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(영문) 광주지방법원순천지원 2015.05.14 2014가합11568
보험금
Text

1. In relation to the Defendant’s diagnosis at the Net B Hospital on February 5, 2014, among the insurance contracts listed in the separate sheet.

Reasons

A principal lawsuit and a counterclaim shall be deemed simultaneously.

1. Basic facts

A. On January 2, 2006, C entered into an insurance contract with the Plaintiff on behalf of the Defendant, one’s spouse, and the said insurance contract includes a special clause under which KRW 40 million of insurance money (hereinafter “instant insurance contract”) is paid in the event that the diagnosis is finalized due to the first her chronic disease during the insurance period (hereinafter “instant insurance contract”).

B. On February 5, 2014, the Defendant was diagnosed by doctors D on the ground that he/she was under the influence of an spaculing beer and spaculing to the spaculous beer and observed at the spaculatory beeral beer (Korean Standard Disease Classification Number 120.9) (hereinafter “instant diagnosis”).

C. The instant insurance terms and conditions set forth the following: (a) Hemical diseases and their diagnosis are determined as follows.

1. The term "hovascular disease" means a disease classified as a stimulism (I20), a acute stimulism (I21), a acute stimulism (I22), a acute stimulism (I23), a specific present complication (I23), or any other acute hovascular disease (I24), or a chronic hovascular disease (I25);

2. The diagnosis and confirmation of a hysmic disease shall be conducted by a person who holds a certificate of doctor's license of a domestic hospital prescribed in Article 3 of the Medical Service Act or an insurance company overseas medical institution recognized as equivalent thereto, and such diagnosis shall be conducted based on heart degrees, hearts, ultra-frequencys, ornamental crymsis, and heart tests, etc. of blood, together with medical history;

[Reasons for Recognition] Unsatisfy, Gap evidence 1 to 3, Eul evidence 1 and 2, the purport of the whole pleadings

2. The parties' assertion

A. Since the Plaintiff’s instant diagnosis did not constitute grounds for the payment of the instant insurance proceeds, it does not constitute the grounds for the payment of the instant insurance proceeds, there is no obligation for the Plaintiff to pay the instant insurance proceeds to the Defendant.

B. The Defendant’s diagnosis of the instant case became final and conclusive.

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