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(영문) 서울중앙지방법원 2019.11.13 2019나44394
보험금
Text

1. The part of the judgment of the court of first instance against the plaintiff, which orders payment below, shall be revoked.

The defendant.

Reasons

1. Basic facts

A. On September 27, 2011, C entered into a medical expense mutual aid agreement with the Defendant (deduction number D, beneficiary E, beneficiary Plaintiff, hereinafter “instant mutual aid agreement”). Under Articles 18 and 37(1) of the said mutual aid agreement (hereinafter “instant terms and conditions”), the Defendant shall pay the Plaintiff an amount calculated by subtracting KRW 10,000 from the sum of the “personal charges” and “non-paid benefits” out of the medical care benefits prescribed in the National Health Insurance Act where E is treated as a member of the National Assembly under the Medical Service Act due to disease (within 180 times from the date of entering into the instant mutual aid agreement every year) within three business days from the filing date of the claim as the insurance money.

B. From January 2017 to April 13, 2018, E received from the physician G in charge with a scambling, scambling, scambling, scambling, and scambling to the instant member from January 9, 2017 to April 13, 2018, as the instant member was diagnosed with a scambling, scambling, scambling, and physical therapy.

Under the instant mutual aid agreement, the Plaintiff claimed KRW 12,565,480 for the above medical expenses, and the Defendant paid the above medical expenses to the Plaintiff.

C. Since August 7, 2018, the Plaintiff filed a claim with the Defendant for medical care expenses of KRW 1,350,300,00, which was received by E eight times from June 20, 2018 to October 18, 2018, but the Defendant did not pay the above medical care expenses by deeming that the aforementioned repetitive medical care expenses do not constitute cases where the treatment was performed due to disease, on the grounds that there was no evidence that E had already been recovered even after the medical care was performed in a long term.

On the other hand, water treatment is to increase the scope of water supply operation by directly adding the knife and low strength to the pains caused by felgical diseases by using hand, and reduce the pains by cutting off the vertebrate in abnormal arrangements.

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