Main Issues
[1] The principle of disadvantage of the author in interpreting the insurance clause
[2] In a case where Gap received a diagnosis from a hospital in order to remove a kind of food discovered in the workplace with a size less than 1§¯, and received a certificate of diagnosis stating "the name: the name of the patient: the behavior pattern of the workplace unfash implementation department or the new life, d37.5 d37.5 d.5 d.," and thereafter received a final diagnosis at a university hospital which received a new diagnosis, "the name of the disease" was issued to "the disease type of the workplace and the Korean Disease Classification C20C", and the above type of food constitutes "the cancer" as stipulated in the insurance contract terms and conditions concluded with Eul insurance company, the case held that the above insurance contract terms and conditions were interpreted objectively and objectively, and the meaning of the terms and conditions is unclear, and thus, it is reasonable to interpret "the name of the person who prepared the contract as "the disease type" as defined in Article 5 (2) of the Regulation of Terms and Conditions as "the 6th malmalmalmalmal disease classification" as "the new disease type".
[Reference Provisions]
[1] Article 5 of the Regulation of Standardized Contracts Act / [2] Article 5 of the Regulation of Standardized Contracts Act
Reference Cases
[1] Supreme Court Decision 2009Da60305 Decided December 9, 2010 (Gong2011Sang, 100) Supreme Court Decision 201Da1118 Decided April 28, 201, Supreme Court Decision 2013Da90891, 90907 Decided October 27, 201 (Gong2016Ha, 1752)
Plaintiff-Appellee
Plaintiff (Law Firm K, Attorneys Kim Gyeong-yeong et al., Counsel for the plaintiff-appellant)
Defendant-Appellant
DB Insurance Co., Ltd. (formerly: Dongbu Fire Insurance Co., Ltd.) (Law Firm Vindication, Attorney Jeon Jae-il, Counsel for the plaintiff-appellant)
Judgment of the lower court
Seoul Central District Court Decision 2017Na18704 Decided November 10, 2017
Text
The appeal is dismissed. The costs of appeal are assessed against the defendant.
Reasons
The grounds of appeal are examined (to the extent of supplement in case of any statement in the supplemental appellate brief not timely filed).
1. The insurance terms and conditions shall be interpreted fairly and reasonably in light of the purpose and purpose of the terms and conditions in accordance with the principle of trust and good faith, but shall be interpreted objectively and uniformly, without taking into account the intended purpose and intent of each party to the contract, based on an average customer’s interests. Even after such interpretation, in cases where the meaning of the terms and conditions is not clear, such as where the provisions of the terms and conditions are objectively and objectively interpreted and their respective interpretations are reasonable, it shall be interpreted favorably to customers (see, e.g., Supreme Court Decisions 2009Da60305, Dec. 9, 2010; 201Da1118, Apr. 28, 2011).
2. According to the reasoning of the first instance judgment as cited by the lower court and the evidence duly admitted, the following facts are revealed.
A. On September 10, 2012, the Plaintiff entered into an insurance contract under which the insured and the beneficiary were himself/herself as the insured (hereinafter “instant insurance contract”).
B. According to the terms and conditions of the instant insurance contract, when paying insurance proceeds differently depending on the cryptity of cancer and boundary, the term “am” refers to the disease specified in the cryptism table of [Attachment Table 8], and the term “dypical species” refers to the disease specified in the crypity classification table of [Attachment Table 10] and the behavior pattern of [Attachment Table 8] or the crypity classification table of [Attachment 8] refers to the disease specified in the crypity classification of the 6th revised Korean Standard Disease and Death Classification, which is below the following. One of them refers to the crypity classification of the c15-26’s crypity classification. [Attachment 10] behavior pattern or the cryp classification table of the U.S. refers to the disease below the 6th revised Korean Standard Disease and Death Classification, which is one of the following.
In addition, the terms and conditions of the insurance contract of this case shall be determined by a person with a professional doctor's license of autopsy pathology or clinical pathology, and the diagnosis shall be based on organizational examination, non-scarbia scarbia test, or current opinion on blood examination. However, when it is not possible to conduct such scarbological diagnosis, there should be a document evidencing that the insured (person subject to insurance) is being diagnosed or treated as a "amb".
