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(영문) 인천지방법원 2016.08.31 2016노1179
사기
Text

The defendant's appeal is dismissed.

Reasons

1. The gist of the grounds for appeal is that the Defendant merely received hospitalized treatment normally, and does not receive insurance money by being hospitalized falsely.

Nevertheless, the lower court erred by misapprehending the legal principles as to guilty.

2. Determination

A. “Hospitalization” refers to a patient’s treatment under the observation and management of a medical staff while staying in a hospital for more than six hours pursuant to the following provisions: (a) where continuous observation of medical staff is required with respect to side effects or incidental effects of the patient’s disease, where the patient’s health condition and the treatment of foods is needed; (b) where the patient’s health care needs to be continuously conducted; (c) where the patient’s health care is in a situation where the patient’s condition is unable to cope with the patient’s disease or where the patient’s risk of infection exists; and (d) where the patient resides in the hospital and receives treatment; and (e) where the patient has to undergo the treatment under the observation and management of the medical staff while staying in the hospital for more than six hours, the determination of whether the patient was hospitalized based only on the period of stay in the hospital cannot be made; and (e) the patient’s symptoms, diagnosis and treatment details and circumstances, and the patient’s actions should be

Meanwhile, in the event of exercise of rights by means of deception, if such deception is not acceptable as a means of exercise of rights in view of social norms, the act of exercising rights constitutes fraud. Even if there are grounds for payment of insurance proceeds, if excessive insurance proceeds are paid by means of long-term hospitalization with intent to acquire a large amount of insurance proceeds than the insurance proceeds actually receivable, fraud is established against the total insurance proceeds paid (Supreme Court Decision 2007Da15488, Apr. 2, 201).

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