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(영문) 의정부지방법원 2015.06.26 2014가단111467
보험금
Text

1. The insurance contract is based on the attached Form with respect to the claim of the Defendant-Counterclaim Plaintiff for the insurance proceeds for brain-cerebrovascular disease diagnosis expenses.

Reasons

A principal lawsuit and a counterclaim shall be deemed simultaneously.

1. Basic facts

A. B around March 6, 2006, a policyholder B, the insured, the Defendant, and the insurance period from March 6, 2006 to March 6, 2039 (hereinafter “instant insurance contract”) entered into an insurance contract with the Plaintiff, which is an insurance company.

B. According to Article 3 of the Clause of Special Expenses for the Examination of Brain Diseases in the instant insurance contract, where the Defendant, the insured, became final and conclusive due to the first diagnosis of cerebrovascular diseases, the Plaintiff is obliged to pay insurance proceeds of KRW 40 million under the name of the expenses for the examination of cerebrscular diseases. According to Article 4 of the Clause of Special Expenses for the Examination of Hospitalization Diseases, where the Defendant, the insured, is diagnosed and confirmed as a cerebrscular disease during the insurance period and was hospitalized for at least four consecutive days for a direct purpose, the Plaintiff is obliged to pay insurance proceeds of KRW 10,000 per day of hospitalization exceeding three days in the name of the daily

(hereinafter referred to as “each of the instant insurance clauses”) C.

On February 3, 2014, the Defendant issued a medical certificate stating that the symptoms of the Defendant constitute "large cerebrovascular (Korean Standard Disease Classification)" from D, a doctor D belonging to the above hospital, after undergoing a brain self-contest (MRI), brain self-contest-contestation (MRA), light-contestation test (MRA), light-contestation test (MRA), light-contestation test, chrecation test, and anti-contestation test, etc., due to symptoms, such as the implied two copies of the latter two parts of the hospital and the flusium, etc., and requested the Plaintiff to pay expenses for the diagnosis of brain-conception disease according to the insurance contract of this case.

Article 2 of the Insurance Terms and Conditions of the instant case provides that “the definition and confirmation of diagnosis of cerebrovascular diseases” shall be as follows:

(1) The term "cerebrovascular disease" means a disease (see attached Table 5) classified as a cerebral cerebrovascular disease in the fourth Korean Standard Industrial Classification.

(2) The diagnosis and confirmation of brain-related diseases shall be prescribed in Article 3 of the Medical Service Act.

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