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(영문) 부산지방법원 2018.01.11 2015가단222834
보험금
Text

1. The plaintiff's claim is dismissed.

2. The costs of lawsuit shall be borne by the Plaintiff.

Reasons

1. Basic facts

A. On May 3, 2005, the Plaintiff entered into an insurance contract with the Defendant as the insured on the attached list (hereinafter “instant insurance contract”).

The main contents of the instant coverage among the instant insurance contracts are as follows.

[Terms and Conditions of Free Distribution Special Agreement for Hospitalization ] In this special agreement, the term "hospitalize" means that a person who is qualified as a doctor, dentist or oriental medical doctor (hereinafter referred to as "doctor") deems it necessary for the direct purpose of treatment as set forth in the table of disease and disaster classification of the insured (insured) and it is difficult to provide medical treatment at his own home and therefore it is difficult to provide domestic hospital under Article 3 of the Medical Service Act or a foreign medical institution recognized by the company as equivalent to the above, and concentrate on the treatment under the control of the doctor.

Article 11 [Types and Grounds for Payment of Insurance Money] The Company shall pay the agreed hospitalization allowances to the person who receives the insurance money (beneficiary) when the insured person has been hospitalized for at least four consecutive days for direct purposes of medical treatment due to diseases or accidents set forth in the Schedule of Classification of Diseases and Disasters during the insurance period of this special agreement.

Article 12 [Detailed Provisions for Payment of Insurance Money] (2) In the case of Article 11, even if a person subject to insurance is hospitalized by transferring a hospital or a member of a council, the company shall be deemed hospitalized if it is recognized by the company.

(3) In cases under Article 11, the number of days of payment of hospitalization benefits shall not exceed 120 days per hospitalization once.

(4) In cases under Article 11, where a person subject to insurance is hospitalized twice or more due to the same disease or disaster, the number of days of hospitalization shall be considered as one time, and paragraph (3) shall be applied thereto.

However, even in case of hospitalization due to the same disease or accident, the hospitalization commenced after the lapse of 180 days from the date of the final hospitalization for which the hospitalization was paid shall be deemed to be a new hospitalization.

(b).

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