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(영문) 대구지방법원 2016.11.10 2016나6567
보험금
Text

1. All appeals filed by the Plaintiff (Counterclaim Defendant) and the Defendant (Counterclaim Plaintiff) are dismissed.

2. The costs of appeal shall be individually counted.

Reasons

1. The principal lawsuit and counterclaim shall also be deemed to exist;

A. On September 12, 2005, the Plaintiff entered into an insurance contract with the Defendant (at the time, the Defendant’s trade name was “green Life Insurance Co., Ltd.,” but, on March 29, 2012, changed to the “On-site Life Insurance Co., Ltd.”; hereinafter all the Defendant referred to as “Defendant”) and entered into a “Class 1 insurance contract with Korea Home Home Infrastructure Insurance Co., Ltd.” (hereinafter “instant insurance contract”) with the following contents.

Securities Number: B policyholders, the Main Insured, the Beneficiary: the due date: the Plaintiff: Sep. 12, 2031

The terms and conditions of hospitalization benefits among insurance proceeds under the insurance contract of this case shall be as follows.

Article 22 (Types and Grounds for Payment of Insurance Money)

6. When an insured person has been hospitalized for at least four consecutive days for direct purposes of treating a disease during the insurance period: Payment of expenses for hospitalized treatment (Provided, That payment of expenses for hospitalized treatment (Provided, That payment of more than three days per day, per one time of hospitalization, and 120 days per time of hospitalization) - 50,000 won (see attached Table 1-1 of the terms

7. When the insured has been hospitalized for at least 31 days for a direct purpose of treating a disease during the insurance period: The payment of expenses for hospitalized treatment (Provided, That payment of expenses for hospitalized treatment (only 90 days per day between 30 days and 1 daily hospitalization) - KRW 50,000 (see attached Table 1-1 of the General Terms and Conditions for the Payment of Insurance Money) - If the calculation method of insurance money under Article 22 of the General Terms and Conditions is less than 4 days and less than 30 days, the insurance money under Article 22 subparagraph 6 of the General Terms and Conditions shall be paid only if the number of days of hospitalized treatment is more than 4 days and less than 30 days, and if the number of days of hospitalized treatment exceeds 30 days, the insurance money under subparagraphs 6 and 7 of Article 22 of the General Terms and Conditions for the Payment of Insurance Money under Article 22 of the Terms and Conditions for the corresponding 30 days in excess of the above 30

Article 23 (Detailed Provisions concerning Payment of Insurance Money) (5) The number of days of payment of hospitalized treatment expenses under subparagraph 6 of Article 22 (Types of and Grounds for Payment of Insurance Money) shall be the maximum limit of 120 days per hospitalization, and subparagraph 7 of the same Article.

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