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(영문) 전주지방법원 2017.10.18 2014나5312
보험금
Text

1. Revocation of the first instance judgment.

2. The Plaintiff paid the Defendant the sum of the expenses for hospitalization of a disease and the expenses for hospitalization of a disease, 1,817.

Reasons

1. Basic facts

A. On December 30, 2005, the Plaintiff entered into a non-distribution agreement (hereinafter “instant insurance contract”) with the Defendant on the basis of the Plaintiff’s medical expenses for the diagnosis of the Hemovascular disease, the daily allowances for hospitalization of the Hemovascular disease, etc., and the instant insurance contract’s special terms and conditions (hereinafter “instant special terms and conditions”) provide for the definition and confirmation of diagnosis of the Hemovascular disease as follows.

(1) Article 1 of the Special Terms and Conditions of this case provides, “Where the insured, as stated in the insurance policy (insurance policy) of this case, entered in the insurance policy of this case, has been diagnosed as the first her chronic disease during the insurance period of this Special Terms and Conditions, the insured shall be compensated for in accordance with the terms and conditions of this case.”

(2) Under the title of Article 2 of the Special Terms and Conditions of this case, “the definition and confirmation of the Hemovascular disease” refers to “The Hemovascular disease shall be done by a person with the certificate of qualification of a domestic hospital under Article 3 of the Medical Service Act or a person with the certificate of qualification of a foreign medical institution (excluding dentists) recognized by the Plaintiff as being equivalent to the above, and the examination shall be conducted based on the examination of the heart, the heart tymphism, the cardiostrophymosis, the acute cardiostrophymosis, the acute hemphymosis, the acute hemphymosis, and the cardiostrophymosis in blood, etc.”

(3) Article 3 of the instant Special Clause provides, “The Plaintiff shall pay 100% of the amount of the insurance covered by the special agreement only once in accordance with the instant Special Clause in the event the insured’s first diagnosis is finalized due to a stimulic disease.”

(b).

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