[Judgment of the court below]

Samsung Life Insurance Co., Ltd. and one other (Attorney Young-chul et al., Counsel for the plaintiff-appellant)

June 22, 2017

Seoul Central District Court Decision 2015Da5332561 Decided August 12, 2016

1. The Plaintiff’s appeal against the Defendants and the Plaintiff’s claim against Defendant Samsung Life Insurance Co., Ltd. expanded in this court is dismissed in entirety.

2. The costs of appeal (including costs of appeal arising from the extension of claim) shall be borne by the Plaintiff.

1. Purport of claim

1. The Plaintiff: (a) Defendant Samsung Life Insurance Co., Ltd. paid 79,779,780 won and 78,979,780 won each year from May 24, 2015 to the service date of a duplicate of the complaint of this case; (b) 15% per annum from the next day to the date of complete payment; (c) the remainder 80,000 won from May 24, 2015 to October 6, 2016 to the delivery date of a duplicate of the claim of this case; and (d) the amount calculated at the rate of 6% per annum from the next day to the date of full payment; and (e) the amount of money calculated at the rate of 18,776,802 won and each of the above amounts to the Plaintiff’s life insurance Co., Ltd. from February 14, 2015 to the date of full payment; and (e) the amount of money paid to the Defendant Samsung Life Insurance Co., Ltd. shall be paid to each of the Plaintiff’s.

2. Purport of appeal

The judgment of the court of first instance is revoked. The plaintiff shall pay to the defendant Samsung Life Insurance Co., Ltd. 78,979,780 won; 18,776,802 won to the defendant Samsung Life Insurance Co., Ltd.; and 5% per annum from February 14, 2014 to the service date of a duplicate of the complaint of this case; and 15% per annum from the next day to the day of full payment.

1. Basic facts

A. On January 31, 2001, Plaintiff Samsung Life Insurance Co., Ltd. (hereinafter “Defendant Samsung Life”) concluded an insurance contract with Defendant Samsung Life Insurance Co., Ltd. (hereinafter “Defendant Samsung Life”) with the content that the name of insurance products is to be paid KRW 20,00,000 at the time of cancer diagnosis, KRW 5,00,00 for the first time from the 0th day of the surgery, KRW 10,00,00 from the 0th day of the surgery, KRW 10,000 for the first time of the insurance period, KRW 10,00,000 for the insurance products, KRW 20,00 for the first time after the 0th day of the insurance period, KRW 10,00,00 for the insurance products, KRW 10,000 for the first time of the insurance products, KRW 20,000 for the first time of the death of Plaintiff Samsung Life Insurance Co., Ltd., Ltd., KRW 30,0000.

B. On September 5, 1998, Nonparty 1 entered into an insurance contract with Defendant New Life Insurance Co., Ltd. (hereinafter “Defendant New Life Insurance Co., Ltd.”). (Contract No. 4 omitted), the name of insurance products is the Health Insurance Co., Ltd., the Health Insurance Co., Ltd., the Insured and Beneficiary (Hospitalization) for each Plaintiff, the insurance period is 80 years old, the maturity date is 20,000,000 won when the insured first diagnosis becomes final and conclusive after the commencement date of liability during the insurance period, and the insured’s treatment is diagnosed and finalized after the commencement date of liability, and at the time of surgery, the insured’s medical care benefits is to be paid KRW 6,00,000 as an operation for a direct purpose.

C. Common terms and conditions relating to each insurance contract of this case are as follows.

(Definition and Confirmation of Various Cancers)

1. In this Agreement, the term “Cance” means a disease (see attached Table 3, e.g., Table 3), which is classified as a malicious new organism in the basic classification of the Korea Standard Disease Death Classification: Provided, That this shall not apply to the NAAC and a disease falling under the classification number C44 listed in attached Table 3, whose symptoms are insignificant, to the NAAC and the Malito-cell new and Malito-mal new organism whose symptoms are insignificant.

2. The diagnosis and confirmation of cancer shall be made by a person who holds a professional doctor's license of autopsy pathology or clinical pathology, and this diagnosis shall be based on the present opinion on tissue or blood test. However, if it is not possible to conduct the above pathological diagnosis, the clinical diagnosis of cancer is recognized as evidence of cancer. In this case, there shall be documents or evidence proving that the insured is receiving the diagnosis or treatment by cancer.

