2013 Gohap 543543 Insurance proceeds

A

Korea Commercial Insurance Co., Ltd.

August 14, 2014

September 4, 2014

1. The plaintiff's claim is dismissed.

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

With respect to the Plaintiff KRW 290,205,884 and KRW 280,630,000, the Defendant shall pay to the Plaintiff 5.7% per annum from March 26, 2013 to the service date of the duplicate of the instant complaint; KRW 20% per annum from the next day to the day of complete payment; and KRW 9,575,884 from March 26, 2013 to the service date of the duplicate of the application for modification of the purport of the instant claim and the cause of the instant claim; KRW 5.7% per annum from the next day to the day of complete payment; and KRW 20% per annum from the next day to the day of complete payment.

1. Facts of recognition;

A. Conclusion of insurance contracts between the plaintiff and the defendant

1) On July 20, 201, the Plaintiff entered into a contract on July 20, 201 with the Defendant on the basis of which the term “the harm from the harm caused by general injury” is “the harm caused by the death of a disease (Renewal)” and “the harm caused by a disease of at least 50%” (hereinafter “instant insurance”). The coverage of the instant insurance is as follows.

A) A policyholder and the insured: The Plaintiff

B) Beneficiary: Legal heir in case of death, and Plaintiff in case of death other than death.

C) Details of the security

(1) Disease, death, or injury after death (e.g. renewed)

(1) Insurance period: From July 20, 2011 to July 20, 2014

(2) Subscription amount: 50 million won.

(3) Maximum compensation limit: Limit on subscription amount.

(2) A disability pension with at least 50% of a disease (Renewal penalty)

(1) Insurance period: From July 20, 2011 to July 20, 2014: 30 million won.

(3) Maximum compensation limit: Ten times the subscription amount (payment in installments for ten years).

3) The content of the instant insurance terms is as follows.

A) The special terms and conditions of disability after the death of the patient

(1) If any of the following events occurs to the insured, the defendant shall pay the insurance proceeds agreed upon to the beneficiary (Article 1.1. (i) to the beneficiary of the insurance (Article 1. ) and if the insured status becomes a disability corresponding to each disability payment rate set forth in the disability classification table set forth in the disability classification table (attached Table 1), and if the rate of payment set forth in the disability classification table is less than 80%, it shall be paid as follows: If the rate of payment set forth in the disability classification table is less than 80%: An amount calculated by multiplying the amount of payment set forth in the disability classification table set forth in

B) 50% or more of the ex post facto disability pension (Renewal of the Special Provisions)

(1) Where the insured has left a disability equivalent to at least 50% of the disability payment rate set forth in the disability classification table of the insured period due to a disease the diagnosis of which has become final and conclusive during the insurance period, the defendant shall pay the amount of insurance coverage stated in the insurance policy (certificate of insurance) on the relevant day of each insurance year for ten years only once for the first time as a disability pension to the beneficiary of the disability pension: Provided, That

In this case, it is possible to pay in lump sum and in this case, the amount discounted at the scheduled interest rate (the scheduled interest rate at the time of conclusion of the contract) shall be paid (Article 1).

(C) [Attachment I] Disability Classification Table

(1) The term " disability" means a state of permanent mental or physical damage remaining in the body after recovering from an injury or disease: Provided, That symptoms temporarily appearing in the course of receiving a medical treatment for a disease or injury, combined symptoms, and treatment for them shall not be included in the disability (I).

1.1(1));

(2) The term "permanent domicile" means, in principle, a state in which no possibility of recovery in the future is medically recognized as a state of mental or physical damage (I.I. 2). (3) The term "after recovery" means a state in which the effect of treatment of an injury or disease cannot be expected and the symptoms are fixed (I. 1. 3).

(4) The term "physical part" means 13 parts of snow, ear, coaches, chewing or other functions, hair, spine, verte, vertebral body, arms, legs, legs, fingers, stoves, stoves, plesium, chest, pletoves, and innogenesis, and the body part of each body shall be deemed the same body part, respectively: Provided, That the eye, ear, arms, and bridges shall be deemed different body parts (1.2.).

(5) When he/she has a obvious obstacle to chest, parthe/sheer, and parthe/shenogenesis (II. 12.9) (i) chest, parthe/sheer organs, or parthe/shenogenesis, among criteria for determining by classification of disabilities: 50% (a. 2) of the payment rate (a. 50%).

ii) "When there has been a significant obstacle to chest, her part-to-child organs or part-productive organs" means when they have lost both her part of her part or both her part of her part (b)(3).

B. On January 25, 2013, the Plaintiff got from a doctor B belonging to the Incheon National University Seoul National University of Madon Madon Madon Madon Madon Madon Madon Madon Madon Madon Madon Madon (hereinafter “the instant surgery”). As a result, the Plaintiff became disqualified from both pets.

