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(영문) 서울중앙지방법원 2016.05.17 2015가단5028237
보험금
Text

1. The Defendant: KRW 23,411,222 to the Plaintiff and KRW 5% per annum from December 9, 2013 to May 17, 2016.

Reasons

1. Basic facts

가. 원고는 계약자 겸 피보험자로서 피고와 사이에 2010. 8. 2. 무배당퍼펙트통합보험∥(이하 ‘이 사건 1 보험’이라 한다), 2012. 9. 17. 무배당퍼펙트통합보험I2.0(이하 ‘이 사건 2 보험’이라 한다), 2013. 8. 15. 무배당스마트변액유니버설CI종신보험(이하 ‘이 사건 3 보험’이라 한다)에 각 가입하고, 위 각 보험료를 납부해 오고 있다.

B. The main contents of the special agreement to guarantee unpaid, lost, and medical expenses (hereinafter “the instant special agreement”) applicable to the instant insurance contract are as follows.

Article 3(2)(1) Where an insured person (person insured) is hospitalized in a hospital due to a disease or injury during the insurance period of this special agreement, the company shall be compensated for the medical expenses for hospitalization up to the amount of insurance covered (50 million won) per disease or one injury as follows:

Article 4 of the Medical Care Assistance Act provides that the amount equivalent to 90% of the total amount of hospitalization fees, hospitalization expenses, medical care benefits prescribed in the National Health Insurance Act, or medical care benefits prescribed in the Medical Care Assistance Act (excluding the difference between the actual usage of the disease and the standard disease room at time of hospitalization) and the amount equivalent to 90% of the total amount of non-payment (Provided, That where the amount equivalent to 10% exceeds 2 million won a year from the contract date or from the contract date applicable to each year, the excess amount shall be compensated) shall be deducted from the difference between the actual usage of the disease room and the standard disease room after deducting 50% of the difference between the actual usage of the disease room and the standard disease room (Provided, That the average daily amount shall be limited to 100,000 won, but the difference between the average daily amount of the disease room and the standard disease room shall be calculated by dividing the total number of days of hospitalization) of the total amount

(2) A company shall conduct the 5th Korean Standard Disease Death Classification (K CDs: No. 2007-4, Jan. 1, 2008; hereinafter referred to as the "Korean Standard Disease Death Classification").

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