[1] The principle of objective and uniform interpretation of the insurance contract

[2] The case holding that the court below erred by misapprehending the legal principle that the exemption clause does not apply to the above accidents, where the company Gap's general terms and conditions of the insurance contract concluded with Eul as Eul as Eul's insured, "the insured shall compensate for damage caused by the injury when the insured suffered bodily injury due to a sudden and remote accident during the insurance period," and "the insured shall not compensate for damage caused by pregnancy, childbirth (including king), miscarriage, or external surgery, or other medical treatment. However, in the case of injury caused by the company's injury, it shall be compensated," and Eul received propothn care due to the cosmetic surgery using a high frequency surgery, which is administered for cosmetic after he was administered with propothn, and died after he was killed, it shall be deemed that it constitutes a injury excluded from the subject of insurance protection pursuant to the exemption clause.

[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 good faith, and shall be interpreted objectively and uniformly in consideration of the interests of the entire insurance organization based on the average customer's understanding potential, without taking into account the intended purpose and intent of each party to the contract.

[2] Where the general terms and conditions of the insurance contract concluded by the insurance company A with Eul as the insured, provide that "the company shall compensate for damage caused by the injury when the insured suffered bodily injury due to a sudden and remote accident during the insurance period," provides that "no compensation shall be made for damage caused by the pregnancy, childbirth (including king), miscarriage or surgery, or any other medical treatment of the insured. However, in the case where the insurance company B is exempt from liability for damage caused by the injury to the insured from the insurance company's daily life, since the insurance company was treated with propool in its cosmetic at its cost and died after receiving the propool surgery based on high frequency surgery using cosmetic for cosmetic purposes, the case held that the judgment below erred by misapprehending the legal principles as to the above exemption from liability for damage caused by the insurance company's surgery to provide treatment for non-compensation diseases, etc. (hereinafter "non-compensation surgery, etc."), and thus, the insurance company's exemption from liability for injury to the insured company's daily life is clearly excluded from liability for injury from the insurance company's daily life.

[1] Article 5 (1) of the Regulation of Standardized Contracts Act / [2] Article 737 of the Commercial Act, Article 5 (1) of the Regulation of Standardized Contracts Act

[1] Supreme Court Decision 2009Da60305 decided Dec. 9, 2010 (Gong2011Sang, 100)

Plaintiff 1 and one other (Law Firm Mankla et al., Counsel for the plaintiff-appellant-appellee)

DB Insurance Co., Ltd. (formerly: Dongbu Fire Insurance Co., Ltd.) (Law Firm Vindication, Attorney Jeon Jae-il, Counsel for the plaintiff-appellant)

Seoul Central District Court Decision 2016Na38213 Decided October 12, 2016

The judgment below is reversed, and the case is remanded to the Seoul Central District Court.

The grounds of appeal are examined.

1. A. Review of the reasoning of the first instance judgment cited by the lower judgment and the record reveals the following circumstances.

(1) On September 23, 2009, the Defendant entered into a non-dividend agreement with Plaintiff 2, whereby the Nonparty is the insured (hereinafter “instant insurance contract”).

(2) Article 14(1) of the General Terms and Conditions of the instant insurance contract provides that “a company shall compensate for any loss incurred by the insured’s bodily injury caused by a sudden and remote accident that occurred during the insurance period,” and Article 15(1)7 provides that “no loss shall be compensated for any loss caused by the insured’s pregnancy, childbirth (including a king), miscarriage or surgery outside the country, or any other medical treatment. However, if the insured is caused by an injury that the company bears, it shall be compensated.” Meanwhile, Article 15(1)7 provides that “this case’s exemption clause” (Article 15(1)7 is construed as “instant exemption clause”. Meanwhile, in the standardized terms and conditions of disease, accident insurance, and standardized terms and conditions of the Insurance Business Supervision of the Financial Supervisory Service, which was amended on January 29, 2010 and enforced from April 1, 2010, deleted.”

(3) On August 13, 2013, the Nonparty was administered with propool in ○○○dong located in Seoul Special Metropolitan City, Nowon-gu on August 13, 2013, and was subject to the hysium hysium (hereinafter “instant procedure”) based on the anti-malopic surgery using high-frequency surgery (hereinafter “the instant procedure”). Ultimately, on December 31, 2013, the Nonparty died of the instant accident due to multiple organ hysium, etc. (hereinafter “the instant accident”).

(4) The non-party’s family members filed a lawsuit claiming damages against the doctor, etc. who performed the instant medical treatment. In the said lawsuit, the medical doctor was found to have been negligent in violating the duty of care, such as active surveillance in the course of anesthesia for the instant medical treatment and thus, liable for damages.

B. The Defendant asserted that this case’s exemption clause should be applied since the instant accident was caused by an external surgery or other medical treatment. Accordingly, the lower court rejected the Defendant’s assertion on the ground that this case’s exemption clause is not due to an external surgery for treating a disease, but due to the instant surgery for beauty art purposes, not due to an external surgery for treating a disease, etc., and thus, the instant exemption clause is not applicable, and recognized the Defendant’s obligation to pay insurance money.

2. The insurance terms and conditions shall be interpreted fairly and reasonably in light of the purpose and purpose of the terms and conditions in good faith, and shall be interpreted objectively and uniformly in consideration of the interests of the entire insurance organization based on the average customer’s understanding potential, without taking into account the intended purpose or intent of the individual contracting party (see Supreme Court Decision 2009Da60305, Dec. 9, 2010, etc.).

We examine the reasoning of the lower judgment in accordance with such legal doctrine.

The purpose of the exemption clause is to protect insurance only for risks arising from the surgery, etc. to treat the injury, which is not compensated by the insurance company against the insured (hereinafter “over-the-counter surgery, etc.”), since there is a significant increase in the risk of injury compared to the risks exposed in daily life, the insured is excluded from the subject of insurance protection from the beginning. However, this case’s treatment does not include an extra operation, etc. to treat the injury, which is the insurance accident covered by the insurance company (see, e.g., Supreme Court Decision 2008Da78491, 78507, Aug. 19, 2010). However, the non-party who is the insured, is in a state of considerable increase in the risk of injury compared to the risks exposed in daily life, and has died as a result of the fact that such risk has come to death. This constitutes the subject of exemption from insurance protection under the instant provision.

Nevertheless, the lower court determined otherwise that this case’s exemption provision does not apply to the instant accident. In so determining, the lower court erred by misapprehending the legal doctrine on the interpretation of the exemption provision of an accident insurance, thereby adversely affecting the conclusion of the judgment. The allegation contained in the grounds of appeal

3. Therefore, the lower judgment is reversed, and the case is remanded to the lower court for further proceedings consistent with this Opinion. It is so decided as per Disposition by the assent of all participating Justices on the bench.

Justices Park Jung-hwa (Presiding Justice)