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(영문) 대전지방법원 2021.03.25 2020나102738
보험금
Text

On November 10, 2020, the plaintiff added and reduced in this Court.

Reasons

1. As to this part of the facts admitted, the corresponding part of the reasoning of the judgment of the first instance is cited pursuant to the main sentence of Article 420 of the Civil Procedure Act.

2. The parties' assertion

A. The Plaintiff’s assertion 1) The Plaintiff was hospitalized or performed surgery as stated in the separate sheet for calculation of the amount of hospitalization and the table for calculation of the amount of surgery. Therefore, the Defendant is obligated to pay to the Plaintiff the insurance proceeds of KRW 63,330,000 in total as stated in the “amount of claim” in each of the above table of insurance contract in the instant case and damages for delay.

2) The facts of the occurrence of the instant insurance accident under the instant insurance contract were objectively clear on December 21, 2016, which was sentenced to the relevant criminal judgment, and the Plaintiff filed the instant lawsuit within two years thereafter, and thus, the Plaintiff’s claim for the insurance money did not extinguish by prescription.

B. Defendant’s assertion 1) As to hospitalization exceeding the adequate period of hospitalization according to the result of the commission of appraisal to the F Association of the first instance court, the Defendant is not obliged to pay the hospitalization allowance.

2) Treatment such as plastic surgery using the carter does not constitute the subject of insurance payment under a special contract on operation guarantee among the instant insurance contract.

3) According to the instant special agreement on the guarantee of operation, an internal border operation and a carter operation are entitled to insurance money within 60 days from the date of commencement of the operation within the scope of one time.

Therefore, since each operation mentioned in 7, 15, 18, 20 of the attached table in the calculation table of the benefits for the operation was conducted repeatedly within 60 days after the previous operation, there is no obligation of the defendant to pay the operating benefits.

4) Even if the Plaintiff’s claim for insurance money was established, the period of prescription is two years pursuant to the former Commercial Act (amended by Act No. 12397, Mar. 11, 2014; hereinafter “former Commercial Act”).

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