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(영문) 서울고등법원 2015.11.20 2013나33494 (1)
보험금반환청구 및 계약무효
Text

1. Of the part concerning the principal lawsuit in the judgment of the court of first instance, the Plaintiff (Counterclaim Defendant) who falls under the following order to pay.

Reasons

Basic Facts

On March 14, 2002, the Defendant entered into an insurance contract with the Plaintiff, as indicated in the separate sheet of insurance, for which the Plaintiff and the Plaintiff are the insured, the “Non-Distribution Health K Medical Security 3” contract (hereinafter “No. 1 insurance contract”) and “Non-Distribution X-AHH health care 2” contract (hereinafter “No. 2 insurance contract”), and on May 15, 2003, the “Korea House Insurance 3” contract (hereinafter “Third insurance contract”).

General Terms and Conditions

4. (Compensation for Loss) The Company shall be the Insured under the Insurance Policy after the date of commencement of liability as set out in 7. of the Insurance Period.

)The diagnosis of the 16th disease has become final and conclusive and the hospitalization for the direct purpose of the treatment of the 16th disease (in the case of hospitalization by moving to a hospital or clinic, if the company recognizes this, the hospitalization shall continue to be concluded and shall be deemed to have been concluded if the company recognizes it.”

5.In the event that the medical treatment or the surgery is conducted by hospitalization as determined by the medical doctor, the treatment or the surgery shall be covered in accordance with the terms and conditions. 5. (In the definition and place of the hospitalization and the term "inpatient" in this insurance, the term "inpatient" shall be defined as "the doctor", "the doctor", "the dentist" or "the person qualified as "the doctor"

It is recognized that the treatment of 16 major diseases is necessary under the control of the doctor because it is difficult to treat at his own home, etc. and it is difficult to treat at his own home, etc., and he is admitted to a hospital, clinic, or medical institution deemed to be equivalent to this under the control of the doctor.

"Continued hospitalization" in this insurance refers to the continued hospitalization of the same 16-year disease diagnosed for the purpose of hospitalized treatment, and the number of days of hospitalization shall be calculated by considering the continued hospitalization even if the person is hospitalized at least twice during the insurance period.

However, hospitalization for the same 16th disease exceeds 180 days from the date of discharge of the final hospitalization payment.

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