[Ground of recognition] Facts without dispute, entry of Gap evidence 1 to 5, purport of the whole pleadings

2. The plaintiff's assertion

On January 14, 2013, the Plaintiff was diagnosed with the name of “pactival fluor of a deceased-satise” and “satise of a deceased-satise of a deceased-satise of a deceased-satise of a deceased-satise of a deceased-satise of a deceased-satise of a deceased-satise of a deceased-satise of a deceased-satise of a deceased-satise of a deceased-satise of a deceased-satise of a deceased-satise of a deceased-satise of a deceased-satise.” The Plaintiff

Therefore, according to the insurance contract of this case, the defendant is obligated to pay to the plaintiff the insurance proceeds of 25 million won under the insurance contract of this case, the insurance proceeds of 26,52 million won, the sum of 290 million won, 5,884 won, the sum of 29,02 million won, 5,884 won, and damages for delay.

3. Whether there exists causation between the Plaintiff’s disease and the aftermath disability

(a) Facts of recognition;

1) Details of written consent and records of the operation in the course of the instant surgery

A) On January 25, 2013, the Plaintiff drafted a written consent (No. 4, hereinafter referred to as “instant consent”). The Plaintiff explained the instant surgery process from a doctor C at the time, but C stated the following in the instant consent.

(1) The present state of the plaintiff: "Greinary type of Rose of Sharon - blood transfusion and pain certificate".

③ The process of the operation: The following are written in a recording book (Evidence B 3; hereinafter referred to as “the recording book of this case”) prepared at the time of the operation of this case (hereinafter referred to as “the recording book of this case”).

(1) Radiological name before and after a surgical operation: Shall be deemed to have been conducted at the same time with dymology (referring to the quantity of cultivated species arising from normal activity which forms most of chrona; hereinafter referred to as “unchronth marization”): A person who, among operations, finds out at least an electronic chronology (referring to an operation to cut all of stomy; hereinafter referred to as “Oophorecomy”); Both string-Oophorecomy; hereinafter referred to as “Ooprecomy”); and (3) no person who finds any specific Guideth strings, pos, and no person who finds at least two houses from among these operations.

2) Preparation, etc. of a medical certificate against the plaintiff by the doctor in charge of the instant surgery

A) On February 8, 2013, after the instant surgery, B, a doctor in charge of the instant surgery, drafted a medical certificate (Evidence A 4; hereinafter “the instant medical certificate”). In other words, on January 23, 2013, the Plaintiff discharged the Plaintiff from the hospital under the name of C of the following medical certificate (referring to the Plaintiff’s reproduction of the instant medical certificate on January 25, 2013 after undergoing the instant surgery on February 1, 2013).

B) On February 18, 2013, B drafted a medical certificate (No. 3, hereinafter referred to as “the instant medical certificate”) as follows at the request of the International Damage Adjustment Co., Ltd.:

① The time of the first diagnosis of the class of Rose of Sharon: The reason why the Plaintiff performed the instant surgery against the Plaintiff on January 14, 2013: This is because the number of the class of Rose of Sharon was increased by the size of at least three months of pregnancy, and that the state of in without fault has continued after October 2009.

③ Medical grounds for conducting the instant surgery: It is due to the fact that there was a satisfacination on the right side of the instant surgery, and that it was in contact with a closed competition since October 2009.

(iii) the content of the relevant medical advice reply;

A) On February 26, 2013, the Defendant requested the director of the Central University and the professor D to give medical advice regarding the instant surgery against the Plaintiff.

B) On February 28, 2013, D responded as follows:

(1) In most cases, it is necessary to provide medical treatment and most of it is administered when it causes severe symptoms. The method of surgery is known as a clinical therapy, a part-time Rose of Sharon, and an electronic Rose of Sharon. The method of surgery is more flexible than that of the flag. It is known that the flag surgery is a clinical therapy.

(2) In the course of performing an operation for the scopical treatment of the scopic species, scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopic scopics: Provided, That scopic scopic scopic scopic scopic scopic scopic scopic scopic scopicscopic scopicscopic scopicscopic scopic scopic scopicscopics

③ In the instant surgery with respect to the Plaintiff, it is deemed that the instant surgery is performed by an indeption to the right in the case of an indeption to the right side. The left indeption to the left indeption is a clinical opinion, and the clinical doctor’s opinion on surgery is presumed to have been performed by an indeption to the right side.

4) On January 24, 2014, the fact inquiry B sent to the fact inquiry of this court as follows.

① The fact that the Plaintiff was suffering, or was anticipated to have had an impact on a long time different from the dysium was that the dysium was by itself a part of the fysium, and that the urine symptoms, such as an urology, urology, etc., arising from the division of brys, urine urine, etc., and a part of the fysium, and that a part of the fysium appeared to have a dysium, and that a part of the fysium appeared to have a dysium and a part of the fysium.