(attached Table 3) The classification table of malicious life;

The following diseases are the Korean Standard Disease Classification (Enforcement Date of the Statistics Korea Notice No. 1993-3, January 1, 1995), which is classified as malicious new organisms as provided for in the terms and conditions of the third amendment:

Matern Matern C15 to C26 of Matern Matern C26 of a fire extinguishing agency with malicious species subject to the list contained in the main text

After the fourth amendment, in addition to the above-mentioned diseases, I will also include the disease if there is an additional disease falling under the above-mentioned classification.

(Attachment 4) Definitions of “Serious Diseases”

Ⅰ.Serious cancer

(1) The term "serious cancer" means the amount of malicious species, the characteristics of which can be characterized by destructive reproduction of malicious species cells existing in and around the classical cells, and shall be excluded from guarantees in any of the following cases:

1. The following:

(a) Where the degree of crime is lower among malicious black species;

2. A disease that does not correspond to "serious cancer", such as cyrology and thyroid cancer, in a pathology;

D. (1) On February 11, 2015, the Plaintiff was undergoing the internal scambling test at the ○○○○○○○ Branch located in the Gunsan-si (hereinafter “the instant species”). The Plaintiff was found in the workplace and was subject to the scambling test, and Nonparty 2 of the medical specialist affiliated with the said hospital completed the organizational inspection of the instant species, and completed the organizational scambling report with the following contents.

NET contained in the main sentence: NET (0.4 x 0.3 m) (T1a : 1 x 1 m) Red Section (2) (T1a x 1 m) type size: Negrative (-) type size: 0.4 x 0.3 m (b) type size: there is no opinion that each kind of ngrative is invaded on the face of the Section.

2) Afterwards, Nonparty 3, the principal doctor of the above hospital, diagnosed the Plaintiff’s religious service as “work bad faith and Korean Standard Disease Classification C20” on February 14, 2015, based on the result of the above tissue pathology test report.

E. On April 14, 2015, Nonparty 4 diagnosed the Plaintiff’s disease as “Minsung (workplace cancer)” and “Korea Standard Disease Classification Number C20” with respect to the Plaintiff’s disease, Nonparty 4’s main values at △△ University Hospital, and is written as “in the remarks column of the said medical certificate” and “in the external area.”

F. The Plaintiff claimed cancer insurance money under each of the above insurance contracts (hereinafter “each of the insurance contracts of this case”) against the Defendants, but the Defendants paid only insurance money for the species of boundary on the ground that the Plaintiff’s disease constitutes “salary species.”

(g) Of the contents of the third Korean Standard Disease Classification, the parts relating to this case are as follows:

Part III: Equitable table and item classification table of 4 unit figure;

Ⅱ Noplasms (C00-D48)

C0-C75 M&C75 F. H. M. and related organizations are the origin of the parts, other than, or assumpted, malicious life (M.N.) which has been determined, or is assumed, to be the origin of the parts, other than those of the C00-C75 P. M.C. and related organizations.

C20 Work musical life (Malant neopla)

Workplace expansion loans fl.m. Apulla

Noplas, uncinta or unknows, etc. (D37-D48) (D37-D48)

Note:Items D37-D48 classifys, on the basis of the upper part, new organisms that are suspected of being gender-sensitive training, in which behavior patterns are unclear or that are suspected of being maliciously cultivated. These new organisms grant behavior-based classification/1 in terms of formological classification.

D37 The behavior patterns of the mouth and fire extinguishing body is unknown or isthodic Organisms (Noplainor unkown et al.)

D37.5 Workplace

WorkS joints of contact with each workplace juncy

(h) even if the Korean Standard Disease Classification in the 4th and 7th Amendment is relevant to the behavior patterns of new organisms, it is classified into Category 437-D48 of the Product Classification.

(i) Medical opinions;

1) Details of the examination of the medical record entrusted on March 21, 2016 by the examination of the medical record of the medical record of the medical record of the medical record of the medical record of the National Tol University.

