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1. The plaintiff's claim against the defendants is dismissed.
2. All the costs of lawsuit are assessed against the Plaintiff.
Reasons
1. Facts of recognition;
A. On May 15, 2006, Defendant A entered into an insurance contract with the Plaintiff listed in attached Table 1 (hereinafter “instant insurance contract”).
On November 15, 2011, the beneficiary was changed from Defendant A to Defendant B.
Defendant A received hospitalized treatment over a total of 807 days from July 2007 to December 2014, 2014, and thereafter, Defendant A claimed insurance money based on the instant insurance contract to the Plaintiff. Accordingly, the Plaintiff paid Defendant A KRW 49,456,262, and KRW 41,173,523, and KRW 90,629,785.
C. From January 20, 2015 to February 2, 2015, Defendant A received hospitalized treatment at C Hospital under the diagnosis of “the extreme and full-time tear or yellow fever” for 14 days from January 20, 2015 to February 2, 2015. From March 4, 2015 to March 21, 2015, Defendant A received 1,906,600 won in total from the daily allowances for hospitalization of diseases and the medical expenses for hospitalization of diseases, after receiving hospitalized treatment at D Hospital for 18 days from March 4, 2015 to March 21, 2015.
[Reasons for Recognition] The entries in Gap 1 through 3, 8 through 11, and the purport of the whole pleadings
2. The plaintiff's assertion and judgment
A. The Plaintiff’s assertion (1) 543 days out of 807 days of total hospitalization of Defendant A was unjustly hospitalized even if the need for hospitalization was not occurred due to the possibility of hospital treatment. Thus, the insurance money paid by the Plaintiff (Defendant A’s KRW 32,214,381, and Defendant B KRW 17,334,198) should be returned to the Plaintiff as unjust enrichment by the Defendants.
(2) Although Defendant A claimed insurance money to the Plaintiff after receiving additional hospitalized treatment as shown in the attached Table 2, Defendant A was sufficiently able to receive outpatient treatment, there is no obligation to pay the insurance money to the Plaintiff.
B. In the absence of clear evidence to suspect that the diagnosis by a doctor directly diagnosed himself/herself was erroneous, Defendant A was hospitalized unfairly.