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(영문) 울산지방법원 2015.04.29 2014나3023
보험금
Text

1.The judgment of the first instance shall be modified as follows:

Attached Form

2. The plaintiff against the defendant in relation to the insured events mentioned above.

Reasons

1. Basic facts

A. On December 28, 2009, the Defendant entered into an insurance contract with the Plaintiff, stating the details of the insurance contract in attached Table 1 (hereinafter “instant insurance contract”).

B. According to the instant insurance contract, where the insured receives outpatients or hospitalized treatment from a hospital due to a disease, he/she may receive insurance proceeds, such as extra-patients medical expenses, expenses for hospitalization of a disease, and daily allowances for hospitalization of a disease.

C. However, according to the terms and conditions of the insurance contract of this case, in the case of daily allowances for hospitalization of a disease, if the insured has received diagnosis or treatment due to the disease within the past five years from the date of application for the insurance contract, it shall be deemed not to have been received, and even in the case of medical expenses for hospitalization of a disease or outpatient treatment expenses, it shall be deemed not to have been received if the insured has received the previous diagnosis or treatment due to disease falling under “the obligation to inform before the contract (limited to important matters

The defendant had undergone an operation with the escape certificate on February 10, 2009 and on the 17th of the same month, which was within five years before entering into the insurance contract of this case. The defendant received the diagnosis of the escape certificate of estimated signboards at the Changwon-si Hospital on April 1, 201 and received the diagnosis of the escape certificate of estimated signboards at the same month on April 1, 201.

7. &

8. A person who received an operation and received hospital treatment for 18 days at the relevant hospital as a result, and received hospital treatment by May 14, 2012;

Attached Form

2. The insurance accident is described as the insurance accident in this case;

E) Unless there are other circumstances, the insurance money to be paid with respect to the instant insurance accident based on the instant insurance contract is KRW 8,071,638, the amount of medical expenses for hospitalization of a disease, KRW 540,00, the daily amount of hospitalization of a disease, KRW 1,220,480, and KRW 1,220,480.

2. Determination on the cause of the claim

A. The plaintiff's assertion is the insurance accident of this case within five years before the subscription of the insurance contract of this case.

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