In the category of ‘Nuroendcoplas' in ○ work site, the types of ‘Neurine fluoride fluoride fluoride fluoride fluoride fluoride fluoride fluoride fluoride fluoride fluoride, mixed fluorine fluoride fluoride fluoride, L cell cell gluoride fluoride fluoride fluoride fluoride fluorum fluoride fluor, etc., all of them do not correspond to malicious species.

It is classified into the G1st of the ○ workplace’s G1st of the path of the path of the path of the path of the path of the G1st of the path of the path of the path of the path of the path of the path of the path of the path of the path of the path of the path of the path of the path of the path of the path of the path of the

○ In the workplace’s “Nuroendcoplas” as a person suggesting malicious performance, there are species differentiations, neighboring floors, or blood transfusions, the number of cells divided, Ki-67 propagation index, and other nearby long-term crimes.

According to the ○ medical opinion, it is reasonable to classify the Plaintiff's appearance as a salvical species based on the salvology of the species, the size of the species, and the opinion of blood ties, etc.

In light of the Plaintiff’s autopsys, medical records, etc., it is reasonable to give shape/copon to a small-scale 1 cm or smaller-scale 1 cm or lower-level 1 cm or lower-level 1 cm or lower-level 1 cm or lower-level 1 cm or less-type 1 cm or less-type 1 cm or less-type 1 cm or less-type 1 cm or less-type 1 cm-type 1 cm or less-type 1 cm-type 37.5. In accordance with the Korean Standard Disease Disease Classification, the disease classification number is 8240/1, and the disease classification number is 437.5. In the case of a workplace-type knife-type knife-type knife-type knife-type knife-type knife-type is treated properly.

2) Medical technicians on May 27, 2016, at the examination and treatment of a medical specialist (medical specialist) at the Atol University's Institute of Government Nature Hospital.

Record Results of the request for appraisal

○ The Plaintiff’s genetic cancer falls under T1a in light of the size and degree of crime.

○○ The location of the Plaintiff’s species is the chronology of workplace, the size of the decentralization is less than 1 cm, the degree of decentralization is organized G1, and the degree of aggression is not blood erosion. According to the medical opinion, it is reasonable to classify the Plaintiff’s species into the form code “8240/1”, the Korean Standard Disease Disease Classification D37.5, the behavior pattern is unclear, or the non-new life.

The diagnosis results issued by the Plaintiff’s clinical doctor are based on the results of the pathology of the pathology. However, it seems that the code classification was applied by the medical records of the hospital of the cariology (pactr). In recent years, according to the Korean Standard Quality Classification of Disease (2014), according to the Korea Standard Classification of Disease (2014) revised by the Statistics Korea, the formological classification code of new life that occurs in the workplace is d37.5.

On April 14, 2015, the diagnosis name of the △△△△ Group for the Plaintiff is the place of work neutism, grade 1 (HA). When preparing a medical certificate, it should not be recorded by the classification code in the medical records of the hospital of the gascarnoid.

[Ground of recognition] The absence of dispute, Gap evidence Nos. 1 through 18, Eul evidence Nos. 4 and 6 (including virtual numbers), the result of each request for the examination of medical records by the court of first instance toTol University's Head of the Government Nature Hospital, the purport of the whole pleadings

2. The parties' assertion and judgment

A. The parties' assertion

1) The plaintiff's assertion

The Defendant is obligated to pay to the Plaintiff the remainder of the amount calculated by subtracting the insurance money already paid from the respective cancer insurance money under each insurance contract of this case, on the premise that the Plaintiff falls under the pattern of boundary from the respective cancer insurance money under each of the insurance contracts of this case, which constitutes the category of the Korean Standard Disease Disease Classification Code C20.

2) The defendants' assertion

The species of the instant case fall under the category of workplace cancer, the size of which is less than 10m and which has no blood ties, and the diagnosis of cancer according to the insurance terms and conditions should be conducted by a professional doctor of autopsy pathology or a person holding a professional doctor's license of clinical pathology. Since doctors who have diagnosed the Plaintiff as cancer are not medical specialists with the above qualification certificates, they cannot be deemed to fall under the category of "male" or "serious cancer" which are compensated under the insurance terms and conditions of each of the instant case, and thus, there cannot be a final diagnosis of cancer, and thus, there is no obligation for the Defendants to pay cancer insurance to the Plaintiff under each of the insurance contracts of this case.

