebral cerebral tyrosis itself generated to the deceased as an external accident

② The possibility of deeming the deceased’s brain-resistant blood transfusion was caused by the physical physical factors of the deceased, such as the scarcity of cerebrovascular wall caused by aging.

③ There is no evidence to deem otherwise that the deceased’s cerebral resistant transfusion occurred due to any affirmative act of the medical team of this case.

B. Examining the above circumstances in light of the legal principles as seen earlier, even if the deceased did not undergo a diagnosis of normal high blood pressure, it cannot be readily concluded that the deceased’s death was caused by a sudden and incidental external accident.

C. Nevertheless, the lower court determined otherwise solely on the grounds indicated in its reasoning. In so doing, the lower court erred by misapprehending the legal doctrine regarding the requirements for recognition of insurance accidents and the burden of proof thereof, or by failing to exhaust all necessary deliberations, which affected the conclusion of the judgment. The allegation contained in the grounds of appeal on this point is with merit.

4. Therefore, the lower judgment is reversed, and the case is remanded to the lower court for further proceedings consistent with this Opinion. It is so decided as per Disposition by the assent of all participating Justices on the bench.

Justices Park Sang-ok

Justices Lee Sang-hoon

Justices Kim Chang-tae, Counsel for the defendant

Justices Cho Jong-hee