According to the organizational path report prepared after the operation of this case, there is a malkin type in the plaintiff's womb (10cm X9.5cm X8cm size) and there is some signs of malkinosis in part (3cm x 1.5cm size) in the right part (4.5cm x 2cm size). At the time of the operation of this case, the size of the accident in the left part of the plaintiff's right part at the time of the operation of this case, however, there was a bottle suspected of malkinosis, and the left part part part of the accident in this case could not be ruled out the possibility of other salkinary because the size of the accident in this case is larger than that of the general waste games. Thus, both sides of this case carried out salkin salking in both sides.

③ If the Plaintiff’s right-hand smoke does not remove the Plaintiff’s satisfy, it is highly likely that the satisfy may occur for a long time different from the left-hand satch prior to the closure competition, but it is very low possibility after the closure competition.

[Ground of recognition] The entry of Gap evidence Nos. 3, 4, Eul evidence Nos. 2 through 4, and the fact-finding results of this court's inquiry into Eul, the purport of the whole pleadings

B. Determination

The insurer for insurance proceeds bears the burden of proving the contingency of an accident, which is the requirement of an insurance accident guaranteed by an insurance contract, and the causal relationship between the accident and the result of injury (see, e.g., Supreme Court Decisions 2001Da5549, 5505, Nov. 9, 2001; 2003Da35215, 3522, Nov. 28, 2003).

Insurance money under the instant insurance is paid in cases where the insured was diagnosed and confirmed during the insurance period, and the disability corresponding to a certain disability payment rate set forth in the disability classification table. Therefore, in order for the Plaintiff to seek insurance money against the Defendant under the instant insurance contract, the causal relationship between the Plaintiff’s disease in the old class or the old classic disease caused by the Plaintiff and the after classic disability caused by the instant surgery should be recognized. The instant diagnosis document prepared by B, a doctor in charge of the instant operation, against the Plaintiff on February 8, 2013, stated that “the Plaintiff was hospitalized in the old class and the old classic body of the Plaintiff on January 23, 2013, and received the instant surgery on January 25, 2013.” Moreover, the fact inquiry by the court stated that “The possibility of the instant surgery was not considered to have been implemented by the Plaintiff on January 25, 2013, while it was inherent in the right scarcity of the Plaintiff at the time of the instant surgery, it could not be ruled out to be a general le to the left side.

However, in light of the following points, it cannot be deemed that there exists a causal relationship between the Plaintiff’s disease of the prone type of Rose of Sharon or the prone certificate of my own womb and the subsequent disability caused by the Plaintiff’s loss of the disease caused by the instant surgery.

① The written consent of this case and the records of this case include only the fact that the plaintiff was diagnosed as the type of her own womb, and there is no mentioning about the her part of her own womb. In other words, the written consent of this case prepared by the plaintiff on January 25, 2013 indicate that the plaintiff's symptoms were 'self-finite type', 'finite type', 'finite type', 'finite type, and 'finite type', 'finite type', and 'finite type', 'finite type', and 'finite type', 'finite type', 'finite type, and 'finite type', 'finite type', 'finite type', 'finite type of her part of this case', 'finite type of her part of this case', 'finite type of her part of this case', 'finite type of her part of this case'.

② Although it is not necessarily necessary to conduct an infertility surgery in the course of performing a surgery, in cases where the military register conditions are discovered in the infertility during the surgery or where it is deemed necessary to prevent related diseases, such as dynasium and dynasium, it may conduct dynasium dynasium dynasium dynasium dynasium dynasium dynasium dynasium dynasium dynasium dynasium dynasium dynasium dynasium dynasium dynasium dynasium dynasium dynasium dynasium dynasium dynasium dynasium dynasium

Considering the fact that the plaintiff did not find any special problem in the plaintiff's subfertility, but the plaintiff could prevent the relevant diseases, such as dysia, in the closed competition, it can be deemed that the plaintiff decided to implement dysia dysia dysia dynasium dysium dynasium both on the opportunity to treat the dysia

③ According to the result of the fact-finding on B of this Court, even if the Plaintiff did not remove the Plaintiff’s satisfy from the right satisfy, the possibility that the satisfy in the left satisfy may occur to the Plaintiff’s satisfy at the left satfy, as long as the Plaintiff had been in a closed competition since October 2009. Even if the Plaintiff discovered a satisfy in the right satfy at the Plaintiff’s right satfy before carrying out the instant operation, it cannot be deemed that the instant operation was performed to remove both satisfys at the right satfy in a time, depending on medical judgment that the satisfy in the right satfy from the left satfy, or that there is no need to refrain from the right satfy to the left satfy.

Therefore, the Plaintiff’s assertion based on the premise that there exists a causal relationship between the Plaintiff’s disease of a prone type of Rose of Sharon or a prone pathy and the subsequent disability caused by the instant surgery and the Plaintiff’s injury caused by each side of the instant surgery is without merit without further consideration.

4. Conclusion

Therefore, the plaintiff's claim is dismissed as it is without merit. It is so decided as per Disposition.

The presiding judge, the full-time judge

Judges Lee Jin-hin

Judges 00 Efficacy