2013 Gohap 1624 Insurance proceeds (main office)

2014Gahap833 (Counterclaim Insurance Proceeds)

State Fire & Marine Insurance Corporation

A

August 22, 2014

October 17, 2014

1. The Plaintiff (Counterclaim Defendant) shall pay 42,400,000 won to the Defendant (Counterclaim Plaintiff) and 5% per annum from June 5, 2013 to October 17, 2014, and 20% per annum from the next day to the day of full payment.

2. The Plaintiff (Counterclaim Defendant)’s principal claim and the remainder of the Defendant (Counterclaim Plaintiff) claim are dismissed, respectively.

3. The costs of the lawsuit are assessed against the Plaintiff (Counterclaim Defendant) and the Defendant (Counterclaim Plaintiff), respectively, by adding the principal lawsuit and the counterclaim.

4. Paragraph 1 can be provisionally executed.

The main claim is to confirm that there is no general cancer diagnosis expenses and general cancer surgery expenses liability of the plaintiff (Counterclaim defendant, hereinafter referred to as "the plaintiff") against the defendant (Counterclaim plaintiff, hereinafter referred to as "the defendant") according to the insurance contract listed in the attached list (2) with respect to the insurance accident listed in the attached list (1).

Counterclaim: The plaintiff shall pay to the defendant 42,40,000 won with an annual interest of 5% from May 15, 2013 to the date of this judgment, and 20% interest per annum from the next day to the date of full payment.

1. Basic facts

The following facts are not disputed between the parties, or may be acknowledged in full view of the entries in Gap evidence 1, 2, and Eul evidence 1, 2, and 3 and the purport of all pleadings:

A. A. Around May 20, 201, the Plaintiff running non-life insurance business: (a) the Defendant is the insured or beneficiary of the Defendant; (b) the insurance period from May 20, 201 to May 20, 2064; and (c) the insurance period is from May 20, 2011 to May 20, 2064; (d) the Defendant entered into an insurance contract (hereinafter referred to as “the insurance premium in this case”) in the attached Table (2) with only one time when the first diagnosis becomes final and conclusive during the insurance period; (e) the 10 million won when the first diagnosis becomes final and conclusive for the boundary type of cancer; (e) the 600,000 won when the surgery is conducted for a direct purpose of treatment; and (e) the 2.4 million won when the operation becomes final and conclusive; and (e) the insurance premium was paid from that time.

B. Of the terms and conditions of the instant insurance contract, the contents of cancer and boundary species are as follows.

III.(Definition and diagnosis determination of cancer and upper cancer, and of boundary specifications)

1. The term “Cance” in this Special Terms and Conditions means the following diseases in the basic classification of the Korean Standard Industrial Disease Classification 6th:

1. "Cancer" means a disease (see attached Table 22) classified as a malicious life ( cancer) (hereinafter referred to as the "Canceral Life (Canceram) table;

5. The term “salvegetable species” means diseases (see Table 21) classified as either an unknown behavior pattern or an aesthetic life, i.e., an unknown or aesthetic species;

② “암관련질병의 진단확정은 해부병리 또는 임상병리의 전문의사 자격증을 가진 자에 의하여 내려져야 하며, 이 진단은 조직(fixed tissue)검사, 미세바늘흡인검사(fine needle aspiration) 또는 혈액(hemic system) 검사에 대한 현미경소견을 기초로 하여야 합니다. 그러나 상기의 병리학적 진단이 가능하지 않을 때에는 피보험자가 “암”으로 진단 또는 치료를 받고 있음을 증명할 만한 문서화된 기록 또는 증거가 있어야 합니다.

[Attachment 21]

Action patterns or personal life classification tables in the United States

The following diseases are the Korean Standard Disease Classification (Enforcement Date of the Statistics Korea Notice No. 2010-246, January 1, 2011), which is classified as border species under the terms and conditions, of the sixth amended.

A person shall be appointed.

[Attachment 22]

Classification table of malicious life (Cr.A.)

The diseases classified as cancer prescribed in the terms and conditions refer to the following diseases among the Korean Standard Disease Death Classification (Statistics Notice No. 2010-246, January 1, 201).

A person shall be appointed.

