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(영문) 울산지방법원 2020.04.23 2017나2649
입원비
Text

1. The plaintiff's appeal is dismissed.

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

Purport of claim and appeal

The first instance court.

Reasons

Facts of recognition

A. On November 15, 2002, the Plaintiff entered into a DNA contract with the Defendant and the insured as C, and with the content that the insurance period from November 16, 2002 to November 15, 2035 (hereinafter “instant insurance contract”).

B. According to the terms and conditions of the instant insurance contract, the amount of KRW 10,000 per day of hospitalization as a result of continuous hospitalization for at least four days due to a disease (at least three days per day, per day, and per 120 days). According to the special agreement to guarantee a specific disease without a dividend, the amount of hospitalization benefits per day for at least four consecutive days (at least three days per day, per day, and per 120 days per day) is to be paid as 30,000 won per day of hospitalization for at least four consecutive days due to a disease.

C. C was hospitalized in the F Hospital located in Ulsan-gu E from October 26, 2016 to November 26, 2016, and received cerebrovascular treatment. From November 26, 2016 to December 22, 2016, C was hospitalized in the H Hospital located in Ulsan-gu G and received cerebrscular treatment.

(hereinafter referred to as "the instant hospital treatment". D.

On November 28, 2016, the Plaintiff claimed for the payment of the amount of hospitalization to the Defendant in relation to the instant hospital treatment, but the Defendant rejected the claim.

E. Of the terms and conditions of the instant insurance contract and the terms and conditions of the special agreement to guarantee a specific disease, the main contents of the instant case are as follows.

D In this special terms and conditions of hospitalization (Definition and Place of Hospitalization) "in the case of this special agreement," the term "hospitalizes" means entering a domestic hospital or clinic as provided by Article 3 (2) of the Medical Service Act or a foreign medical institution recognized by the company as equal thereto and under the control of the doctor, as it is deemed necessary to provide medical treatment due to disease or disaster by a doctor, dentist or a person qualified as an oriental medical doctor (hereinafter referred to as "doctor"), and it is difficult to provide medical treatment at home, etc.

D Terms and Conditions of the Special Agreement on the Guarantee of Specific Diseases Article 9 (Definition and Confirmation of Specific Diseases) 1. Two diseases in this Special Agreement and nine diseases are classified into the Third Standard Korean Classification of Diseases.

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