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The plaintiff's appeal is dismissed.
Expenses for appeal shall be borne by the plaintiff.
Purport of claim and appeal
[Claim]
Reasons
1. Basic facts
A. The Plaintiff is a company running the insurance business, etc., and the Defendant is the insured and the beneficiary who entered into an insurance contract with the Plaintiff (securities number D) around July 31, 1997 (hereinafter “instant insurance contract”).
B. After receiving hospitalized treatment due to illness, etc., the Defendant received KRW 22,106,795, totaling 41 times from August 4, 2004 to June 21, 2012, as shown in the attached Table, on the basis of the instant insurance contract.
C. The Defendant was investigated into the charge of fraud regarding the receipt of insurance proceeds, including the above insurance proceeds of KRW 22,106,795.
However, on August 28, 2015, the horizontal Housing Site Office of the Suwon District Prosecutors' Office rendered a disposition of suspending indictment (2015 type 7502) to the Defendant, taking into account the following: “The fact of suspicion is recognized, but this case is a case where the suspect received the insurance money by being hospitalized for a long time more than the actual number of days of hospitalization, etc., and the suspect actually has a disease in urology, and some days of treatment are deemed appropriate, which is the first offender, and is not re-offending in the future.”
(hereinafter referred to as “the instant disposition of suspending indictment” . [Grounds for recognition] of absence of dispute, entry of evidence No. 1, and purport of the entire pleadings.
2. Determination as to the cause of action
A. The defendant alleged by the plaintiff is liable to pay the plaintiff the above 22,106,795 won as compensation for damages caused by the tort and delay damages for the above 22,106,795 won, since the defendant received the medical treatment repeatedly for a long time, even though the medical treatment is appropriate for the purpose of receiving the insurance proceeds, and then claims the insurance proceeds from the plaintiff.
In addition, since the defendant received insurance money from the plaintiff without any legal ground even though there is no ground to pay the insurance money, the defendant is obligated to pay the plaintiff 22,106,795 won as unjust enrichment and delay damages.