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(영문) 대구고등법원 2016.01.20 2015나21104
채무부존재확인
Text

1. The judgment of the court of first instance is modified as follows.

Based on the insurance contract stated in the annexed Table 1.

Reasons

1. The following facts do not conflict between the parties, or may be acknowledged by the purport of Gap evidence Nos. 1, 2, and 5, and Eul evidence Nos. 1, 2, and 3 and all pleadings, and there is no counter-proof.

On February 9, 2007, the Plaintiff entered into an insurance contract in attached Form 1 (hereinafter “instant insurance contract”) with the Defendant, the main content of which is to pay the fixed amount of insurance money when being hospitalized for the direct purpose of treatment of a specific disease or received surgery (hereinafter “instant insurance contract”). The main content of each of the terms and conditions applicable to the instant insurance contract is as set forth in attached Table 3.

B. During the period from October 4, 2013 to November 27, 2014, the Defendant received, as indicated in the attached Table 2, hospital B, hospitalized treatment (hereinafter “reward hospitalized treatment at once”) for six (6) days in total, as indicated in the attached Table 2, from the hospital, and filed a claim against the Plaintiff for the amount indicated in the column of each claim amount in relation to the hospitalized treatment set forth in subparagraphs 1 to 6.

C. The Defendant asserted that the hospitalized treatment No. 1 through 6 constituted an insurance accident in the instant insurance contract, and filed a claim for the payment of insurance proceeds of KRW 20,602,152 in total as the name of hospitalization medical expenses, hospitalization expenses, sickness expenses, and specific hospitalization expenses. The amount claimed by the Plaintiff for each hospitalized treatment is as indicated in the column for claim amount in the attached Table 2.

2. Although the Plaintiff’s assertion 1 to 6 medical treatment is not recognized as a necessity of hospitalization, it does not constitute an insurance accident stipulated in the insurance contract of this case, as the Defendant was unfairly hospitalized treatment for the purpose of acquiring insurance money by deceit.

Therefore, the Plaintiff seeks to confirm that there is no obligation to pay insurance money under the insurance contract of this case between the Defendant and the Defendant regarding hospitalized treatment No. 1 through 6.

3. Determination

A. Determination of the necessity of hospitalized treatment is the insurance contract of this case.

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