갑이 을 보험회사 등과 체결한 보험계약의 약관에 ‘재해분류표에서 정한 재해로 피보험자가 장해상태가 되었을 때 보험금을 지급한다’는 취지로 규정하고 있는데, 갑이 골프장에서 드라이버 티샷을 하던 중 목 부위가 젖혀지면서 통증이 발생하였고, MRI 촬영 결과 경추부 추간판탈출증을 진단받자 보험금 지급을 구한 사안에서, 골프라는 반복적인 운동 동작에서 비롯된 사고는 보험금 지급대상인 재해사고에 해당하지 아니한다고 한 사례

갑이 을 보험회사 등과 체결한 보험계약의 약관에 ‘재해분류표에서 정한 재해로 피보험자가 장해상태가 되었을 때 보험금을 지급한다’는 취지로 규정하고 있는데, 갑이 골프장에서 드라이버 티샷을 하던 중 목 부위가 젖혀지면서 통증이 발생하였고, MRI 촬영 결과 경추부 추간판탈출증을 진단받자 보험금 지급을 구한 사안에서, 위 사고는 골프라는 반복적인 운동 동작에서 비롯되었는데, 보험약관의 재해분류표에서 기타 불의의 사고 중 ‘과로 및 격심한 또는 반복적 운동으로 인한 사고’를 명시적으로 재해사고의 유형에서 제외하고 있고, 여기서 반복적 운동이란 운동 횟수의 반복은 물론 동일한 동작의 반복을 의미하므로, 동일한 스윙 동작을 반복하면서 발생한 사고는 보험금 지급대상인 재해사고에 해당하지 아니한다고 한 사례.

Article 737 of the Commercial Act

Plaintiff (Attorney Park Jae-sik, Counsel for the plaintiff-appellant)

Young Life Insurance Co., Ltd. and one other (Law Firm Chungcheong, Attorney Lee Young-chul, Counsel for the plaintiff-appellant)

July 22, 2015

1. The plaintiff's claims against the defendants are all dismissed.

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

The Plaintiff shall pay 56,00,000 won to Defendant Muden Life Insurance Co., Ltd., and 60,000,000 won to Defendant Fuden Social Life Insurance Co., Ltd., and 20% interest per annum from December 5, 2013 to the day of complete payment.

1. Basic facts

A. On July 23, 1998, the Plaintiff concluded each insurance contract with Defendant Muden Life Insurance Co., Ltd. (hereinafter “Defendant Muden Life Insurance”) with the insurance period of July 23, 1998 to July 23, 2013, and with Defendant Puden Social Life Insurance Co., Ltd. (hereinafter “Defendant Puden Social Life Insurance”) on March 12, 1999, with the insurance period of the insurance period of the insurance period of the Fuden Life Insurance Co., Ltd. (hereinafter “Defendant Puden Social Life Insurance”).

B. Article 3(1)2 of the Clause of the Disaster Pension Special Agreement concerning Disability Pension among the Life Master Insurance Contract, which is a workplace of the defendant Moran Life Insurance, provides that “The insured during the insurance period, on Saturdays or holidays prescribed by the Regulations on Holidays of Public Offices, shall be paid disability benefits in accordance with attached Table 2 [Attachment Table 2] (Disaster Classification Table 3] (Disaster Classification Table) and the disability classification table as prescribed by the Regulations on Holidays of Public Offices due to a direct cause (Attachment Table 3), among the disability classification table, when the insured becomes disabled in Grades I through III, and Class II shall be paid disability benefits.”

C. Article 2(1) of the Terms and Conditions of the Disaster Injury Special Agreement among Defendant Puden Social Life Insurance Co., Ltd. provides that, “When the insured becomes a disability of Grades II through VI in the disability grade table prescribed in [Attachment Table 3] due to a disaster set forth in [Attachment Table 1] [Attachment Table 2] (Disaster Classification Table 3] during the insurance period, the insured shall be paid the benefits agreed to the beneficiary.”

D. Each of the terms and conditions of the above accident disability pension agreement and the terms and conditions of the above accident accident compensation agreement (hereinafter “each of the terms and conditions of this case”) [Attachment 2] (Disaster Classification Table] (hereinafter “Disaster Classification Table”) are the same as those of the attached Table.

마. 원고는 법정 공휴일(일요일)인 2012. 4. 8. 경주시 양남면 소재 마우나오션 골프장에서 드라이버 티샷을 하던 중 목 부위가 젖혀지면서 찌릿한 느낌을 받고 통증이 발생하였다(이하 ‘이 사건 사고’라 한다).

