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(영문) 광주지방법원순천지원 2016.08.09 2015가단78752
부당이득금
Text

1. The plaintiff's claim is dismissed.

2. The costs of lawsuit shall be borne by the Plaintiff.

Reasons

1. Facts of recognition;

A. On April 13, 2009, the Plaintiff entered into an agreement with the Defendant with the “Family Love Insurance (0904) that guarantees “general hospitalization expenses for injury (at least one day)” and “the expenses for hospitalization for disease (1-180 days)” and “the expenses for hospitalization for disease (1-180 days)” which include the contents guaranteeing “the expenses for hospitalization for disease” (20,000 won.

(Securities Number: B, insurance period: April 13, 2009 to April 13, 2005; the contractor and the insured: the defendant; hereinafter “instant insurance contract”).

After the conclusion of the instant insurance contract, the Defendant was hospitalized in Seoul National University Hospital, etc. for 1,010 days from June 2, 2009 to July 6, 2015, and received insurance proceeds of KRW 32,067,738 in total from the Plaintiff based on the instant insurance contract, under the diagnosis of acute engine infection, shoulderers, acutely fluoritis, fluenite infection, mytho high blood pressure, brain knee, knee-fengne, knee-fenger disease, telegraph-freshosis, the left-hand slotitis, and detailed fluencies, etc.

[Ground of recognition] Facts without dispute, entry of evidence A1 to 3, purport of the whole pleadings

2. The plaintiff's assertion and judgment

A. The Plaintiff’s assertion that the Defendant received hospital treatment at least once on an average of 2.1 day between them is extremely exceptional. As such, the Defendant’s hospitalized treatment should be deemed to have concluded multiple insurance contracts and artificially or excessively hospitalized for the purpose of receiving the daily allowances for hospitalization, etc.

Therefore, the amount of hospitalization allowance paid by the Plaintiff to the Defendant should be returned as unjust enrichment.

B. The determination is based on the following circumstances: (a) the Defendant appears to have been hospitalized according to the diagnosis of a doctor who directly conducted a medical examination on his/her own; and (b) there is no other evidence to suspect that such diagnosis was erroneous; (c) the hospital treatment is unreasonable

There is no evidence to deem that the defendant was artificially or excessively hospitalized, and there is no need to further examine the plaintiff's assertion based on this premise.

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