2013 Gohap 1624 Insurance proceeds (main office)

2014Gahap833 (Counterclaim Insurance Proceeds)

000 Marine Insurance Corporation

Law Firm Yong-Nam, Attorneys Cho Young-tae, and the final leather

○ ○

Attorney Kim Jong-chul, Counsel for the defendant-appellant

August 22, 2014

October 17, 2014

1. The Plaintiff (Counterclaim Defendant) shall pay 42,400,000 won to the Defendant (Counterclaim Plaintiff) and 5% per annum from June 5, 2013 to October 17, 2014, and 20% per annum from the next day to the day of full payment.

2. The Plaintiff (Counterclaim Defendant)’s principal claim and the remainder of the Defendant (Counterclaim Plaintiff) claim are dismissed, respectively.

3. The costs of the lawsuit are assessed against the Plaintiff (Counterclaim Defendant) and the Defendant (Counterclaim Plaintiff), respectively, by adding the principal lawsuit and the counterclaim.

4. Paragraph 1 can be provisionally executed.

The main claim is to confirm that there is no general cancer diagnosis expenses and general cancer surgery expenses liability of the plaintiff (Counterclaim defendant, hereinafter referred to as "the plaintiff") against the defendant (Counterclaim plaintiff, hereinafter referred to as "the defendant") according to the insurance contract listed in the attached list (2) with respect to the insurance accident listed in the attached list (1).

Counterclaim: The plaintiff shall pay to the defendant 42,40,000 won with an annual interest of 5% from May 15, 2013 to the date of this judgment, and 20% interest per annum from the next day to the date of full payment.

1. Basic facts

The following facts are not disputed between the parties, or may be acknowledged in full view of the entries in Gap evidence 1, 2, and Eul evidence 1, 2, and 3 and the purport of all pleadings:

A. A. Around May 20, 201, the Plaintiff running non-life insurance business: (a) the Defendant is the insured or beneficiary of the Defendant; (b) the insurance period from May 20, 201 to May 20, 2064; and (c) the insurance period is from May 20, 2011 to May 20, 2064; (d) the Defendant concluded the insurance contract from the time of the first diagnosis and confirmation of the first diagnosis of the boundary species (general cancer diagnosis costs), KRW 10 million at the time of the first diagnosis and confirmation of the boundary species ( border species diagnosis costs), KRW 600,00 won at the time of the operation for the direct purpose of the treatment, and KRW 2.4 million at the time of the operation for the first time of the operation for the direct purpose of the treatment (hereinafter referred to as “the insurance premium in this case”).

B. Of the terms and conditions of the instant insurance contract, the content of cancer and boundary species are as follows.

75. Article 3 of the Special Terms and Conditions for Cancer Examination Expenses (Definition and Confirmation of Typtoptoptoptoptoptoptoptoptoptoptoptop

1. The term “Cance” in this Special Terms and Conditions means the following diseases in the basic classification of the Korean Standard Industrial Disease Classification 6th:

1. "Cancer" means a disease (see attached Table 22) classified as a malicious life ( cancer) (hereinafter referred to as the "Canceral Life (Canceram) table;

5. The term “salvegetable species” means diseases (see Table 21) classified as either an unknown behavior pattern or an unknown new life pattern (see Table 21).

② “암관련질병의 진단확정은 해부병리 또는 임상병리의 전문의사 자격증을 가진 자에 의하여 내려져야 하며, 이 진단은 조직(fixed tissue)검사, 미세바늘흡인검사(fine needle aspiration) 또는 혈액(hemic system) 검사에 대한 현미경소견을 기초로 하여야 합니다. 그러나 상기의 병리학적 진단이 가능하지 않을 때에는 피보험자가 “암”으로 진단 또는 치료를 받고 있음을 증명할 만한 문서화된 기록 또는 증거가 있어야 합니다.

[Attachment 21] The following diseases are the Korean Standard Disease Disease Classification (Enforcement Date of Notice No. 2010-246, January 1, 2011), which is classified as boundaryal species prescribed in the terms and conditions of the 6th revised Korean Standard Disease Classification Table:

A person shall be appointed.

[Attachment 22]

The following diseases are included in the Korean Standard Disease Death Classification (Statistics Notice No. 2010-246, January 1, 2011), which is classified as cancer prescribed in the terms and conditions of the classification table:

A person shall be appointed.