F. On April 12, 2012, the Plaintiff was diagnosed of the escape certificate No. 5-6, 6-7 of the MI in light of the results of the MI shooting conducted by the Institute of Modern Images, and was subject to the examination of the escape certificate of the memorial signboard No. 5-6, 6-7 of the MI on May 9, 2013 at the Ulsan National University Hospital, Ulsan National University Hospital No. 5-6, 6-7.

[Reasons for Recognition] Unsatisfy, Gap evidence 1 and 4 (including each number without special reference; hereinafter the same shall apply), Eul evidence 1 and 2, and the purport of the whole and arguments as a result of the plaintiff's personal examination

2. The parties' assertion

A. The plaintiff

As a result of the instant accident, the Plaintiff caused a subsequent disability falling under No. 24 of the Korean Standard Disease Classification Table and the grade No. 24 of the disability grade table, the Defendant Muden Life Insurance is obligated to pay each insurance money according to the special accident-based disability pension agreement among the above workplace Muden Senior Life Insurance Contract, and Defendant Puuden Social Life Insurance is obligated to pay each insurance money according to the special accident-related agreement among the above non-dividend

B. The Defendants

1) The instant accident does not constitute a contingency accident, and also constitutes a type of accident that is excluded from the type of accident under each of the instant terms and conditions.

2) Even if the instant accident constitutes the said accident, it is merely a minor external factor that has caused the disease or the aggravation of symptoms to a person with physical or mental factors, and the Plaintiff’s disability status due to the instant accident does not fall under class 4. In addition, there is a lack of causation between the instant accident and the Plaintiff’s disability status.

3. Determination

A. The plaintiff asserts that the accident of this case is a imprudent exposure to the Korean Standard Disease Disease Classification No. 24 and other detailed unknown factors. Thus, according to the Eul evidence No. 3, the plaintiff's accident of this case can not be classified as a imprudent exposure to the disease refund and death (V01-Y98) in the Korean Standard Disease Classification Table (V01-X59), and other external factors (W00-X59) for the damage of the non-damage (W0-X59), and other detailed unknown factors (X58-X59). In this case, since there are the explicit factors that the plaintiff is golf, it cannot be classified as a imprudentive exposure to other detailed factors.

나. 앞서 본 바와 같이 이 사건 사고는 원고가 골프장에서 드라이버 티샷을 하던 중 발생하였고, 원고 본인신문 결과에 의하면 이 사건 사고가 발생할 무렵 원고는 한 달에 2~3번 정도 골프장을 방문하고 1주일에 1~2번 정도 연습장을 찾았으므로, 이 사건 사고는 골프라는 반복적인 운동 동작에 의해서 비롯된 것임을 인정할 수 있고, 이 사건 재해분류표에서는 기타 불의의 사고 중 한국표준질병사인 분류표상 X50~X57에 해당하는 ‘과로 및 격심한 또는 반복적 운동으로 인한 사고’를 명시적으로 재해사고의 유형에서 제외하고 있는바, 여기서 반복적 운동이라 함은 운동 횟수의 반복은 물론 동일한 동작의 반복을 의미한다고 할 것이어서 동일한 스윙 동작을 반복하면서 발생한 이 사건 사고는 이 사건 각 약관상 보험금 지급대상인 재해사고에 해당하지 아니하므로 원고의 청구는 더 나아가 살필 필요 없이 이유 없다.

C. Even if the instant accident falls under the type of accident stipulated in each of the instant terms and conditions, the following facts are added to the statement Nos. 5 through 7; the results of physical examination commissioned to the head of the Busan White Hospital affiliated with the U.S. University; and the results of fact-finding conducted on the head of the U.S. University Hospital, the entire purport of arguments. If the instant accident falls under the category of accident under the instant terms and conditions, it is hard to find that the instant accident occurred due to pure external trauma, and continuous and chronic external external external protruding, and there are protruding signboards in the case of the Plaintiff. Accordingly, the Plaintiff’s involvement in the instant accident seems to fall under the category of 6-7, 6-6, and 80%, and the part Nos. 6-7, and 5-6, cannot be seen to fall under the category of insurance proceeds of the Plaintiff’s external prone accident as the result of the organization examination conducted by the U.S. Hospital affiliated with the Plaintiff after a minor operation.

4. Conclusion

Therefore, each claim against the Defendants against the Defendants is dismissed as it is without merit. It is so decided as per Disposition by the assent of all participating Justices.

[Attachment] Disaster Classification Table: omitted

Judges Or Dong-dong (Presiding Judge) Kim Jong-young