(영문) 대법원 2015.9.24.선고 2015다217546 판결

The part of the judgment below against the defendant is reversed, and that part of the case is remanded to the Panel Division of the Seoul Central District Court.

Reasons

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

1. As to the grounds of appeal on the causes of suicide, the lower court determined as follows: (a) the death of B for the excessive use of drugs constitutes a case where the death result was caused in a state where free decision-making cannot be made due to severe depression.

Examining the reasoning of the judgment below in light of the relevant legal principles and records, the judgment of the court below is just and acceptable. Contrary to the allegations in the grounds of appeal, there is no error of law such as misunderstanding of legal principles as to the terms

2. As to the ground of appeal on the death benefit for illness

A. Review of the reasoning of the lower judgment and the record reveals the following facts.

(1) On May 14, 2009, the Plaintiff entered into an insurance contract between the Defendant, an insurance company, and the insured of B’s without dividends, whose father is the insured (hereinafter “instant insurance contract”).

(2) B received psychological counseling from a university that attended from around June 2012, and was provided with a mental therapy from October 22, 2012 to June 12, 2013, and attempted suicide two times by taking a large amount of mental disorder. On October 16, 2013, B died of drug addiction.

(3) General Terms and Conditions for Guarantee of General Injury, Death, and Ex Post Facto Disability in the instant insurance contract (hereinafter “Bodily Injury Death Special Provisions”)

Article 1 of the Clause provides that the insured shall compensate for the loss caused by the injury according to the special terms and conditions of death when he/she suffers bodily injury due to a sudden and unexpected accident that happens during the insurance period. Article 2 and Article 3 provide that the insured shall compensate for the loss due to the injury.

On the other hand, Article 16 (1) of the General Terms and Conditions applicable mutatis mutandis under Article 5 of the Special Terms and Conditions for Death (hereinafter referred to as the "Terms and Conditions for Exemption") lists the damage caused by ‘the intention of the insured' (Article 1), ‘the self-injury of the insured, suicide, etc.' (Article 4), ‘the disease of the insured' (Article 5), ‘the defect or mental illness of the insured' (Article 6).

(4) Article 1(1) of the instant insurance contract provides that, in the event the insured dies of a disease, or loses part of his body as a direct result after recovering the disease during the insurance period, or the remaining disability remains in excess of 80% of the payment rate set forth in the Disability Classification Table due to the permanent loss of its function, the amount of the insurance proceeds for death of a disease shall be paid. Article 6 of the instant insurance contract provides that the matters not specified in the instant special terms and conditions for death of a disease shall be governed by ordinary terms and conditions, but Article 17 of the General Terms and Conditions and Article 18 shall not apply without paying the insurance proceeds for death under Article 1

B. In light of the terms and conditions of the instant insurance contract, the insurance accident stipulated in the instant insurance contract’s special terms and conditions refers to the case where the insured’s disease, which is not covered by the accident insurance under the instant insurance contract, itself as a direct cause, is caused by the death, etc., and does not include the case where the insured’s physical injury is caused by other ex-post factors or death resulting from the death (see, e.g., Supreme Court Decision 2013Da18929, Apr. 10, 2014). In the instant case, B, rather than by the depression itself, died with the external act of the body called “the excessive taking away of medicine” as a direct cause, and thus, even if B was unable to make free decision due to depression, it cannot be deemed as the death of the insured’s disease itself, which is the special terms and conditions for guaranteeing the death of the disease.

Nevertheless, the lower court determined that B’s death constituted death as an insurance accident under the special terms and conditions for guaranteeing the death of a disease. In so doing, the lower court erred by misapprehending the legal doctrine on accident insurance and disease insurance, thereby adversely affecting the conclusion of the judgment. The allegation in the grounds of appeal assigning this error is with merit.

3. Where the grounds of appeal on the general injury, death, and death are stipulated as an insurer’s exemption from liability in an insurance contract which covers the death of an insured event, suicide refers to an act of causing death by intentionally cutting one’s own life for its purpose and intentionally cutting it into one’s own life. It does not include cases where the insured’s direct cause of death occurred in a situation where free decision-making is impossible due to mental illness, etc. If the insured’s act of causing death occurred out of the past, such death may constitute an insured accident, which is not caused by the insured’s intentional act. However, the instant exemption clause provides that the insured’s mental illness as an accident, separate from the insured’s intentional act or suicide. The purport of this exemption is to exempt the insured from liability for exemption from insurance protection if the insured’s risk substantially increases due to the weakening ability or judgment ability of the insured’s mental illness. The risk taken over from the insurance can be determined differently according to the insurance contract, and thus, the insured’s duty to exempt the insured from liability for exemption from liability for exemption from insurance protection.

Nevertheless, the court below rejected the defendant's claim for discharge on the ground that the part of "damage caused by the mental illness of the insured" in the exemption clause of this case should be deemed null and void pursuant to Article 6 (1) and (2) 1 of the Regulation of Standardized Contracts Act, so long as the insured interpreted that the "damage caused by the mental illness of the insured" includes the case of suicide in a situation where the free decision-making is impossible due to mental illness. Therefore, the court below erred in the misapprehension of legal principles as to the invalidation

4. Conclusion

Therefore, the part of the lower judgment against the Defendant is reversed, and that part of the case is remanded to the lower court for further proceedings consistent with this Opinion. It is so decided as per Disposition by the assent of all participating Justices on the bench.