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(영문) 광주지방법원 2015.07.15 2014가단509335
보험금
Text

1. The plaintiff under an insurance contract in accordance with the attached Table No. 2 relating to the insurance accident stated in the attached Table No. 1.

Reasons

1. Facts of recognition;

A. The Plaintiff entered into an insurance contract with the Defendant as shown in attached Table 2(2)

(hereinafter referred to as "the insurance contract of this case". (b)

On August 23, 2011, the defendant was diagnosed with her, and performed a surgery at the Madern Hospital.

C. The insurance contract of this case includes a general cancer special agreement (in the amount of KRW 80,00,000), and the terms and conditions pertaining to this case are as follows.

Article 1 (Types and Grounds for Payment of Insurance Money) The Company shall pay to the insured the amount of insurance coverage per day exceeding three days if the insured is diagnosed and confirmed as "Cance-related diseases" after the date of commencement of coverage and is hospitalized for at least four consecutive days for direct purposes of treatment.

Article 2 (Detailed Provisions for Payment of Insurance Money) (4) In the case of Article 1, even if the insured has been hospitalized twice or more during the insurance period for direct purpose, the number of days of hospitalization shall be considered as continuous hospitalization.

The Defendant hospitalized respectively at B Hospital after the surgery from November 1, 2013 to February 24, 2014, and from March 3, 2014 to July 18, 2014.

(hereinafter referred to as “instant hospitalization”). [Grounds for recognition] The fact that there is no dispute, Gap evidence Nos. 1 through 3, Eul evidence No. 1, and the purport of the whole pleadings.

2. The plaintiff does not directly aim at cancer treatment, and therefore, the plaintiff is not obligated to pay insurance money to the defendant under a special contract for general cancer treatment of the insurance contract of this case. Since the defendant was hospitalized for a direct purpose of cancer treatment, the plaintiff is entitled to claim insurance money pursuant to the special agreement. Thus, the issue of this case is whether the hospitalization of this case is "the purpose of which is directly for cancer treatment".

3. According to the records of Gap evidence Nos. 3 and Eul evidence Nos. 1, the results of this court's entrustment of medical record appraisal to the Korean Compensation Medical Association, and the purport of the whole pleadings, the defendant shall operate celebites.

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