[1] Whether the term "when a part of the body is lost or its function has been lost" as a requirement for payment of the insurance proceeds for the follow-up disability is also included in the market where "when a part of the body is lost or its function has been lost" (affirmative)

[2] With regard to the scope of payment of the insurance proceeds for the remaining disability to be paid for the Korean market damage, the rate of payment of the insurance proceeds for the remaining disability should be deemed to be the standard for permanent disability as stipulated in the remaining disability grade table according to the insurance terms and conditions, and its application to the Korean market sea is against the principle of equity on the ground that it goes against the principle of equity, and the rate of payment of the insurance proceeds for the remaining disability is adjusted in consideration of the rate of the

[1] In general, the remaining disability refers to the loss of the remaining physical function after treatment of the early acute symptoms of disease or injury, so long as there is no reasonable ground to deem that it is possible to recover after the passage of time in the future does not fall under the disability (in order to make a fair and reasonable apportionment of responsibility, it is divided into permanent disability and a single market according to whether the duration of disability remains over the entire operating period, and whether it remains over a certain period of time in order to promote fair and reasonable allocation of responsibility). Under the ordinary terms and conditions, the remaining disability is defined only as a result of the insured's completion of treatment by suffering from injury, which means the time the insured has lost a part of body or has lost its function, and it is not limited to the case of permanent disability, so long as the meaning of the standardized terms and conditions is not clear, it shall be interpreted in favor of the customer, so that it shall also be included in the insurance money to be paid by the policyholder.

[2] With regard to the scope of payment of the insurance proceeds for the remaining disability to be paid for the Korean market damage, the rate of payment of the insurance proceeds for the remaining disability is deemed to be the standard for permanent disability as stipulated in the subsequent disability grade table under the insurance terms and conditions, and its application to the Korean market sea is against the principle of equity, and the rate of payment of the insurance proceeds for the remaining disability is adjusted in consideration of the percentage of the maximum working age of policyholders for the Korean market sea and the king

[1] Article 737 of the Commercial Act; Article 5 (2) of the Regulation, etc. of Standardized Contracts Act; Article 737 of the Commercial Act

Choi Byung-Jin (Law Firm Law, Attorneys Kim Jong-sung et al., Counsel for the plaintiff-appellant)

Maritime Insurance Co., Ltd. (Attorney Yellow-il, Counsel for the plaintiff-appellant)

Incheon District Court Decision 98Na225208 delivered on August 23, 1999

1. Of the original judgment, the part against the Defendant ordering the Plaintiff to pay the amount exceeding 3,200,000 won per annum from September 5, 1998 to April 21, 200, and the amount exceeding 25 percent per annum from the next day to the date of full payment, shall be revoked, and the Plaintiff’s claim corresponding to the above revocation portion shall be dismissed.

2. The plaintiff's incidental appeal and the defendant's remaining appeal are all dismissed.

3. The total costs of the lawsuit shall be four minutes and three of them shall be borne by the plaintiff and the remainder by the defendant respectively.

The defendant shall pay to the plaintiff 12,00,000 won with the annual interest rate of 5% from September 5, 1998 to August 23, 1999, and 25% per annum from the next day to the date of full payment (the plaintiff has reduced his claim in the trial).

The part of the judgment below against the defendant is revoked, and the plaintiff's claim is dismissed.

1. Basic facts

The following facts may be admitted if there is no dispute between the parties, or if the whole purport of the pleading is added to Gap evidence 1, 2, 3, and evidence 4-7, 11, and 16.

A. On February 24, 1994, the plaintiff, as a member of the company that was born on September 30, 194, set the insured amount as KRW 20,000,000, respectively, when the plaintiff and the insured were to enter into an insurance contract, which is a kind of special life insurance between the defendant and the plaintiff, from February 24, 1994, to February 16, 190, to February 24, 1999, and from February 16, 199, to KRW 20,00,000.

(b)23.A of the above General Terms and Conditions 23.A prescribes that the amount calculated by applying the rate of payment specified in the General Terms and Conditions 1 attached Table 1 to the above insurance amount shall be paid to the insured as a result of the above insurance amount of the aftermath disability insurance, and in particular, the standard amount for calculating the above insurance amount of the aftermath disability insurance amount shall be double the above insurance amount if the insured was operated while it was operated by a motor vehicle.

