2016 Ghana 5080232 Insurance proceeds

A

Law Firm Yu-il, Counsel for the plaintiff-appellant

[Defendant-Appellant]

B Stock Company

Attorney Park Jong-tae, Counsel for the plaintiff-appellant

October 2, 2018

October 30, 2018

1. The Defendant shall pay to the Plaintiff the amount of KRW 43,675,053 insurance proceeds and the interest rate of KRW 15% per annum from April 27, 2016 to the date of full payment.

2. The costs of the lawsuit are assessed against the defendant.

3. Paragraph 1 can be provisionally executed.

The same shall apply to the order.

1. Facts of recognition;

A. The Plaintiff entered into an insurance contract with the Defendant with the following content (hereinafter “instant Bob power contract”).

1. Name of insurance product: D2. Contract number: D3. D3. Contractor and insured beneficiary: Basic contract amount: 10,000,000 won: Additional Security for a disability requiring general injury and injury: 90,000,000 won: Insurance premium amount: 50,000,000 won: Insurance premium amount: 29,300 won: Insurance period from the date of March 31, 201 to the date of March 31, 207. The General Contract, General Injury, Disability after Death, Injury, Disease, Loss and Health Care Security;

B. On August 12, 2015, the Plaintiff suffered bodily injury, such as an indiciencies, damage to water level, and impairment of the function of neutical mineing, etc. (hereinafter “accident in this case”) on the floor below 5 meters while putting an artificial rocking (hereinafter “the artificial rocking in this case”) in the artificial rocking facility located in the Sungnam-si E Park (hereinafter “the artificial rocking in this case”).

C. The general terms and conditions of the instant insurance contract and the special terms and conditions related to the Plaintiff’s claim (hereinafter collectively referred to as “the instant insurance terms and conditions”) are as shown in the attached sheet. In addition, among the instant insurance terms and conditions, the exemption clauses related to the instant accident (hereinafter referred to as “instant exemption clauses”) are as follows.

Article 19 (Grounds for Not Paying Insurance Money)

(2) Unless otherwise agreed, the company shall not prevent the relevant insurance proceeds when any ground for paying insurance proceeds in relation to an injury provided for in Article 17 occurs while the insured (person subject to insurance) engages in any of the following activities for the purposes of occupation, duties or club activities:

1. Specialized light team (referring to a team that gets off or can cover both walls or ice walls using a professional mountain aid, or that requires prior training, such as skills, experience, and light that require prior training), operated by Bangladesh, scood ice, scood ice, and written trading;

[Ground of recognition] Facts without dispute, Gap 1, 2, 6, Eul 1, and 2

2. Judgment on the assertion

A. Summary of the assertion

1) The plaintiff's assertion

In the instant accident, the Plaintiff suffered an obstacle corresponding to “where the instant insurance accident happens with significant athletic harm in spine,” as set forth in the attached Table 1 of the instant insurance clause (hereinafter referred to as “attached Table”). In addition, the instant team not only does it fall under the specialized class group, but the Plaintiff did not engage in the instant class group for the purpose of club activities. Accordingly, the Defendant is obliged to pay the Plaintiff general ex post facto disability insurance money and loss medical expenses as prescribed in the attached Table of the instant insurance clause.

2) The defendant's assertion

A) Since the instant accident occurred while the Plaintiff was engaged in a specialized class for the purpose of club activities, the Defendant is not obligated to pay the insurance proceeds to the Plaintiff pursuant to the exemption clause of this case.

B) In the instant accident, there is insufficient evidence to deem that the Plaintiff suffered disability in spine, which is obvious harm to spine, as stipulated in the attached Table, and the actual medical expenses should be calculated in accordance with the terms and conditions of the instant insurance.

(b) Markets:

1) Whether the defendant is exempted from liability

We examine whether the case constitutes a professional class team and whether the plaintiff was a member of the club for the purpose of the club activity.

