2014 Ghana 1374 (Confirmation of Non-existence of Obligations)

2014Ba1142 (Counterclaim) Insurance proceeds

K non-life insurance Co., Ltd. (former trade name: ELI non-life insurance Co., Ltd.)

A person shall be appointed.

August 31, 2016

September 28, 2016

1. In relation to the accident described in paragraph 2 of the attached list, it is confirmed that the insurance payment obligation of the Plaintiff (Counterclaim Defendant) against the Defendant (Counterclaim Plaintiff) under the insurance contract stated in Paragraph 1 of the attached list does not exist in excess of the amount described in Paragraph 2 below.

2. The Plaintiff (Counterclaim Defendant) pays to the Defendant (Counterclaim Plaintiff) 25,230,00 won with 5% interest per annum from October 5, 2013 to September 28, 2016, and 15% interest per annum from the next day to the day of full payment.

3. The remaining main claim of the Plaintiff (Counterclaim Defendant) and the remaining counterclaim claims of the Defendant (Counterclaim Plaintiff) are dismissed, respectively.

4. The costs of the lawsuit are assessed against Plaintiff (Counterclaim Defendant) and Defendant (Counterclaim Plaintiff) respectively for 85% of the costs of the lawsuit in combination with the principal lawsuit and counterclaim.

5. Paragraph 2 can be provisionally executed.

1. Main elements;

In relation to the accident described in paragraph (2) of the attached Table 2, the avoid of the plaintiff (the counter defendant; hereinafter referred to as the "Plaintiff")

J. (Counterclaim Plaintiff; hereinafter “Defendant”)’s obligation to pay insurance proceeds exceeds KRW 9,473,254.

to confirm that the existence does not exist.

2. Counterclaim;

The Plaintiff’s KRW 29,460,000 and its amount from March 23, 2013 to June 14, 2016 of this case.

Until the date of service of a copy of the request for modification of the purpose and cause of the counterclaim, 5% per annum and 0% from the following day.

Until the date of full payment, 15% interest per annum shall be paid.

A principal lawsuit and a counterclaim shall be deemed simultaneously.

1. Facts recognized;

A. On January 2, 2009, the Defendant entered into an insurance contract (hereinafter “instant insurance contract”) entered into between the Plaintiff and the Plaintiff on the attached list No. 1 (hereinafter “instant insurance contract”).

2) At the time of the application for the instant insurance contract, the Defendant notified the Plaintiff of his occupation as “sale of agricultural products.” The Plaintiff determined that the Defendant’s occupation constitutes “management of agricultural products, food, and tobacco,” which correspond to class 1 of hazardous water supply, and concluded the instant insurance contract by calculating the insurance premium for the aforementioned dangerous water supply.

B. The part relating to this case in the insurance clauses of this case (hereinafter referred to as "the insurance clauses of this case") shall be as follows. (1) The plaintiff suffered bodily injury (excluding physical assistance equipment, such as number, capacity, franchis, etc.) during the insurance period or due to sudden and incidental accidents. (2) The plaintiff did not request the plaintiff to pay for the change of the insurance clauses of this case within 10 days after its entry into an insurance contract of this case. (3) The defendant shall not request the change of the insurance clauses of this case to the left-hand side of this case. (2) The defendant shall not request the plaintiff to pay for the change of the insurance clauses of this case. (3) The defendant shall not be required to pay for the change of the insurance clauses of this case. (3) The defendant shall not be required to pay for the change of the insurance clauses of this case. (2) The defendant shall not be required to pay for the change of the insurance clauses of this case. (3) The defendant shall not be required to pay for the change of the insurance clauses of this case.

D. Termination of the instant insurance contract

On November 6, 2013, the Plaintiff sent the instant insurance contract to the Defendant by content-certified mail on the ground that the Defendant did not immediately notify the Plaintiff of the change of occupation, and accordingly, sent the instant notice of termination to the Defendant by content-certified mail. Around that time, the instant notice of termination was served to the Defendant.