C.However, the plaintiff was travelling to Thailand for tourism on January 20, 1995, and on the 21st following day, on the 3rd following the day when he was boarding a truck for business use and driving a U-turn on the national highway on the national highway No. 3rd, he suffered injury, such as typitis, distribution of the truck, the whole and plesle portion of the cargo loaded on the right-hand side of the truck by being received from the taxi for business use, and owing to the shock, owing to the shock.

D. In this regard, the Plaintiff started to receive the treatment of the above injury at the Pacific Hospital located in Canadian on the day of the accident, and completed the treatment at the Incheon Pacific Hospital on January 24, 1996. As a result, the Plaintiff lost 24% of its labor ability for a limited period of five years, considering the movement restriction on the gravity of distribution and the cryp change in the crypity of the crypium (hereinafter referred to as “the instant market damage”).

2. Determination on the claim for the insurance proceeds of the residual disability

A. The parties' assertion

As the cause of the claim in this case, since the market damage suffered by the plaintiff was caused by the insurance accident occurred during the operation of a motor vehicle, and since it falls under paragraph 6.2-2 of the type of subsequent disability in the disability grade table set forth in the ordinary terms and conditions, the defendant is obligated to pay 12,00,000 won, calculated by applying 30% of the payment rate set forth in paragraph 6.2 of the above table of the disability grade to the plaintiff, which is the purchase amount of the insurance contract in this case, as the payment rate set forth in paragraph 6.2 of the above 6.2 of the above 6.2 of the above 6.2 of the above 30% of the above 6.0% of the above 30% of the above 6. The defendant asserts that the above 4.0% of the amount of subsequent disability insurance premium set forth in the insurance contract in this case, which was directly caused by the injury set forth in the ordinary terms and conditions, cannot be seen as being subject to the above 2.0% of the above 2% of the insurance premium rate for the plaintiff's loss.

(b) Markets:

(1)Subject to the payment of the benefit of the latter disability and the injury to the Han Market;

Pursuant to the insurance contract of this case with respect to an accident occurring during the operation of a motor vehicle, the insurance proceeds paid when the insured dies or is missing (2.2.), medical expenses for treatment of injury (special terms and conditions for medical expenses) and expenses for maintaining livelihood paid when the insured is hospitalized or charged for an accident (26.26.), after the completion of treatment (ordinary terms and conditions) insurance proceeds paid when a motor vehicle is not operated or has lost its function, emergency expenses and alternative expenses (special terms and conditions for securing own emergency expenses and vehicle replacement expenses), expenses to be borne according to criminal punishment due to an accident (ordinary terms and conditions 24.25.). Since the insurance of this case only means that there is no possibility that the remaining part of the insurance benefits will be recovered after the expiration of the term of the insurance proceeds due to the absence of any special terms and conditions for treatment of the insured's life or physical accident (special terms and conditions for suspension) and then the remaining part of the insurance proceeds will not be provided for the purpose of restoring the health or physical disability after the expiration of the term.

(2) Whether the "Terms and Conditions of Accidents during Operation" can be applied to the Korea Market Sea in this case

In light of the above general terms and conditions, in the case of "accidents during operation" in 23.A, the standard amount to be calculated as double the above insurance coverage amount. It is acknowledged that the above "accidents during operation" in 3.C is an accident that occurred while the insured operates within the Republic of Korea during the insurance period. Meanwhile, in the conclusion of the insurance contract, the insurer should clearly state and explain the important contents of the insurance clauses such as the contents of the insurance contract and the premium rate system, etc. When the insurer violates the duty to specify and explain such insurance clauses, it cannot be asserted as the contents of the insurance contract (see Supreme Court Decision 96Da4893, Apr. 12, 1996). Since the plaintiff and the defendant's insurance contract in this case stated that the above accident occurred within 1.3 times the insurance contract of this case without any specific and detailed explanation of the insurance contract of this case, it is not sufficient to acknowledge that the above accident occurred within 1.3 times the insurance contract of this case after the conclusion of the insurance contract of this case.

