2013No1911-1 (Separation) Fraud

J

Prosecutor

Isle (prosecution) and Yellow-line (Public trial)

P Law Firm, Attorney Q Q

Incheon District Court Decision 2012Gohap366 Decided June 14, 2013

February 20, 2014:

The prosecutor's appeal is dismissed.

1. Summary of the grounds for appeal;

The Defendant, despite having actually received outpatient treatment, was hospitalized in the victim insurance company as if he were hospitalized for 2 days at least one day, and accordingly, acquired the property by deceiving the victim insurance company. Nevertheless, the lower court erred by misapprehending the facts charged, or by misapprehending the legal doctrine, thereby adversely affecting the conclusion of the judgment.

2. Determination

A. Summary of the facts charged

On February 19, 2010, the Defendant returned to Korea without hospital treatment after receiving an operation of a dominced beer from the WT, which provides specialized treatment of dominc beer on the 6th floor of Bupyeong-gu Incheon, Bupyeong-gu V history. However, on February 22, 2010, the Defendant issued a false hospitalization certificate stating the content of being hospitalized for two days, and received KRW 2,557,520 from the insurance company on February 25, 2010, by claiming insurance proceeds to the Samsung Fire Insurance Company, and by deceiving the insurance company.

B. The judgment of the court below

The court below acknowledged the following circumstances as recorded in the records: ① Whether hospitalization of a patient is necessary means to determine the method of appropriate treatment depending on the patient’s specific circumstances; ② the patient’s recovery level can be different for each patient after the surgery; and there can be an emergency due to merger symptoms, side effects, etc.; thus, it cannot be readily determined that there is no need for hospitalization without any need for hospitalization after the surgery (However, there are many patients who complained of serious pain among the patients who underwent surgery, and were hospitalized). ② Generally, the term “the Ministry of Health and Welfare publicly notified” means that the patient stays in a hospital for more than six hours and undergo treatment under the observation and management of the medical staff; (i) whether the patient was hospitalized and discharged; (ii) whether the medical record was presented; and (iii) whether the defendant was hospitalized or discharged for more than one time after the surgery; and (iv) whether the defendant did not receive treatment for more than six hours on the date of entrance or supervision, and (iii) whether the defendant was unable to obtain sufficient medical treatment or supervision by the medical staff.

C. Judgment of the court below

In light of the following circumstances, in addition to the above circumstances as stated by the court below, the decision of the court below that found the defendant not guilty of the facts charged is justified, and there is no erroneous determination of facts or misapprehension of the legal principles as argued by the prosecutor.

(1) Even according to the medical record submitted by Co-Defendant A in the trial, since there is no indication of the time when the defendant stayed in the court, it cannot be readily concluded that the time when the defendant stayed in the hospital is less than six hours.

(2) Furthermore, even if the period of the Defendant’s stay in the hospital does not exceed six hours, the Minister of Health and Welfare’s notice is the requirement for hospitalization. However, there is no evidence to deem that the victim’s insurance company absolutely takes six hours in determining whether to be hospitalized, and ② there is no evidence to prove that the insurance sales employee explained the Defendant that he/she can receive insurance money premised on “inpatient” only when he/she was hospitalized and operated for six or more hours when explaining the insurance for lost medical expenses. Therefore, it is difficult to readily conclude that the Defendant had been well aware of the contents of the above notice given by the Ministry of Health and Welfare or of the special clause for hospitalization under the insurance terms and conditions in which the Defendant was admitted. In light of the above, it cannot be ruled out that the Defendant himself/herself considered to have satisfied the “one day of hospitalization” requirement in light of the contents of the operation and treatment he/she received

(3) However, even though the Defendant did not actually have been hospitalized for two days, it is recognized that Co-Defendant A received a written confirmation of hospitalization from Co-Defendant A that he was hospitalized for two days of one-day stay, and on this basis, the Defendant received an additional amount of KRW 1 to 50,000 per admission.

However, in the meantime, there is no difference in the amount of insurance money such as operating expenses, etc., which can be paid in the case of an in-service medical expenses insurance without being hospitalized. However, in the case of a in-service medical expenses insurance, the amount of insurance money such as operating expenses, etc., which can be paid in the case of a in-service medical expenses without being hospitalized. However, even if only one day is hospitalized, there is no difference in the insurance money such as operating expenses, etc. which can be paid in the case of a in-service medical expenses without being hospitalized for 2 days, so the defendant was treated as a "in-patient" and cannot be ruled out that there is no particular interest in the daily amount of hospitalization, and the possibility that the defendant could not receive medical expenses such as surgery, etc., in fact, third, Co-Defendant K and E do not have any special difference in the number of days of hospitalization between 1 day and 2 days of hospitalization in the investigative agency, and it cannot be concluded that the defendant received a written confirmation from the defendant and made a statement that he was hospitalized for 12 days.

3. Conclusion

Therefore, the prosecutor's appeal is without merit, and it is dismissed in accordance with Article 364 (4) of the Criminal Procedure Act. It is so decided as per Disposition.

The assistant judge of the presiding judge;

Judges Senior Superintendent General

Judge Han-dong