Text
1. The Plaintiff’s medical examination costs for brain cerebrovascular diseases based on the insurance contract indicated in the attached Form between the Plaintiff and the Defendant.
Reasons
1. Basic facts
A. The Plaintiff is an insurance company that carries on various non-life insurance, etc., and the Defendant (1954 students) is an insurance policyholder who has concluded an insurance contract with the Plaintiff listed in the separate sheet (hereinafter “instant insurance contract”) and is entitled to receive a final diagnosis as a cerebrovascular disease under the said insurance contract.
B. Insurance Terms and Conditions [Special Terms and Conditions for the Examination of Brain Diseases] Article 1 (Definition and Confirmation of the Diagnosis of Brain Diseases) (1) The term "cerebrovascular diseases" in this Special Terms and Conditions refers to the diseases stipulated in the attached Table 11 (Classification of Brain Diseases) in the 5th Korean Standard Medical Patients Classification.
(2) The diagnosis and confirmation of a cerebrovascular disease shall be conducted by a person with a medical license (excluding dentists) of a hospital specified in Article 3 (2) of the Medical Service Act or of a medical institution recognized as equivalent thereto, and such diagnosis shall be conducted based on the cerebral negoscopic chronological examination, nuclear negoscopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic s
However, only if the insured dies and cannot be based on the above method of inspection, it can be based on the documentized records or evidence verifying that the insured was under diagnosis or treatment due to cerebrovascular disease.
(Annex 11) The following diseases are included in the Korean Standard Industrial Disease Classification (No. 2007-4, January 1, 2008, the Statistics Korea Notice No. 2007-4, January 1, 2008), which is classified as brain cerebrovascular diseases as provided for in the terms and conditions:
8. The main contents of the insurance terms and conditions related to cerebrovascular diseases and classification numbers I67 are as follows:
C. According to the insurance contract of this case, the defendant's claim for the medical insurance for brain cerebrovascular diseases and the plaintiff's refusal to pay.