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(영문) 서울중앙지방법원 2014.11.05 2014나11832
보험금
Text

1. The plaintiff's appeal is dismissed.

2. The plaintiff's claim extended in the trial is dismissed.

3. Claim for the costs of appeal.

Reasons

1. Basic facts

A. On February 22, 200, the Plaintiff entered into a mutual aid agreement with the Defendant (hereinafter “the 4 mutual aid agreement”) with the Defendant respectively, (i) “the 1st century female cancer mutual aid agreement” (hereinafter “the 2 mutual aid agreement”), (ii) “the 5th March 2001”; (iii) the Green Cancer Mutual Aid agreement (hereinafter “the 3 mutual aid agreement”); and (iv) January 25, 2007 “the 4 mutual aid agreement” (hereinafter “the 4 mutual aid agreement”).

B. On May 6, 2009, the Plaintiff was performing the upper cancer diagnosis and the upper cancer surgery, and was paid with the Defendant the upper cancer diagnosis and the surgery expenses. On July 20, 2012, the Plaintiff received specific cancer diagnosis and the surgery expenses from the Defendant.

C. From October 8, 2012 to November 22, 2012, the Plaintiff received 33 times for radiation research and treatment at the Seoul National University Hospital, and received 15 times for high-frequency heat treatment in B convalescent from December 2, 2012 to December 31, 2012.

In accordance with each of the instant mutual aid agreements, the Plaintiff requested the Defendant to pay for operating expenses for radiation research and high-frequency heat therapy. However, in relation to the mutual aid agreement, the Defendant refused to pay for the reason that radiation research and high-frequency heat therapy did not constitute cancer surgery under the terms and conditions of the first and second mutual aid agreement in relation to the first and second mutual aid agreement. With regard to the third and fourth mutual aid agreement, the radiation research constitutes “radiation exposure” under the terms and conditions of the third and fourth mutual aid agreement, and thus, the Defendant paid KRW 1,00,000 as operating expenses for the mutual aid agreement on February 21, 2013 in accordance with the criteria for the payment of operating expenses for 60 days, on the ground that the radiation research constitutes “radiation exposure” under the terms and conditions of the third and fourth mutual aid agreement, and thus, the insurance money may be paid within the scope of the benefits for 60 days.

Article 11 of the first mutual-aid contract for payment related to operation: Article 9(2) of the second mutual-aid contract for the first time when diagnosis is finalized for the first time and when the surgery is performed for the purpose of direct treatment of the cancer, 25% to 35% of the amount of deduction per operation: operation.

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