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(영문) 인천지방법원부천지원 2013.12.26 2012가단41290
보험금
Text

1. The Defendant shall pay to the Plaintiff KRW 21,491,100 and the interest rate of KRW 20% per annum from December 8, 2012 to the day of complete payment.

Reasons

1. Basic facts

A. On February 26, 2004, the Plaintiff entered into a contract between the Defendant and the policyholder, the insured, the Plaintiff’s insurance period, and the period from February 26, 2004 to February 26, 2050, for a long time as to non-payment of dividends (hereinafter “instant insurance contract”). The details of the insurance coverage related to the instant case and the special terms and conditions are as follows.

(1) The secured life-sustaining medical expenses, 30,000,000 won Company shall compensate for the following expenses for the medical expenses for hospitalization of a disease where the insured, as stated in the insurance policy, was hospitalized in a hospital or clinic under Article 3(2) of the Medical Service Act due to a disease that occurred during the insurance period.

(1) In cases of hospital room fees: 2 hospital fees, radiation fees, medication and prescription fees, main feed, ecology, mental therapy, physical therapy, materials for treatment, stresses, designated medical treatment fees, etc. 3: Medical treatment fees, surgery fees, anesthesia fees, and expenses for surgery. 4. The difference between the actual user's room and the standard sick room: The company shall guarantee the amount equivalent to 50 million won out of the total expenses and 30 million won out of the expenses to be borne by the insured under the National Health Insurance Act.

However, if the insured is not subject to the national health insurance due to unavoidable circumstances, the amount equivalent to 40% of the total amount of the above-mentioned hospitalization medical expenses shall be compensated for up to 30,000 won.

Here, if the number of national health insurance is not applicable, it refers to medical expenses and national health insurance which are compensated in industrial accident insurance.

(2) The company has been hospitalized and treated for at least four consecutive days at a medical institution prescribed in Article 3 of the Medical Service Act due to injury or disease during the insurance period as stated in the insurance policy (one day for more than three days).

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