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(영문) 대법원 2017.09.26 2015다7626
보험금
Text

The appeal is dismissed.

The costs of appeal are assessed against the defendant.

Reasons

The grounds of appeal are examined (to the extent of supplement in case of supplemental appellate briefs not timely filed).

1. Ground of appeal Nos. 1 and 3

A. The lower court determined that, on the following grounds, the grounds for the payment of insurance proceeds pursuant to the terms and conditions of special clause for the second hospitalization day among the instant insurance contract between the original Defendant cannot be acknowledged.

① Under the above terms and conditions, in cases of hospitalization for at least four days for the purpose of treating cerebrovascular diseases and cerebrovascular diseases, the daily allowances for hospitalization shall be paid as insurance proceeds.

② Although the Defendant received hospitalization from December 5, 2005 to August 3, 2009, it is difficult to view that it is necessary to treat brain spacifies.

The judgment below

In light of the evidence duly admitted, the lower court did not err in its judgment by exceeding the bounds of the principle of free evaluation of evidence against logical and empirical rules, contrary to what is alleged in the grounds of appeal.

B. In cases where the insured was hospitalized to treat a disease stipulated in the terms and conditions of the insurance, such as an agreement between the parties and a violation of the good faith, and accordingly, the insurer has paid the insurance money as the insurance money, but it is found that the requirements for the payment of the insurance money have not been satisfied later, the insured shall return the insurance

At this time, it is not different because the insurer did not disclose that it failed to meet the requirements for payment of insurance premiums at the stage of examining the payment of insurance premiums based on the data of medical records, opinions, etc. submitted by the insured.

The court below held that the insurance money that the defendant received for hospitalized treatment that does not fall under the grounds for the payment of insurance money constitutes unjust enrichment.

Furthermore, the circumstance that the Plaintiff paid the instant insurance money upon the Defendant’s request is that the Defendant.

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