2017Na84596 Insurance proceeds

A

M&D Co., Ltd.

Seoul Central District Court Decision 2015Da5294904 Decided November 17, 2017

March 13, 2018

April 5, 2018

1. The defendant's appeal is dismissed.

2. The costs of appeal shall be borne by the Defendant.

1. Purport of claim

The defendant shall pay to the plaintiff 90 million won with 15% interest per annum from the day after the delivery of a copy of the complaint of this case to the day of complete payment.

2. Purport of appeal

The judgment of the first instance is revoked. The plaintiff's claim is dismissed.

1. Basic facts

The court's explanation on this part is based on the reasoning of the judgment of the court of first instance, because it is the same as the part on the basis of the judgment of the court of first instance.

2. The parties' assertion and judgment

A. The parties' assertion

1) Plaintiff

Since the species of this case constitute cancer or high-amount therapy cancer stipulated in the contract of this case (hereinafter only referred to as cancer), the defendant should pay the Plaintiff the cancer diagnosis benefit and the third high-amount therapy amount.

2) Defendant

In the case of the species of this case, it cannot be interpreted as a time when pathological diagnosis is not possible solely on the ground that there is a high risk of tissue testing and pathological diagnosis, or that there is no rare species, or that there is no rare disease classification code and disease name as a result of tissue testing. Furthermore, even though the form of behavior of the species of this case is '/1', the C Code cannot be granted in consideration of WH level, etc. according to the organizational testing on March 10, 2015. Accordingly, the species of this case can be deemed to have been granted a d43.2.2, the Korean Standard Disease Classification, as it does not constitute cancer stipulated in the contract of this case.

B. Determination

In light of the aforementioned evidence and the results of the fact-finding conducted by the court of first instance, each fact-finding conducted against E University N&L, professors D, and the Korean Medical Association, the following facts or circumstances acknowledged in full view of the overall purport of the arguments on the medical record appraisal conducted by the court of first instance, it is reasonable to deem that the instant species constitute cancer (cerebral dysia), and serious cancer stipulated in the instant contract.

① A clinical medical specialist who diagnosed the Plaintiff, based on the result of the pathology diagnosis by a medical specialist, confirmed and diagnosed the instant species of the instant case as the Korean Standard Disease Disease Classification Number C71.9 (Minsung C71.9) and D43.2 (centralal psychotropic cells). It is reasonable to view the instant insurance contract as being in the same way that the final diagnosis of “serious cancer” was issued by a person who holds a postmortem disease or clinical pathology professional license as stipulated in the terms and conditions of the instant insurance contract (see Supreme Court Decision 2011Da13968, 13975, May 24, 2012).

(2) The central category of a brain cell falls under the category 2 of WHO and is classified into GHO category 1. The relevant species fall under the category 2 of BHO category in comparison with the central category of organ cells in the pathology 15. The relevant species of the instant case fall under the category 2 of BHO category in the case of 2% or more of the fluoral fluoral fluoral fluoral fluoral fluoral fluoral fluoral fluoral fluoral fluoral fluoral fluoral fluoral fluoral f

③ Since the species of this case are the species of rare celebrosis, there is no classification code and name of disease that is a Korean Standard Disease Death up to now. The Plaintiff’s doctor also stated that since there is no disease code for the species of this case in the Korean Standard Disease Classification Number, the Da43.2 (U.S. e., an unknown brain behavior pattern or an unknown celebrosis) was applied mutatis mutandis as brain cancer code.

④ As a result of a pathology examination, the Plaintiff was classified into the species of this case, 5% of the cell proliferation capacity, 24 cells divided into cells and 24 non-specific species. The Korean Standard Disease Classification follows the International Disease Classification System of the World Health Organization (WHO) under the United Nations, and the Species International Disease Classification (ICD-O) for the species of this case. According to the result of the medical record evaluation entrustment, the Korea Standard Disease Classification cannot assign D43, 2 (U.S. al. al. e.s. al. e.s. al. e., e.s. s. e.s. s. am.s. s. s. s. e.s. s. s. am.s.) for the species of this case. Although the species caused by brain fall under the species category code 9506/1, 9506/1 of the species of this case.

⑤ As seen above, insofar as it is deemed that a clinical doctor issued a final diagnosis of the instant species, it is difficult to view the instant species merely based on the fact that there is no disease code for the instant species or that the behavior pattern is “/1”.

C. Sub-committee

According to the terms and conditions of the contract of this case, the Defendant is obligated to pay the Plaintiff damages for delay calculated at the rate of 15% per annum under the Act on Special Cases Concerning the Promotion, etc. of Legal Proceedings, which is the insurance proceeds on the ground of the final diagnosis of 'Cam' as stipulated in the terms and conditions of the contract of this case, and the amount of KRW 90 million (40 million + the amount of high-amount treatment expenses of KRW 3,000) and the amount of KRW 50 million, which the Plaintiff seeks, following the delivery of a copy of the complaint of this case to the date of full payment.

3. Conclusion

Therefore, the judgment of the first instance court is legitimate, and the defendant's appeal is dismissed. It is so decided as per Disposition.

Judges Park Byung-hee et al.

Judges Cho Sung-sung

Judges Jeong Jin-hun

1) On September 1, 2011, the International Cancer Research Institute under the WHO (IARC) revised the Sejong International Disease Classification (ICD-0, No. 3) according to the aforementioned new WHO classification criteria (see htp://codes.iarc. f/ contents).