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1. The part against the defendant among the judgment of the first instance is revoked and the plaintiff's claim corresponding to the revoked part is dismissed.
Reasons
1. Basic facts
A. On June 11, 2016, the Plaintiff subscribed to the Non-Distribution Protocol Co., Ltd. 1605 (hereinafter “instant insurance”) that the Defendant sold as the insured.
B. The insurance of this case includes 16,000 won, 21, 16, 21, and 80% of the medical expenses incurred by the insured in the course of being hospitalized in, commuting to, and receiving treatment due to a disease, where the insured was diagnosed and confirmed by a specific disease, such as a white site, and undergone an operation prescribed in the terms and conditions for the purpose of direct treatment.
C. On November 23, 2016, the Plaintiff was diagnosed in detail as an unidentified, and received medical treatment, such as surgery, opportune TTRAFLEX malilization of artificial insemination plants, etc. on the left and right and right and right and right and right and right and right and right and right and right and right and right and right and right and right and right and right and right and right and right and right and right and right and right and right and right and right and right and right and right and right and right and right.
Although the Plaintiff claimed insurance money from medical treatment in a white paper, on February 27, 2017, the Defendant refused payment on the ground that medical expenses incurred by the Plaintiff for multi-point artificial insemination is eligible for exemption under the terms and conditions, and paid only the remainder of medical expenses and expenses incurred in surgery for specific diseases.
E. The parts directly related to the instant case among the terms and conditions of exemption (hereinafter “the relevant parts”) are as follows.
Section 3. Non-compensation for the Company
4. (Matters not compensated) Matters not compensated by the Company are as follows for each category of security:
(3) The new disease hospital shall not guarantee the following hospital medical expenses:
(8) Medical expenses incurred for medical treatment for the purpose of improvement of appearance, which is not for improvement of physical essential functions, for non-payment of the following national health insurance:
(c)the operation method or material for medical care benefits covered by the National Health Insurance for the replacement of megales, contact lensess, etc. are not used.