In cases where an insurer paid insurance proceeds upon the insured’s claim but it is found that the requirements for the payment of insurance proceeds were not satisfied later, whether the insured shall return the insurance proceeds to unjust enrichment (affirmative in principle), and whether it is different from the fact that the insurer did not disclose that the insurer failed to meet the requirements for payment of insurance proceeds at the stage of examining the payment of insurance proceeds based on the materials, such as medical records and opinions

Article 741 of the Civil Act

Dongbu Fire Marine Insurance Co., Ltd. (Attorneys Ansan Jae-sik et al., Counsel for the plaintiff-appellant)

Defendant

Incheon District Court Decision 2012Na14111 Decided December 18, 2014

The appeal is dismissed. The costs of appeal are assessed against the defendant.

The grounds of appeal are examined (to the extent of supplement in case of supplemental appellate briefs not timely filed).

1. Ground of appeal Nos. 1 and 3

A. Necessity for hospitalized treatment

For the following reasons, the lower court determined that the grounds for the payment of insurance proceeds under the terms and conditions of the instant insurance contract between the Plaintiff and the Defendant could not be recognized. ① The said terms and conditions provide that the daily amount of hospitalization shall be paid as insurance proceeds in cases of being hospitalized for at least four days for the purpose of treating cerebrovascular diseases and hovascular diseases. ② The Defendant received hospitalization from December 5, 2005 to August 3, 2009, but it is difficult to view that it is necessary for the treatment of cerebrovascular diseases.

Examining the reasoning of the lower judgment in light of the evidence duly admitted, the lower court did not err in its judgment by exceeding the bounds of the principle of free evaluation of evidence against logical and empirical rules.

B. Agreement between the parties and violation of the good faith principle

In a case where, while the insured was hospitalized to treat a disease prescribed in the terms and conditions of insurance, the insurer claims for the payment of the insurance proceeds as the insurance proceeds, but it is found that the requirements for the payment of the insurance proceeds were not satisfied later, the insured shall return the insurance proceeds to unjust enrichment, barring any special circumstance. In this case, the fact that the insurer did not disclose that the insurer failed to meet the requirements for the payment of the insurance proceeds at the stage of examining the payment of the insurance proceeds based on

The lower court deemed that the Defendant’s insurance proceeds received from the Defendant for hospitalized treatment, which does not fall under the grounds for the payment of insurance proceeds, constituted unjust enrichment. Furthermore, it cannot be said that there was an agreement that the Plaintiff would definitely pay insurance proceeds to the Defendant solely on the ground that the Plaintiff paid the instant insurance proceeds upon the Defendant’s request, and determined that the Plaintiff’s exercise of rights

Examining the reasoning of the lower judgment in light of the record, the Plaintiff’s payment of the instant insurance proceeds to the Defendant is not subject to an agreement on the payment of insurance proceeds, but is erroneous and paid. Therefore, the Plaintiff may seek the return of the instant insurance proceeds with unjust enrichment, and the Plaintiff’s claim for the return after the payment of the insurance proceeds cannot be deemed impermissible

In the same purport, the lower court did not err by misapprehending the legal doctrine on the agreement on the payment of insurance proceeds or the principle of trust and good faith.

2. The second ground for appeal

The court below determined that the evidence presented by the defendant alone is insufficient to recognize that the defendant suffered an injury from a road crossing on November 7, 2008 and thereby caused an escape from a conical signboard, and there is no other evidence to acknowledge it.

Examining the reasoning of the lower judgment in light of the record, the lower court did not err by exceeding the bounds of the principle of free evaluation of evidence against logical and empirical rules.

3. Conclusion

The Defendant’s appeal is dismissed as it is without merit, and the costs of appeal are assessed against the losing party. It is so decided as per Disposition by the assent of all participating Justices.

Justices Kim Chang-suk (Presiding Justice)