(c) The Korean Standard Disease and Death Classification is a data systematically classified according to the similarity of diseases and death data, such as mandatory recording data and statistical surveys on the cause of death, in the Republic of Korea. This is based on the criteria and system of the International Disease Classification (ICD) of the World Health Organization.
In Chapter 2 of "The Korean Standard Disease Classification", Part 3, Part 3, the No. 4, the classification of new organisms according to the behavior pattern is subdivided into parts of the body and assign disease classification numbers to them. To apply these disease classification numbers, Part 4, the classification of new organisms shall be referred to as "the classification of new organisms". Here, for the classification of new organisms in the form of paper D-O, the first four types of new organisms shall be expressed the organizational form, and the number of new organisms shall be expressed the behavior pattern. In other words, Part 4, if the behavior pattern of new organisms is in bad faith, 00, 00-D4, 0000, 7,0000,000,000,0000,000,000,000,000,000,000,000,000,000,000,000,000,000,00.
Therefore, in the case of workplace protein (paciology, carciologic species), the type classification number under Part 4 of the Korean Standard Disease and Death Classification falls under the category category C20, and the type classification number under Part 3 falls under the category of disease as the "workplace protein (M8240/3)," and the type classification number is "M8240/1," if the form classification number is "M8240/1," it falls under the category of disease d37. However, the Korean Standard Disease and Death Classification does not include the disease classification number by distinguishing information such as the size, aggression, and decentralization of workplace protein.
D. Under the Korean Standard Disease Classification 6th Amendment, the term "unscopic silkworm species" shall be read as "M8240/1," and the term "NOS" shall be read as "M8240/1," and the term "unscopic baby species (i.e., carimerx M8240/1) occurred in other parts than filling water" shall be read as "M8240/3." However, according to the Korean Standard Disease Classification 3 Board (ICD-O3), which was based on the Korean Standard Disease Classification 200, the term "unscopic acid species" shall be defined as "M8240/1," and the term "unscopic acid species" shall be defined as "unscopic acid species", and the term "unscopic weather species" shall be defined as "unscopic and 6," the term "unscopic acid species" in the 2000th Amendment.
E. In recent years, there was controversy as to whether it was malicious species, whether it was caused by the fire extinguishing machine, or a cross-border species.In 2008 thesis (a proposal for registration of fire extinguishing machine for pathology) and 2012 paper, which referring to foreign data, were prepared by the Kiology Association in 2008 and in 2012, this paper suggested that if the neutic flabic fladic fladic fladic fladic fladic fladic fladic fladic fladic fladic fladic fladic fladic fladic flad flad flad flad flad flad flad flad flad flad flad flad flad flad flad flaf flaf flaf.
F. On October 2, 2013, the Plaintiff received an internal crypary crypism from ○○ Hospital, and immediately following the Plaintiff’s organizational inspection on the Plaintiff’s cypical organization, the Plaintiff was diagnosed by pathology with “L-cellal pathic fypine (LL) species (M8240/1) (M8240/1)” (M8240/1). On October 14, 2013, the clinical doctor of ○○ Hospital issued to the Plaintiff a written diagnosis stating “the name of the disease: the name of the disease: new or US, the Korean number of disease classification (D37.5)” as at the time of the cypary examination. However, the Plaintiff did not have exempted tissue for the verification of the entry into a workplace cell.
