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(영문) 전주지방법원 2017.10.19 2014나5329
보험금
Text

1. Revocation of a judgment of the first instance;

2. The plaintiff's claim is dismissed.

3. All costs of the lawsuit shall be borne by the Plaintiff.

Reasons

1. Facts of recognition;

A. Article 1 of the conclusion of the instant insurance contract, where the insured as stated in the insurance policy (insurance policy) becomes final and conclusive as the first bruent disease during the special insurance period stipulated in the insurance policy (insurance policy), the Defendant is bound to compensate for it in accordance with the terms and conditions of this contract.

Article 2 (Definition and Diagnosis Confirmation of Hemovascular Diseases) (1) The Hemovascular diseases refer to diseases classified as Chovascular, acute cardioscular typhism, chronic chronological ephism, acute chronological ephism, acute chronological ephism, and chronic hovascular diseases in the fourth Korean Standard Classification for Patients.

(2) The diagnosis and confirmation of a hovascular disease shall be conducted by a person with a doctor's license (excluding dentists) of a domestic hospital prescribed in Article 3 of the Medical Service Act or a foreign medical institution overseas recognized by the defendant as equal thereto, and this diagnosis shall be conducted based on the depth degree, heart, ultra-spathy, ornamental crymsis, and cardio-psymology test, etc. of blood together with medical history.

Article 3 (Expenses for Diagnosis of Hetic Diseases) If the insured has become final and conclusive due to an initial Hetic disease, the defendant shall pay 100% of the amount of the insurance covered by the special agreement only once in accordance with this special terms and conditions.

On December 30, 2005, the Plaintiff entered into a non-distribution agreement with the Defendant (hereinafter “instant insurance contract”) on the basis of the diagnosis cost A, daily hospitalization day B, etc. of the Hedic heart disease. The A Special Clause for the Examination Cost of the Hedic heart disease (hereinafter “instant Special Clause”) provides for the definition, confirmation, etc. of the Hedic heart disease as follows.

B. The Plaintiff, as a result of the outbreak and diagnosis of scarcity, complained of a scarcity from around 5 days before September 6, 201, was hospitalized by the time of the scarcity C Hospital located in the Jeonsi-gu Seoul Metropolitan City and was hospitalized by September 10, 201, and was hospitalized by the time of the scarcity and the chest X line.

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