(영문) 대법원 2015.6.23.선고 2013다201776 판결

1. As to the ground of appeal No. 1, in light of the overall purport of pleadings and the result of examination of evidence, the court shall determine whether the assertion of facts is true or not in accordance with logical and empirical rules based on the ideology of social justice and equity (Article 202 of the Civil Procedure Act). The court shall bind the Re-appeal Court (Article 432 of the Civil Procedure Act), citing the reasoning of the judgment of the court of first instance, and find the facts as stated in its reasoning. The court below determined that the Plaintiff’s claim for the payment of insurance money to the Defendant on June 7, 2010, prior to the expiration of the extinctive prescription constitutes a peremptory notice under Article 174 of the Civil Act, and that the Plaintiff’s demand for submission of documents necessary for the examination of the payment of insurance money, including a criminal judgment, should be considered to have been postponed on the ground that it is necessary to view the existence of the obligation to pay insurance money when the judgment of the Defendant was rendered in a criminal case, and thus, the Defendant’s demand for the payment of insurance money from the Defendant was suspended.

The purport of this part of the grounds of appeal is nothing more than interference with the selection of evidence, determination of value of evidence, and fact-finding based on the free evaluation of the fact-finding court. In addition, even when examining the reasoning of the judgment below in light of the above legal principles and the relevant legal principles and evidence duly admitted by the court of first instance, the court below did not err by misapprehending the legal principles as to the validity of a peremptory notice demanding the interruption of extinctive prescription and the postponement of performance of the claim, or by exceeding the bounds of the free evaluation of evidence, contrary to what is alleged in the grounds of appeal (see, e.g., Supreme Court Decision 2004Da1

The Supreme Court decision cited in the ground of appeal is not appropriate to be invoked in this case, since the case differs from this case.

2. As to the grounds of appeal Nos. 2 and 3, Article 732-2(1) of the Commercial Act provides, “In the case of an insurance contract which has caused the death as an insured event, an insurer shall not be exempted from liability to pay the insurance proceeds even if the accident occurred due to gross negligence of the policyholder, the insured, or the beneficiary,” and Article 739 of the Commercial Act provides, “In accordance with a special agreement between the parties concerned, an insurer shall not be exempted from liability to pay the insurance proceeds.”

Therefore, according to the above provisions, an insurance contract exemption clause purporting that an insurance accident against death or bodily injury shall not be compensated for even if it is caused by an act which is assessed as negligence (including gross negligence) beyond the case where the insurance accident is assessed as a whole by an intentional act in light of the whole as an insurance accident (see, e.g., Supreme Court Decision 97Da48753, Mar. 27, 1998).

Meanwhile, the term "accident" among the requirements of an accident covered by a personal insurance contract means an accident caused by an unforeseeable cause, not intentional but unexpected cause, and an accident means an accident which causes an unforeseeable result due to ordinary process (see, e.g., Supreme Court Decision 2003Da35215, 3522, Nov. 28, 2003).

Based on the reasoning of the judgment of the court of first instance, the court below rejected the defendant's defense of immunity to the effect that (1) B intentionally caused an act of violence in order to cause the result of an injury to oneself, or (2) it is difficult to consider that B intentionally intended or intended to cause the result of an injury to oneself, and that (3) B constitutes a case where the result of an injury in this case occurred due to a sudden and remote accident beyond the ordinarily foreseeable scope, and (4) B is a non-compensation of the exemption clause of this case, which constitutes a damage caused by an "criminal act or an act of violence" under the Criminal Act.

The part of the ground of appeal disputing the lower court’s fact-finding is merely an error in the selection of evidence and the determination of the value of evidence belonging to the free trial of the fact-finding court.

In addition, examining the reasoning of the lower judgment in light of the aforementioned relevant provisions and legal principles as well as the evidence duly admitted, the lower court did not err in its judgment by misapprehending the legal doctrine on injury accidents, burden of proof of insurance accidents and interpretation of the terms and conditions, omitting judgment or exceeding the bounds of the principle of free evaluation

The Supreme Court decisions cited in the grounds of appeal are different from this case, and thus are inappropriate to be invoked in this case.

