logobeta
본 영문본은 리걸엔진의 AI 번역 엔진으로 번역되었습니다. 수정이 필요한 부분이 있는 경우 피드백 부탁드립니다.
텍스트 조절
arrow
arrow
(영문) 서울중앙지방법원 2020.06.18 2017가합543824
보험에관한 소송
Text

1. The plaintiff's claim is dismissed.

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

Reasons

1. Basic facts

A. On September 1, 2008, C Co., Ltd. (hereinafter “C”) concluded an insurance contract (hereinafter “instant insurance contract”) with the Defendant (i.e., the name of the Defendant: D); and (ii) with the insured as the Defendant and entered into an insurance contract (hereinafter “instant insurance contract”) with the same content as indicated in the attached Table 1 that guarantees general injury, temporary living expenses, hospitalization expenses, etc.

B. On May 3, 2013, the Plaintiff (former: E Co., Ltd.) acquired the status of insurer of the instant insurance contract from C pursuant to a decision to transfer a contract under Article 14(2) of the Act on the Structural Improvement of the Financial Industry.

C. From April 14, 2009 to April 25, 2017 after the conclusion of the instant insurance contract, the Defendant was hospitalized for 490 days in total due to the instant insurance accident under the instant insurance contract, as shown in the attached Table 2 attached hereto, and received insurance money of KRW 34,089,860 (general injury, temporary living expenses, disease hospitalization expenses, etc.) from the Plaintiff.

[Ground of recognition] The facts without dispute, Gap evidence Nos. 1 through 6 (including paper numbers; hereinafter the same shall apply), each entry into the National Health Insurance Corporation, F Hospitals, G Council members, Haryary departments, I Hospital, J Hospital, K Extraordinary departments, LI Hospital, MI Hospital, NI Hospital, NI Hospital (as of March 6, 2018), and O hospital, the purport of the entire pleadings, as a result of the response of each order to submit documents to the respective institutions.

2. As a result of the Plaintiff’s appraisal of medical records on 247 days during which the Defendant received hospitalized treatment, the Defendant received hospital treatment for at least 180 days, as shown in the attached Table 2, even if there is no need to be hospitalized for at least 180 days.

Since the trust relationship, which forms the basis of the instant insurance contract, has been destroyed due to such falsity and excessive hospitalization, and thus, it was difficult for the Plaintiff to maintain the instant insurance contract as it is. As such, the Plaintiff terminated the instant insurance contract by serving the application for modification of the purport of the claim and the cause of the claim on December 21, 2017, and sought confirmation therefrom.

In addition, the defendant received unnecessary hospitalization for 180 days from the plaintiff and entered the above list as insurance money (general injury, temporary living expenses, hospitalization expenses, etc.) from the plaintiff.

arrow