(3) Scope of payment of insurance money

나아가 원고의 이 사건 한시장해에 대하여 지급되어야 할 위 후유장해보험금의 지급범위에 관하여 보건대, 보통약관 23. .B는 위 후유장해등급표에 해당되지 아니하는 후유장해의 경우는 피보험자의 직업, 신분 또는 성별 등에 관계없이 신체의 장해 정도에 따라 위 후유장해등급표의 구분에 준하여 보험금의 지급액을 결정할 수 있도록 정하고 있어 위 후유장해등급표를 바로 적용할 수 없는 후유장해에 대하여는 위 등급표를 준용하거나 조정할 수 있다고 할 것인바, 갑 제4호증의 16의 기재에 의하면 원고의 이 사건 한시장해는 보통약관의 후유장해등급표상 6.의 2) '등뼈에 운동장해를 남긴 때'에 해당되고 이에 적용되는 지급률이 30%인 사실은 인정되나, 위 후유장해등급표에서 정하고 있는 신체기능의 상실에 따른 각 지급률은 그 전체적 취지가 후유장해 가운데서도 신체의 일부를 잃은 것과 비견할 정도의 영구적 장해의 경우를 기준으로 삼고 있다고 보여 이를 이 사건 한시장해에 대하여 그대로 적용하는 것은 형평의 이념에 반하므로 이를 조정할 필요가 있다고 할 것인데, 이 사건 후유장해보험이 상해보험의 일종으로서 피보험자에게 후유장해가 생긴 경우에 일실수입의 전보 등을 목적으로 하고 있는 점을 감안할 때, 회사원인 원고가 입은 상해에 대한 치료종결일인 1996. 1. 24.경부터 가동연한인 60세에 이르는 2008. 9. 30.까지 12년 8개월(월 미만 버림)간을 영구장해에 따른 기능상실기간으로 보고 그 기간중 원고가 입은 후유장해 잔존기간 5년이 차지하는 비율을 위 지급률에 적용하여 조정함이 상당하다 할 것이다(지급률：30%×5/(12＋8/12)년≒11.84%).

In addition, according to the statement No. 4-11 of the plaintiff's evidence of this case, it is recognized that the plaintiff contributed to the plaintiff's king due to changes in the diversity of flasium, and on 32.A of ordinary terms and conditions, after the insured suffered bodily disability or disease that existed before entering into the contract of this case or after being injured under the insurance contract of this case, it is determined that the amount equivalent to the time when the injury suffered by the plaintiff was affected by the new accident or disease, regardless of the accident which caused it, should be determined and paid. In this case, the plaintiff's injury was concentrated in the estimated part of this case. The plaintiff's market of this case is highly likely to be naturally cured in the future. At the completion of the treatment of the above injury, the plaintiff is 47 years old and has not been engaged in the category of work that he severely uses it x the cause and degree of king evidence 】 0% of the injury, 00% of the total amount of injury and health insurance money paid by the defendant 20% of this case.

3. Defendant’s defense of set-off and judgment

In addition, the defendant judged that the plaintiff's "accident during operation" stipulated in the general terms and conditions of the Korea-Japan market damage of this case and paid 1,400,000 won to the plaintiff for the cost of living which is the premise of "accident during operation" under the insurance contract of this case. Since this was paid by mistake, the plaintiff is obligated to return the above money to the defendant. Thus, this is a defense that the plaintiff offsets the plaintiff's claim against the insurance money for the future disability of this case recognized as automatic claim. Therefore, there is no evidence to prove that the defendant first paid the above money to the plaintiff at the cost of maintaining the living, and even if there is such a fact, the plaintiff's damage in the Korea-Japan market of this case was caused by "accident during operation", and therefore the defendant's defense different from this premise is not justified.

4. Conclusion

Therefore, the defendant is obligated to pay to the plaintiff the delayed disability insurance amount of KRW 3,200,00 as well as damages for delay at the rate of 5% per annum under the Civil Act from September 5, 1998 to April 21, 2000, which is deemed reasonable for the defendant to dispute about the existence and scope of the performance obligation of this case as requested by the plaintiff since the due date, and from April 21, 200, from the next day to the due date, 25% per annum under the Act on Special Cases Concerning the Promotion, etc. of Legal Proceedings. Thus, the plaintiff's claim of this case is accepted within the above recognized limit as reasonable, and the remaining claims are dismissed as there is no reason. The part against the defendant of the court below which partially different conclusions is unfair, and the plaintiff's claim is dismissed. The plaintiff's incidental appeal and the defendant's remaining appeal are dismissed. It is so decided as per Disposition.

Judge Lee Jong-hoon (Presiding Judge)