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(영문) 서울고등법원 2016.04.15 2015나12163
보험금
Text

1. The plaintiff's appeal is dismissed.

2. The costs of appeal shall be borne by the Plaintiff.

Purport of claim and appeal

The first instance court.

Reasons

Facts of recognition

On January 10, 2007, the Plaintiff entered into a contract with the Defendant, the insured, and the beneficiary at the time of the injury by hospitalization as the Plaintiff, and entered into a mutual agreement with Korea Social I insurance with the cover period as the Plaintiff, and entered into a contract with the insured, and entered into a non-payment agreement with the content that, in the event that the diagnosis is confirmed as an adult specific disease and that the insured is hospitalized for a direct purpose of the treatment, the amount of hospitalization benefits and nursing funds are paid (hereinafter “instant special agreement”); the insured’s non-payment guarantee agreement with the content that, in the event that the insured is hospitalized for at least four days for a direct purpose of the treatment due to a disease or accident, the amount of hospitalization benefits of KRW 20,00 per day exceeding three days and KRW 15,00 per day if the insured is hospitalized for at least four days for a direct purpose of the treatment.

The main contents of the instant special agreement related to the instant case are as follows. The cerebrovascular (Classification No. 161) under the instant special agreement is classified as an adult specific disease, but the cerebral cerebral cerebral cerebral cerebral cerebral cerebral cerebral cerebral cerebral cerebral cerebral Mano. 1

[Special Agreement on the Guarantee of Life and Medical Care] The definition and determination of “sexually specific disease” under Article 12 (1) of this Special Agreement refers to the type 1, 2, and 3 diseases specified in the Revised Korean Standard Disease Classification (See attached Table 8) of the 4th Amendment.

Article 15 (Types and Grounds for Payment of Insurance Money) If any of the following events occurs to a person eligible for insurance (insured) during the insurance period of this Special Agreement, the company shall pay the insurance money agreed upon to the person (beneficiary) who receives the insurance money (see attached Table 1 of the Standards for Payment of Insurance Money).

1. An insured person shall be diagnosed as a specific adult disease after the commencement date of guarantee during or after the insurance period;

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