B. Determination

1) The insurance terms and conditions shall be interpreted fairly and reasonably in light of the purpose and purpose of the terms and conditions in good faith, and shall be interpreted objectively and uniformly in consideration of the interests of the entire insurance organization based on average customer’s understanding potential without taking into account each party’s intended purpose or intent (see Supreme Court Decision 2010Da45777, Nov. 25, 2010, etc.).

2) In light of the following circumstances, in light of the facts acknowledged earlier and the overall purport of the arguments on the evidence presented by the Plaintiff, each of the evidence presented by the Plaintiff alone is insufficient to recognize that the Plaintiff’s diagnosis and confirmation medical life constituted “a cancer” or “here cancer” as stipulated in each of the instant insurance contracts and insurance clauses (3. A., as indicated in the above 1-A), and there is no other evidence to prove otherwise. Therefore, the Plaintiff’s assertion against the Defendants is without merit as to the remainder.

① According to the insurance contract of this case, the diagnosis and confirmation of cancer shall be based on the current opinion on tissue tests or blood tests conducted by a medical specialist of autopsy pathology or clinical pathology. However, if it is not possible to conduct the above pathological diagnosis, the clinical diagnosis of cancer is admitted as evidence for cancer. In this case, considering the circumstance that the medical examination of the species of this case was conducted by the plaintiff by Nonparty 2 of pathology, and the report on the result of the pathology examination of the species of this case was made by the medical specialist of pathology, it cannot be said that the pathology diagnosis of the species of this case is not possible.

② However, it is difficult to view that Nonparty 3 and Nonparty 4’s doctor of △△ University Hospital who diagnosed the Plaintiff as “workplace’s bad faith” or “workplace’s cancer” is not a doctor of pathology. Although the above doctor conducted the above diagnosis based on the medical examination report on the Maternology written by Nonparty 2 in the medical department of pathology, it is only presented in the report on the result of the Maternology examination only that the Maternity of this case is workplace cancer and that there is no specific opinion on the Maternology of this case, and that there is no specific opinion on the Maternology of this case on the Maternology of this case. In addition, it is difficult to find that Nonparty 2 presented the Plaintiff’s medical examination report on the Maternology of the Plaintiff only based on the medical examination opinion on the Maternology’s cell therapy, the size of the Maternology, and the opinion on the Maternology of this case. In light of the above, it is reasonable to find the Plaintiff’s medical examination on the Matern.

③ Medical opinions regarding the examination of the above medical records are as follows: the species of this case, which were revealed as the result of the examination of the above medical records, refer to the disease classification number D37.5; the formal classification number is 8240/1; it is reasonable to diagnose it as the "distinctal species", which is an uncertain malicious locked behavior pattern; and even if it is based on the third, fourth, and seventh revised Korean Standard Disease Classification, it is difficult to view that the pattern of this case, which was revealed as the result of the examination of the above medical records, falls under the types of cancer provided for in each insurance contract of this case, because it is difficult to view that the pattern of this case, which was expressed as the result of the examination, falls under the category of cancer provided for in each insurance contract of this case.

④ According to each of the insurance clauses of this case, a disease classified as a malicious organism shall be based on the third revised Korean Standard Disease Death Classification, but after the fourth amendment, a disease added to the Korean Standard Disease Disease Classification may include a disease classified as a malicious organism under each of the insurance clauses of this case. Even if the form and pattern of a new organism falls under M8240/3 according to the 7th revised Korean Standard Disease Disease Classification, even if the form and pattern of the new organism fall under M8240/3, it is difficult to conclude that the 7th revised Korean Standard Disease Classification as asserted by the Plaintiff falls under the 1st revised Korean Standard Industrial Disease Classification as “new Organism,1 uncertain or not known, 3 malicious, and flador.”

3. Conclusion

Therefore, the Plaintiff’s claim against the Defendants should be dismissed in its entirety because it is without merit, including the claim extended by this court. The judgment of the first instance, which dismissed the Plaintiff’s claim prior to the extension of the period, is justifiable in conclusion. As such, the Plaintiff’s appeal against the Defendants and the claim for Defendant Samsung Life Insurance expanded by this court, are dismissed in its entirety as it is without merit

Judges Kim Jong-ho (Presiding Judge)