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(영문) 서울중앙지방법원 2017.09.14 2016가단5291599
보험금
Text

1. The plaintiff's claims against the defendants are all dismissed.

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

Reasons

1. Basic facts

A. On August 11, 2011, the Plaintiff entered into an insurance contract with Defendant B, with the insurance period from August 11, 2011 to August 11, 2016, and the “E” contract with each of the beneficiaries of the monthly insurance premium of KRW 52,400, the insured and the beneficiary of the non-life insurance (hereinafter “instant Type 1 insurance contract”).

In addition, on August 18, 2004, the Plaintiff entered into an insurance contract with Defendant C with the insurance period from August 18, 2004 to August 18, 204, from August 18, 204, with the monthly insurance premium of KRW 16,500, and with the insured and the beneficiary of the non-life insurance (hereinafter “F Contract 2”).

B. According to the instant insurance contract’s non-distribution special agreement under which payment of insurance proceeds is subject to the payment of insurance proceeds of each of the instant insurance contracts, in the event that an insured worker suffers from a disease or accident during the insurance period and performed an operation prescribed in attached Table 4 “the type and rating table of the insurance contract” for the direct purpose of treatment, the pertinent surgery benefits (Class 1, 40,000 won, Class 2, Class 1, million won, and Class 3 million won) shall be paid to the beneficiary.

According to the instant 2 insurance contract, in the event that an insured worker suffers from a disease or accident during the insurance period, and performs an operation prescribed in attached Table 6 of the Insurance Terms and Conditions for the direct purpose of treating such disease or accident, the insurance beneficiary is required to pay an operating allowance (the operating expense is KRW 30,000,000,000,000,000,000,000 won per operation on the basis of one unit of the operation.).

On the other hand, according to the special contract for living diseases that the Plaintiff subscribed to the second insurance contract, the cost of surgery for living diseases (50,000 won per one unit of operation) is required to be paid when he/she undergoes surgery accompanied by “inpatient” for the direct purpose of treatment as a result of the outbreak of a disease specified in the living disease classification table during the insurance period.

C. The Plaintiff’s poly removal surgery is polyp on the inner wall within the insurance period of each insurance contract of this case.

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