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(영문) 서울중앙지방법원 2015.11.20 2015나46835
보험금
Text

1. The plaintiff's appeal is dismissed.

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

Purport of claim and appeal

1..

Reasons

1. Facts of recognition;

A. On December 22, 1998, the Plaintiff’s wife B entered into a non-payment comprehensive health insurance contract (type 1) with the Defendant as follows (hereinafter “instant insurance contract”).

In the case of the insured and the beneficiary's insurance period from December 22, 1998 to December 22, 2025, the insured and the beneficiary's insurance proceeds under the main contract and the special contract for hospitalization: 1. The diagnosis of the insured's health cost is finalized for the first time after the date of the commencement of the responsibility as "the 12-party disease, such as high blood pressure, cerebrovascular disease, and urine disease," and 2,00,000 won at the time of discharge after hospitalization for at least 31 days, at the time of discharge after hospitalization, at the time of discharge after hospitalization for at least 121 days, the actual tax amount of 5,00,000 won at the time of discharge after hospitalization for at least 181 days: 30 days per day from the date of hospitalization for the direct purpose of treatment due to disease or disaster; 1.60,000 won per day from the date of hospitalization for at least 4 days to the date of discharge;

B. On May 29, 199, the Plaintiff was seriously affected by cerebral cerebral cerebral le, etc. due to a traffic accident, and was receiving treatment due to cerebral le, left-hand marine, etc. from February 28, 2007 to August 31, 2007, the Plaintiff was hospitalized in the rehabilitation department of the D Hospital located in the Bupyeong-gu Incheon Metropolitan City under 185 days and claimed insurance payment under the insurance contract of this case.

C. Accordingly, on September 2, 2007, the Defendant received a medical certificate from the above hospital to the effect that “the Plaintiff was hospitalized, and the reason for long-term hospitalization was aimed at controlling urology in a state where the long-term movement is restricted, and the content of treatment was “the prevention of climatics and physical therapy, 22 times during the duration of hospitalization, and 22 times during the duration of hospitalization,” and “the Plaintiff was hospitalized at the Plaintiff’s request, but the treatment was possible, and the outing and staying are not included in hospitalization under the insurance terms and conditions, and thus, the Defendant paid the health cost for up to 181 days and the hospitalization cost for up to 120 days.”

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