The Plaintiff again received medical treatment at △△ University Hospital. Nonparty 2 and Nonparty 3 issued a final diagnosis report to the Plaintiff on November 1, 2013, based on the report on the foregoing organizational disease, on the basis of the medical doctor of the said hospital, the medical doctor of the said hospital, Nonparty 2, and Nonparty 3 conducted an organizational pathology test with respect to the above control unit sloid, and prepared the organizational pathology report diagnosed as “the first class of 1 influor, grade,” which was diagnosed as “the first class of fluor influor (i.e., e., e., g., g., g., g., g., g., g., e., g., g., e., g., e., g., e., g., the Plaintiff’s disease that was finally diagnosed (hereinafter
사. 2010년 발간한 소화기계 종양에 대한 세계보건기구 분류에서는 신경내분비 종양을 세분화하여 ‘글루카고-유사 펩타이드와 PP/PYY 생산하는 L세포 신경내분비 종양(L cell, Glucago-like peptide-producing and PP/PYY-producing NET, 이하 ‘L세포 타입 종양'이라고 한다)’에 행태 분류번호 ‘/1’을 부여하였다. 대한의사협회장에 대한 각 사실조회촉탁 결과에 의하면, 직장 유암종의 80% 정도가 L세포 타입 종양이므로, 크기가 1㎝ 미만이고 점막층과 점막하층에 국한되며 혈관침윤이 없는 직장 유암종의 경우, L세포 타입 종양일 가능성이 높지만, 현재까지 L세포 타입을 규명할 수 있는 공인된 표지자와 병리학적 진단 기준이 명확하게 존재하지는 않는다.
H. Meanwhile, the Korean Standard Disease and Death Classification 2014, which was prepared to be utilized as auxiliary materials for the 2nd Korean Standard Disease and Death Classification 2nd Guidelines, contains only the code “8240/3” in the form classification code of the fire-fighting system. Each State in the list of the type classification codes of the new life in the fire-fighting system, stating that “in cases where the size of the new life in the workplace is less than 1cm and there is no blood and no adjacent straination, the form of action may be classified as /1”. However, if the contents of the disease code conflict with the Korean Standard Classification 2nd, the Korean Standard Classification 2nd 3th 3th 3th 4th 4th 6th 6th 1st 1st 1st 1st 1st 1st 1st 1st 1st 1st 1st 1st 1st 1st 1st 1st 2014.
3. We examine this in light of the legal principles as seen earlier.
A. In the Drriology conference of Korea, the size of the instant species is less than 1cm as in the instant species, limited to the strato floor and the stratoth floor, and workplace climatic cancers without blood invasions are highly likely to be the species of L cell-typeing from among the negos of the 2010 type of fire extinguishing machinery, which are subdivided in the 2010 type classification of the World Health Organization, and thus, it is reasonable to regard it as a drrimatic species by classifying it as '/1' even under the Korean Standard Disease and Death Classification. Such drriology classification system is reasonable in terms of the content and the results of the survey included in the 2008 and the paper in the 2012 paper, as well as the result of most medical doctors' opinions. Accordingly, it is difficult to readily deny the rationality of the terms and conditions of the instant insurance contract on the premise that the interpretation of the terms and conditions of the instant insurance contract is reasonable.
B. However, the terms and conditions of the insurance contract of this case refer to only the Korean Standard Disease Classification and the terms thereof as the standard classification criteria for 6th category of climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic climatic clip. However, the Korean Standard Disease Classification as well as the Korean Standards and 4th category of climatic cul clip.
In conclusion, from the perspective of the interpretation of the insurance clause, it is sufficiently possible to interpret the terms of the insurance contract of this case as a disease, which is a disease classified as malicious life, and it is also acknowledged that the objectivity and rationality of such interpretation are also recognized.
C. Therefore, with respect to the scope of the insured events or the amount of insurance proceeds of the instant insurance contract, “C20” under the terms and conditions of the instant insurance contract is objectively and objectively interpreted and the meaning of the terms and conditions is not clear. Therefore, applying the principle of disadvantage of the author under Article 5(2) of the Regulation of Terms and Conditions, it is reasonable to interpret that detailed workplace cancer constitutes “the malicious life of the fire extinguishing agency” under the 6th revised Korean Standard Disease and Death Classification, and thus, it is reasonable to interpret that the disease classification number is given.
D. Examining the reasoning of the lower judgment in light of the aforementioned legal principles and records, the lower court did not err by misapprehending the legal doctrine regarding the principle of free evaluation of evidence against logical and empirical rules or by exceeding the bounds of the principle of free evaluation of evidence, contrary to what is alleged in the grounds of appeal.
4. Conclusion
Therefore, the appeal is dismissed, and the costs of appeal are assessed against the losing party. It is so decided as per Disposition by the assent of all participating Justices on the bench.
Justices Park Jung-hwa (Presiding Justice)