C. Around May 15, 2013, medical specialist B conducted an organizational inspection on the Defendant, and issued a final diagnosis stating that the workplace is about 0.7§¯ species of work, the size of which is about 0.7 cm. C hospital doctor D performed an workplace-specific medication to the Defendant, and on September 13, 2013, on September 4, 2013, C hospital doctor issued the Defendant a final diagnosis statement stating C20.

D. The Defendant claimed insurance money of KRW 50 million for general cancer diagnosis expenses, KRW 160 million for cancer surgery expenses, KRW 2.4 million for cancer surgery expenses, and KRW 53 million for cancer surgery expenses. Accordingly, the Plaintiff paid insurance money to the Defendant only KRW 10 million for diagnosis expenses following the boundaryal species diagnosis, KRW 1.6 million for cancer surgery expenses following boundaryal species surgery, and KRW 1.6 million for cancer surgery expenses.

2. Summary of the parties' arguments

A. The Plaintiff asserts that the Defendant is not obligated to pay general cancer diagnostic expenses and cancer surgery expenses II, on the ground that the species diagnosed by the Defendant fall under the category of “infinite or infinites,” which is “infinite or infinites,” under the Korean Standard Disease Classification stipulated in the instant insurance contract.

B. On this issue, the defendant asserts that he is obliged to pay KRW 42,40,000,000,000, which remains after subtracting the fixed payment insurance amount from the total insurance amount of general cancer diagnosis expenses and cancer surgery expenses stipulated in the insurance contract of this case, since he paid only the insurance amount corresponding to the boundary species, although the life insurance amount which he was diagnosed by himself falls under the category of cancer under the insurance contract of this case.

3. Determination

The principal claim and counterclaim claims shall be judged together.

In full view of Gap evidence Nos. 3 and 5 and appraiser E's appraisal results and the overall purport of arguments, "I" published in 2008 stated that "A's proposal on registration of cryp cancer for pathology / [I] is limited to 2/3 in the case of the cypian cryp pattern of work site / it is properly treated only with sypical agents that occupy 2/3 in the case of the cypian cryp pattern of work site / 1 in the case of a small species of not more than 1 cm in the case of the cryp pattern of the cryp International Disease Classification (ICD-O), it is reasonable to grant the cryp code /1 in the case of the cryp behavior of the defendant as the result of the cryp international examination of the defendant's species / it is recognized that the cryp code is more than 0.7m code / 10.7.3m.

However, the following circumstances, which are considered as a whole based on Gap evidence No. 4 and Eul evidence No. 3 and appraiser E's appraisal results, i.e., the International Disease Classification (ICD) of the World Health Organization (WHO) in 2010 did not classify all workplace cancer into malicious and boundary pattern. Even according to the Korean Standard Disease Classification Guidelines (ver. 2014), the defendant's pattern constitutes 8240/3 of the disease classification number and behavior code, and the above behavior code/3 of the defendant's pattern refers to badness, and it is reasonable to view that there is considerable room to view that there is a considerable progress of marity as a potential consequence of the defendant's appraisal, such as the defendant's workplace cancer, as well as that of the defendant's practice, it is reasonable to consider that the defendant's marological examination of the defendant's new marology as a result of the examination of the defendant's marological disease, and that it does not constitute the defendant's specialized marological examination of the defendant's disease.

4. Conclusion

Therefore, the Plaintiff is obligated to pay damages for delay at the rate of 5% per annum under the Civil Act from June 5, 2013, which is the day following the Defendant’s final diagnosis on the unpaid insurance money, to June 5, 2013, to the extent that it is reasonable for the Plaintiff to resist the existence or scope of the instant obligation, and 20% per annum under the Act on Special Cases concerning the Promotion, etc. of Legal Proceedings from the next day to the day of full payment (the Defendant claimed payment of damages for delay from May 15, 2013, but there is no evidence to acknowledge that damages for delay will accrue from that time).

Therefore, the defendant's counterclaim claim is accepted within the scope of the above recognition, and the remaining claims are dismissed as it is without merit. The plaintiff's main claim seeking confirmation of the absence of the above payment obligation against the defendant is dismissed as it is without merit. It is so decided as per Disposition.

Justices Kim Hyun-hwan

Judges Cho Young-young

Judges Park Jin-jin

A person shall be appointed.