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(영문) 광주지방법원 2020.06.05 2017가단522650
부당이득금
Text

1. The plaintiff's claim is dismissed.

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

Reasons

1. Basic facts

A. On March 26, 2010, C concluded an insurance contract with the Plaintiff as the insured with the following content (hereinafter “instant insurance contract”).

The name of goods: E Insurance Period: The major coverage period from March 26, 2010 to March 26, 2037; the amount of general injury and injury admission expenses (at least one day): 30,000 won per day of hospitalization - General injury and injury nursing expenses: 1,00,000 won per day of hospitalization (at least 31 days, 50% of the amount of insurance coverage, the additional payment of 61 days or longer, 50% of the amount of insurance coverage, the additional payment of the amount of insurance coverage for at least 91 days, the additional payment of the amount of insurance coverage for at least 121 days, the additional payment of the amount of insurance coverage for at least 181 days, the amount of two times the amount of insurance coverage for disease: 1,00,000 won (at least 31 days, 50% of the amount of insurance coverage for at least 61 days, the additional amount of insurance coverage for at least 10 days, 10 days or more than 20 days per admission.

B. From June 25, 2011 to August 31, 2017, the Defendant received a total of 1,314 days of hospitalization due to an insured event that occurred between June 25, 2011 and August 31, 2017. The Defendant received insurance proceeds from the Plaintiff in total of 93,83,578 won in relation to the medical expenses for hospitalization among the details of the instant insurance contract.

[Reasons for Recognition] Unsatisfy, each entry in Gap evidence 1 through 6 (including virtual numbers), and the purport of the whole pleadings

2. Determination on the Plaintiff’s assertion of the cause of claim

A. In the event that the gist of the Plaintiff’s assertion of the cause of the claim did not require hospitalization, or that it was possible to provide medical treatment only with the medical treatment, it does not constitute grounds for the payment of insurance proceeds under the insurance contract of this case. As to the period during which the Defendant did not need hospitalization or was able to provide medical treatment only with the medical treatment from the Plaintiff, the Plaintiff is in accordance with the insurance contract of this case.

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