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(영문) 서울중앙지방법원 2017.03.30 2016나81057
손해배상(기)
Text

1. The part against the defendant in the judgment of the court of first instance shall be revoked, and the plaintiff's primary claim corresponding to the revoked part shall be revoked.

Reasons

1. Basic facts

A. The Plaintiff is an insurer who entered into an insurance contract that covers the medical expenses for hospitalization with the insured as indicated in the attached Table 10 (hereinafter “the insured in this case”). The Defendant is a medical doctor and the operator of the above hospital, who belongs to the Zaeuma (hereinafter “the instant hospital”), a medical hospital specialized in vertebrates (hereinafter “the instant hospital”).

B. The insured in the instant case was diagnosed as knenee-free and human damage, etc., after taking the self-processing Name Images Imagling (hereinafter “MRI”) of the instant hospital, and was diagnosed as e.g., e., e., e., e., e.g., e., e., e.g., e., e., e., e., e.

C. The Defendant claimed for medical expenses for non-benefit in relation to the above MIM diagnosis from the insured and received total of KRW 11,160,000 from the insured in the attached Table 10. The Plaintiff paid the insured amount equivalent to the above MIM diagnosis fees to the insured.

On the other hand, according to the calculation criteria of MDR medical care benefits notified by the Ministry of Health and Welfare, MI does not correspond to medical care benefits if it does not meet the eligibility and calculation criteria for benefits for each disease. However, on October 1, 2010, MI's notice was changed by the Ministry of Health and Welfare No. 2010-75 of the Ministry of Health and Welfare's notice, thereby converting MI into medical care benefits due to acute dynasium infection, fele infection, knee maegrosis, and human damage (i.e., semi-competitious heat, etc.).

[Ground of recognition] The non-contentious facts, Gap evidence 1, Gap evidence 70 to 97, the fact inquiry results to the Ministry of Health and Welfare of the first instance court, the purport of the whole pleadings

2. Summary of the parties’ assertion

A. The summary of the Plaintiff’s assertion 1, while operating the instant hospital, which is a medical care institution under the National Health Insurance Act, the Defendant claimed KRW 400,000, which is the non-payment diagnosis cost, to AA hospitalized to treat the instant hospital on a half-month basis within the left-hand slot.

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