C. On May 15, 2013, after conducting an organizational inspection with respect to the Defendant, medical specialists diagnosed that it is about 0.7§¯ in work place with a size, which is about 0.7 cm, and on September 13, 2013, after performing workplace-specific teaching, medical doctors in racing and doctors issued to the Defendant a final diagnosis statement stating the diagnosis date with respect to the Defendant on June 4, 2013, and on September 13, 2013.

D. The Defendant claimed insurance money of KRW 50 million, KRW 60,000,000,000 for general cancer diagnosis expenses, KRW 10,000,000 for cancer surgery expenses I and KRW 2.4 million for cancer surgery expenses. Accordingly, the Plaintiff paid insurance money to the Defendant only KRW 10,000,000,000 for diagnosis expenses following the boundary-based type diagnosis, and KRW 60,060,000 for cancer surgery due to boundary-based type surgery.

2. Summary of the parties' arguments

A. The Plaintiff asserts that the Defendant’s satisfy that the satisfy that the satisfy that was diagnosed by the Defendant was “infinite or infinite,” which is “infinite or infinite,” as stipulated in the instant insurance contract, does not fall under the category of boundary, and does not fall

B. On this issue, the defendant asserts that he is obliged to pay KRW 42,40,000,000,000, which remains after subtracting the fixed payment insurance amount from the total insurance amount of general cancer diagnosis expenses and cancer surgery expenses stipulated in the insurance contract of this case, since he paid only the insurance amount corresponding to the boundary species of the defendant, even though the life insurance amount which he was diagnosed falls under the category of cancer under the insurance contract of this case.

3. Determination

The principal claim and counterclaim claims shall be judged together.

In full view of the statements in Gap evidence 3 and 5, appraiser Kim Young-ok's appraisal results, and the overall purport of the arguments, "I" published in 2008 stated that "A's proposal on registration of cancer of fire-fighting machinery for pathology / [I] is limited to 2/3 meters in the case of Kakao-si's pattern of work site / the case of not more than 1stm in the case of Kao-od's pattern of work site / The case of small species of not more than 1stm in the case of 1stm in the case of Kao-od's Kaod's c' and the case of small species of which are less than 1stm in the case of mad's c's anti-od' and which are less than the case of 1st in the case of mad's c's anti-od'orthy, it is recognized that the defendant's behavior code [1st in the case of 0.7.3m.

However, as a result of the appraisal by appraiser Kim Young-ok, the following circumstances, which are considered to be comprehensively considered as evidence Nos. 4 and 3 and the overall purport of the arguments, namely, the International Disease Classification (ICD) of the World Health Organization (WHO) in 2010 did not classify all workplace cancer into malicious and boundary pattern, and all three codes were granted. Even according to the Korean Standard Disease Classification Guidelines (ver. 2014), as amended pursuant to the above International Disease Classification, the Defendant’s pattern constitutes the disease classification number and behavior code 8240/3, and the above behavior code/3 is reasonable in view of the fact that there is considerable room to view that there is a considerable progress of the Defendant’s occupational cancer, such as the Defendant’s case, as well as the case of the Defendant, as a potential for less than 1cm, it is reasonable to consider that the Defendant’s medical practice did not have a high level of difficulty in the diagnosis of the Defendant’s tissues disease as a result of the examination of the Defendant’s organization type of disease.

4. Conclusion

Therefore, the Plaintiff is obligated to pay damages for delay at the rate of 5% per annum under the Civil Act and 20% per annum under the Act on Special Cases concerning the Promotion, etc. of Legal Proceedings from June 15, 2013 to June 5, 2014, which is the day following the date on which the Defendant received a final diagnosis on the unpaid insurance money to the Defendant, as well as from June 5, 2013, where it is deemed reasonable for the Plaintiff to resist the existence or scope of the obligation to perform the instant case from October 17, 2014 (the Defendant claimed payment of damages for delay from May 15, 2013, but there is no evidence to acknowledge that damages for delay will accrue from that time).

Therefore, the defendant's counterclaim claim is accepted within the scope of the above recognition, and the remaining claims are dismissed as it is without merit. The plaintiff's main claim seeking confirmation of the absence of the above payment obligation against the defendant is dismissed as it is without merit. It is so decided as per Disposition.

The presiding judge, the whole judge

Judges Cho Young-young

Judges Park Jin-jin