E. Degree of the defendant's residual disability

In the event of the instant accident, the Defendant suffered injury to the left-hand mid-to-hand opening frame, the depth of the left-hand side part, and the left-hand pelgal damage, etc., but the result of the physical examination conducted by the Defendant by the Gangwon University Hospital F, the physical examination of the Defendant, was diagnosed as a result of the instant accident, and the Defendant suffered permanent disability, the exercise scope of which is limited due to the instant accident, and the instant clause 1 is determined in accordance with the disability classification table of the attached Table 1, the Defendant evaluated as constituting “the situation where the Defendant is capable of independent walking, but it is impossible to get out of the stairs without a rail,” and falls under “the payment rate of 100 meters (10%) at ordinary.”

(f) the occupational classification table;

In the instant insurance contract, the calculation of the injured water supply is conducted according to the Plaintiff’s internal criteria, which is formulated pursuant to the employment classification table (No. 14 evidence) prepared by the Insurance Development Institute (No. 14 evidence). Of the employment classification table prepared by the Insurance Development Institute, the part relating to this case is as follows.

The occupational name code-grade injury and water supply business, sales-related office manager (sales, non-participation in delivery), A36 AB Agricultural and Fishery Site Manager (Non-Participation in Work) A369, B537 forest and Youngwon A924 simple employees, i.e., forestry, e., e., e., 1924, and no dispute over the grounds for recognition, i.g., Gap evidence 1-2, 2, 3, and 2-3, Gap evidence 2-1 through 8, Gap evidence 7-1, 7-2, 5, and 8-1, 3, Gap evidence 9-1-2, Gap evidence 11-1 through 13, Gap evidence 13, 14-4, and Eul evidence 1-4, the result of the court's examination on the body of the hospital as a whole, the purport of this court's examination on the body of the hospital at this level, and the purport of this court's oral argument as a whole.

2. The parties' assertion

A. Due to the instant insured event, the Defendant: (a) suffered from a disability falling under the event that the new boundary and mental behavioral disorder on the attached Table 13 of the Disability Classification Table 13 of the instant Terms and Conditions left the limitation on the basic daily living action; and (b) constitutes the cause for the payment of insurance proceeds as stipulated in the instant insurance contract. Therefore, the Plaintiff is obligated to pay insurance proceeds and delay damages to the Defendant in accordance with the terms and conditions of the instant insurance contract. Therefore, the Defendant submitted an application for resumption of argument and an application for modification of purport of purport of claim to seek additional admission since the Defendant had omitted the costs of hospitalization during the period of hospitalization after the closing of argument in the instant case; (b) however, the Defendant filed the instant counterclaim seeking the payment of insurance proceeds under the instant insurance contract on September 10, 27, 2014; and (c) did not delay any assertion and proof despite the lapse of seven years from the date of pleading on the date of the instant declaration; and (d) did not constitute an attack under Article 16(1)4) of the Civil Procedure Act.

B. The plaintiff;

Although the occupation that the Defendant was employed on March 1, 2013 and notified to the Plaintiff at the time of the conclusion of the instant insurance contract, the Defendant violated Article 25(1) of the instant terms and conditions by failing to promptly notify the Plaintiff of the change, and the Defendant violated Article 25(1) of the instant terms and conditions. Although the occupation that the Defendant previously worked was 1st degree, the Defendant’s injury water supply was 3rd level as “a simple worker related to forestry,” the occupation that the Defendant newly worked is 3rd level, and this constitutes a case where there is a significant increase in risk due to a change in occupation. Accordingly, in relation to the instant insurance accident, it is doubtful that the Plaintiff is obliged to pay only the insurance premium reduced in proportion to the rate of insurance premium before the change in the occupation or duty of the insurance premium rate after the change in accordance with Article 26(5) of the instant terms and conditions. (The Plaintiff submitted the instant application for the change in the purpose of the claim to the Plaintiff before 19, 2015.

the defendant's physical examination was made, but the defendant's physical examination was submitted after 2015

11. The application for change of the purport of the claim and the cause of the claim on 19.10 did not contain the same assertion, and thereafter, did not clearly dispute the defendant's subsequent disability. Thus, this part of the claim shall not be deemed to have been withdrawn and judged separately).

3. Determination

(a) Occurrence of liability to pay insurance proceeds;

According to the above facts, the insurance accident of this case constitutes a case where the bodily injury of the insured was inflicted on the insured due to a sudden and incidental accident as stipulated in the terms and conditions of this case. Thus, the insured who is the insurer is liable to pay the insurance money under the insurance contract of this case to the defendant, unless there are special circumstances.

