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(영문) 광주지방법원 2017.06.09 2015가단502683
부당이득금
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 December 30, 2002, the Defendant entered into a non-distribution, dividends, health insurance contract (hereinafter “instant insurance”) between the Defendant and the Plaintiff, the insurance period from December 30, 2002 to December 30, 2042, and the damages covered by the said insurance contract are as follows.

In general injury, death, injury, death, 50,000,000 won of hospitalization expenses of KRW 70,000 of KRW 50,000 of the amount of hospitalization expenses of KRW 70,000 of the amount of hospitalization expenses of KRW 50,000 of the amount of hospitalization expenses of KRW 2,00,000 of the amount of injury medical expenses of KRW 70: 10,000 of the amount of KRW 70 of the amount of hospitalization medical expenses (A): 5,00,000 of the amount of KRW 70 of the age

B. After the Defendant subscribed to the instant insurance, from February 2, 2004 to June 15, 2013, the Defendant was hospitalized for 407 days at a hospital in the 19 place including C Hospital, and at a total of 25 times at a hospital in the 19 place, and was hospitalized for a disease, such as plebing, eating, and tent, and received total KRW 69,025,506 from the Plaintiff.

[Ground of recognition] Facts without dispute, Gap evidence Nos. 2 and 6, the purport of the whole pleadings

2. Determination as to the cause of action

A. According to the Plaintiff’s assertion of the special terms and conditions of the instant insurance contract, the meaning of “inpatient” where the insurer is liable for the payment of the insurance proceeds of the Plaintiff, is defined as “in case where medical treatment is deemed necessary by a doctor and treatment is difficult at home, and it is difficult to treat at home, etc., and is committed under the control of a doctor by entering a hospital, clinic, or medical institution recognized as equivalent thereto.”

Therefore, hospital treatment conducted in a situation where it is possible to treat only after medication or outpatient treatment does not constitute a cause of insurance payment under the terms and conditions.

The defendant from February 11, 2008 to the same year

3. Among 38 days of hospitalization by 19. 35 days, 35 days of hospitalization received hospitalized treatment despite the absence of hospitalization. Thus, 1,765,961 won per day of hospitalization for which interest in arrears are included divided by 38 days and calculated by 35 days after dividing 1,917,330 won per day of hospitalization for which interest in arrears is included, and 31 days or more for which interest in arrears is included.

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