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(영문) 서울중앙지방법원 2017.04.10 2016나18240
보험금
Text

1. The plaintiff's appeal is dismissed.

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

The purport of the claim and appeal is the purport of the appeal.

Reasons

1. Basic facts

A. On January 12, 2005, the Plaintiff’s spouse B entered into a non-dividend agreement (long-term damage insurance) agreement (hereinafter “instant insurance contract”) between the Defendant, an insurance company, setting the policyholder B and the insured as the Plaintiff, which covers expenses for diagnosis of brain-related diseases, etc. (hereinafter “instant insurance contract”).

B. According to Article 1 of the Terms and Conditions of the Medical Examination Expenses for Brain Diseases in the instant insurance contract, where the Plaintiff, the insured, was diagnosed and confirmed as the first brain cerebrovascular disease during the insurance period, the Defendant is obliged to pay KRW 40,000,000 to the Plaintiff as the expenses for diagnosis of brain cerebrscular diseases.

(hereinafter referred to as the “instant insurance terms and conditions”) C.

Article 2 of the Insurance Terms and Conditions of the instant case provides that “the definition and confirmation of diagnosis of cerebrovascular diseases” shall be as follows:

(1) The term "cerebrovascular disease" means a disease (see attached Table 5) classified as a cerebrovascular disease under the third-level Korean Standards for Brain Death Classification, which is classified as a cerebrovascular disease.

(2) The diagnosis and confirmation of a brain-related disease shall be conducted by a person with a physician'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 equivalent thereto, and such diagnosis shall be conducted based on medical history, negonomic calcan, nuclear calcan (MRI), cerebrovascan calcan (PET), cerebral calcan (PET), bielectronic emitting calcan (PET), calcan (SPECT), cerebral calcan examination, etc.

[Attachment 5] The classification number of upper-class disease in the table of classification of cerebrovascular diseases

1. Spande part thereof;

2. Brain;

3. Other blood transfusions from a noncommercial head.

4. Color;

5. Severe dys not indicated by blood or light flaposis;

6. Scrapping and fluoring of bovine spongiform encephalopathy which does not cause any bovine spongiform encephalopathy;

7. Waste color and fluoring of an anti-cerebrovascular which does not cause any bovine spongiform encephalopathy;

8. Other cerebrovascular diseases.

9. Brains in diseases classified otherwise.

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