According to the statement in Eul 2, Eul 2, 3, and 4, the plaintiff is a member of "G, a mountainous father of the F University," and the plaintiff is working as an OB member even after graduation, and all of the above mountain conference's records were filled by excluding Rason, the highest salary class in Antarctica in the world 7th land. The plaintiff continues to engage in the activities of H organization's H organization as a sub-specing instructor with sub-speak technology and street, using the rock wall equipment, Karabner, Hkset, Kwikkset, helick, and he may recognize the fact that the plaintiff used the artificial rock wall of this case for about 11 months from June 3, 2016 to August 12, 2016.

However, in light of the following circumstances, the aforementioned evidence and the statements in Gap 10, 11, and 15 comprehensively revealed the purport of the entire pleadings, it is difficult to see the team of this case as a professional class, and it is insufficient to recognize that the plaintiff committed the team of this case for the purpose of club activities.

Although specialized equipment is required for the reflection of the instant case, the artificial cancer of this case, unlike natural cancer walls, has already been installed such as artificial securings to catch in hand or to alleviate shocks at the time of falling, unlike natural cancer walls.

0 The artificial rock wall of this case is prohibited from being a single light, but it is possible to be accompanied by a skilled person or receive a preliminary light education even if the first person is a skilled person.

0 In general, a group of club members refers to a group of groups created by those who have the same hobby or symbol to carry out the hobby activities in group. The essence of the club is to carry out hobby activities together with the purpose of enjoying hobby activities. As such, the essence of the club is to carry out the hobby activities, and it can be said that a group of club members is to join the club with a professional team, and actually carry out a professional group with other club members. The instant accident occurred under the equipment of the first group of club members, and there is no evidence to recognize that the Plaintiff carried out the instant club for the purpose of enjoying the club activities.

2) Calculation of insurance money

In full view of the overall purport of the arguments as to Gap 2 through 5, 12, 13, and 14 and the result of the request for physical examination to the President of the Jmedical Center, the plaintiff, after the accident in this case, received hospitalized treatment and surgery treatment (after the aftermath cryth cryth cryth cryth cryth cryth cryth cryth cryth cryth cryth cryth cryth cryth cryth cryth cryth cryth cryth cryth cryth cryth cryth cryth cryth cryth cryth cryth cryth cryth cryth cryth cryth cryth cryth cryth cryth cryth cryths

(1) General disability insurance proceeds in general terms and conditions;

10,000,000 won (amount of insurance coverage) ¡¿ 30% (payment rate) = 3,000,000 won

(2) General insurance benefit for disability in general terms and conditions

90,000,000 won (amount of insurance coverage) ¡¿ 30% (payment rate) = 27,000,000 won

③ Loss medical expenses of KRW 13,675,053 (i.e., hospitalization medical expenses of KRW 12,475,053 + 1,200,000)

0 Hospitalization medical expenses

The total amount to be borne by the Plaintiff himself/herself is KRW 16,442,171 [=14,783,671 (K Hospital) + (658,320 + 1,00,180 won + 59,000 won, excluding KRW 2,522,00,000, 13,861, 171 won, 12,475,053 (hereinafter collectively referred to as the “har”).

1,200,000 won in 1,200

2,522,000(실제 상급병실료 차액) × 1/2 ≒ 1,200,000원 (한도 1일 10만 원, 입원일 12일)

(c) Amount quoted;

The Defendant is obligated to pay to the Plaintiff KRW 43,675,053 (= KRW 3,000,000 + KRW 27,000,000 + KRW 13,675,053) and damages for delay calculated by the rate of 15% per annum under the Act on Special Cases concerning Expedition, etc. of Legal Proceedings from April 27, 2016 to the date of delivery of a copy of the instant complaint sought by the Plaintiff.

3. Conclusion

The plaintiff's claim is accepted.

Judges Kim Jong-do

A person shall be appointed.

A person shall be appointed.