B. Judgment on the Plaintiff’s assertion

We examine the Plaintiff’s assertion of breach of duty of disclosure. According to the instant standardized contract incorporated into the content of the instant insurance contract, the insured shall, without delay, notify the Plaintiff of the change in the occupation or duty that he/she notified at the time of the insurance contract. In cases where the risks increase due to the insured’s occupational change or duty change, the Plaintiff may request or terminate the insurance premium increase within one month from the date of receipt of notice of change from the insured, and where the insured did not perform the above duty of disclosure relating to the increase in risks, the Plaintiff may cancel the insurance contract. Meanwhile, in cases where the insurance contract is terminated due to such reason, the Plaintiff is liable to pay only the reduced insurance money in proportion to the premium rate applied after the change in the occupation or duty of the insurance premium rate before the insurance contract was terminated.

According to the terms of the instant insurance contract, the Plaintiff’s assertion is as follows: (a) the Defendant served on March 1, 2013, immediately before the occurrence of the instant insurance accident, as a field management position; and (b) changes in occupation or duties. However, there is insufficient evidence to acknowledge that the Defendant’s occupation or duties were related to an increase in risk, as seen above, solely with the aforementioned facts acknowledged and the evidence mentioned above, and the evidence stated in subparagraphs 8-4 and 5, and there is no other evidence to prove otherwise.

Rather, comprehensively taking into account the following facts and circumstances acknowledged as a whole of the arguments, namely, ① the Defendant entered his occupation as “sale of agricultural products” on the notice for subscription to the insurance contract at the time of the conclusion of the insurance contract, and according to the occupational classification table of the Korea Insurance Development Institute, sales of agricultural products falls under class 2, ② the Plaintiff consented to the subscription of the insurance contract of this case as “agricultural products, food and beverage management, and tobacco management,” which correspond to the Defendant’s occupation for any reason,” ③ the Defendant entered into an employment contract with B, and the type of occupation agreed upon at the time of the conclusion of the employment contract is on-site management, and it is difficult to interpret it as a simple worker related to forestry as alleged by the Plaintiff [it is difficult to view that the Plaintiff is a simple worker related to forestry falling under class 3 of the Defendant’s injury to the water supply, but it is difficult to view that the aforementioned occupational classification table falls under the Defendant’s change of the occupational classification table to the effect that the Defendant’s occupational manager falls under the risk of injury to the agricultural, forestry and forestry, etc.

Ultimately, the Plaintiff’s notice of termination of this case, premised on the fact that the Defendant’s occupation or job change is related to an obvious increase in risk, has no effect, and the Plaintiff’s assertion on the reduction of insurance proceeds based on the premise that the notice of termination of this case is valid is without merit.

C. The scope of the Plaintiff’s obligation to pay insurance money

As seen earlier, the Defendant was hospitalized for 141 days due to the instant insurance accident and suffered permanent harm equivalent to 10% of the disability payment rate. Accordingly, when calculating the insurance amount to be paid by the Plaintiff according to the instant insurance contract on the basis of this, it is as listed below.

D. Sub-committee

Therefore, the plaintiff is obligated to pay the defendant 25,230,00 won with insurance money under the insurance contract of this case = general injury (basic contract) = 20,00,000 won + 4,230,000,000 won per annum, 1,000 won per annum, and 1,00,000 won per annum, and 1,00,000 won per annum, and 1,00,000 won per annum, and 1,00,000 won per annum from October 5, 2013 to September 28, 2016, which is the date on which the defendant's claim for the payment of insurance money was made, to dispute the existence and scope of the above payment obligation of the plaintiff from October 5, 2013 to September 28, 2016, which is the date on which the judgment of this case is rendered, and as long as there is no interest in the plaintiff's claim for the payment of damages against the defendant.

4. Conclusion

Thus, the plaintiff's main claim of this case and the defendant's counterclaim of this case are accepted within the scope of each above recognition. Each of the main claim and counterclaim are dismissed as they are without merit.

Judges Hwang Sung-sung

A person shall be appointed.