3. Regarding ground of appeal No. 4

A. Interpretation of a standardized contract shall be construed fairly and reasonably in light of the purpose and purpose of the standardized contract in good faith, and it shall be objectively and uniformly interpreted based on the average customer’s understanding potential, without taking into account the intended purpose or intent of the individual contracting parties (see, e.g., Supreme Court Decision 2009Da60305, Sept. 12, 2010).

B. The reasoning of the lower judgment and the evidence duly admitted reveal the following.

(1) Of the special terms and conditions of the instant insurance contract, the term “injury, death, highly advanced disability” shall be paid KRW 100,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,00,000,000,000,000,000,00

(2) With respect to the calculation of the rate of the payment of the residual disability in this case, the special terms and conditions on the disability in this case provide that “if two or more residual disabilities have occurred due to the same accident, the rate of the payment of the residual disability shall be added to the calculation of the rate of the payment of the residual disability in this case.”

(3) According to the general rule, the standard for determining disability of the new boundary and mental behavior (hereinafter referred to as the "standard for determining disability of this case") among the criteria for determining disability by the classification of disability in attached Table 2, the standard for determining disability of this case's new boundary and mental behavior (hereinafter referred to as the "standard for determining disability of this case") is as follows: "any other physical disability (e.g., snow, ear, arms, arms, legs, etc.) caused by the new boundary shall be assessed as the corresponding disability and its highest payment rate shall be applied."

(4) Meanwhile, the physical appraisal of the first instance court’s physical examination of the head of Seoul University Hospital, which was prepared by a medical specialist outside the regular zone, is indicated to the effect that “the appraiser shows the influence on the left-hand side and the left-hand side of the accident, and it seems that the whole part of the body is damaged by cerebral damage caused by the accident, and that the left-hand side and the spons, handouts, and the spouts, etc. will have been deteriorated or spouting.” The payment rate of the subsequent disability is calculated as 10% disability, 5% disability from spouting, 10% disability from spouting, 10% disability from spouting, and 10% disability from spouting, 2% disability from spouting, 3% disability from spouting the physical examination of the first instance court, and 5% disability from spouting the remaining-hand side, etc., are written to the purport that the remaining spover physical examination of this case will be made.

C. Examining these facts in light of the legal principles as seen earlier, the playground of this case is due to brain damage and paralysis caused by the instant insurance accident, and it can be deemed that “any obstacle to other physical parts caused by the instant accident” as stipulated in the standard for determining the new boundary disability of this case, and if so, the rate of payment of the follow-up disability of B caused by the instant insurance accident under the insurance terms and conditions, including the disability classification table in [Attachment Table 2], should be calculated by adding 35% of the rate of payment of the follow-up disability caused by the instant sports accident, and 35% of the higher payment rate among 35% of the total of the rate of payment of the follow-up disability of the instant sports ground, which is the 35% of the total of the rate of payment of the new boundary disability of this case and the rate of payment of the follow-up disability of this case (see, e.g., Supreme Court Decision 201Da16101, Dec. 13, 2010).

D. Nevertheless, without examining these circumstances properly, the lower court erred by misapprehending that the payment rate of the disability B arising from the instant insurance accident was 95% by simply adding up all the payment rate of each of the above new boundary obstacles, the playground of this case, and the above Cheong power disability, and concluded that the Defendant is liable to pay the insurance proceeds therefrom due to the occurrence of the subsequent disability exceeding 80% of the payment rate stipulated in the special terms and conditions related to the instant disability.

Therefore, the court below erred by misapprehending the legal principles on the interpretation of the terms and conditions, which affected the conclusion of the judgment. The ground of appeal assigning this error has merit.

4. Conclusion

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.