(영문) 서울중앙지방법원 2020.12.18 2020나7926

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(영문) 서울중앙지방법원 2020.12.18 2020나7926

부당이득금

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1. The plaintiff's appeal is dismissed.

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

The purport of the claim and appeal is the purport of the appeal.

Reasons

1. Basic facts

A. The Plaintiff, a company running the insurance business, concluded an insurance contract between the insured as indicated in the “insured” list of the attached medical treatment statement (hereinafter “insured”) and the insured (hereinafter “insured”).

B. Under the National Health Insurance Act, the Defendant operating a hospital which is a medical care institution under the National Health Insurance Act, conducted self-written diagnosis (MRI) on the part of the insured, such as kneee, etc., and received the payment of the medical expenses indicated in the “MRI Non-Benefits” column from the insured.

C. Meanwhile, the insured received the relevant insurance money equivalent to the medical expenses from the Plaintiff on the ground that the aforementioned medical expenses were paid.

[Ground for Recognition: Facts without dispute, Gap evidence 1, Gap evidence 2-1 to 52, the purport of the whole pleadings]

2. The plaintiff's assertion

A. The Defendant’s conduct of self-identification tests for the insured with respect to medical care benefits and received the full amount of the relevant expenses as “non-benefit medical expenses” is invalid as an act contrary to the provisions related to the National Health Insurance Act.

B. Therefore, the Plaintiff has a claim for return of unjust enrichment equivalent to the above insurance amount unjustly paid to the insured, and the insured have a claim for return of unjust enrichment equivalent to the medical expenses paid to the Defendant. The Plaintiff’s claim for return of unjust enrichment against the insured and the Defendant’s claim for return of unjust enrichment against the Defendant are closely related in that it constitutes a medical treatment contrary to the National Health Insurance Act and the need to exercise the Plaintiff’s claim for return of unjust enrichment against the Defendant in order to effectively and effectively secure the Plaintiff’s claim for return of unjust enrichment against the Defendant. Thus, the Defendant’s claim for return of unjust enrichment against the insured as the preserved claim for return of unjust enrichment against the

참조조문

-국민건강보험법

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