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(영문) 서울중앙지방법원 2016.07.08 2016나17827
보험금
Text

1. Revocation of a judgment of the first instance;

2. The plaintiff's claim is dismissed.

3. All costs of the lawsuit shall be borne by the Plaintiff.

Reasons

1. Facts of recognition;

A. On June 7, 2013, the Plaintiff entered into an insurance contract with the Defendant for the main insured, the insurance premium of KRW 197,00, and the monthly payment period (hereinafter “instant insurance contract”). The main contents of the terms and conditions of the instant insurance contract include the agreement on indemnity medical expenses (hereinafter “instant special terms and conditions”).

Article 3 (Details of Compensation) of theO in cases of injury to a patient shall be compensated for up to the amount of insurance covered (50 million won) for each of the following amounts, if the insured (subject to insurance) is hospitalized in a hospital due to injury during the insurance period of this special agreement:

Article 4(1) of theO (excluding the difference between the actual user's disease room and the standard disease room) 90% of the total amount (excluding the difference between the actual user's disease room and the standard disease room) determined by the Minister of Health and Welfare under the National Health Insurance Act and the medical care Assistance Act among the medical care benefits prescribed by the National Health Insurance Act, the amount of divided compensation, 50% of the difference between the actual user's disease room and the standard disease room (if the amount equivalent to 10% exceeds 2 million won a year from the contract date or the contract date of each year, the excess amount shall be compensated), after deducting 50% of the difference between the actual user's disease room and the standard disease room (However, the average daily amount shall not exceed 100,000 won, and the average daily amount shall be calculated by dividing the difference between the average disease's disease room during the period of hospitalization by the total days of hospitalization).

7. Expenses incurred in the purchase and replacement of medical materials, such as artificial organs, artificial organs, etc., such as artificial organs, artificial organs, etc., and in performing functions instead thereof;

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