2016Da208341 Insurance proceeds

1. A;

2. B

3. C

K non-life insurance Co., Ltd.

Seoul Central District Court Decision 2015Na52076 Decided January 12, 2016

June 23, 2016

The judgment below is reversed, and the case is remanded to the Seoul Central District Court.

The grounds of appeal are examined.

1. An insurance contract shall be interpreted fairly and reasonably in light of the purpose and purpose of the contract in question in accordance with the principle of trust and good faith, and it shall be interpreted objectively and uniformly in consideration of the interests of the entire insurance organization based on the average customer’s interest, without taking into account the intended purpose and intent of the individual contracting party. Even after the aforementioned interpretation, in cases where the meaning of the contract is not clear, such as where the standardized contract terms are objectively and objectively interpreted and their respective interpretations are reasonable, it shall be interpreted favorably to customers (see, e.g., Supreme Court Decision 2015Da24347, May 12, 2016).

2. Review of the reasoning of the lower judgment and the evidence duly admitted reveals the following facts.

A. On July 26, 2007, Plaintiff B entered into a three-class non-paid family life insurance contract (standard body insurance contract) with the Defendant and the insured as the deceased, and the beneficiary as the inheritor at the time of the death (hereinafter “instant main contract”) and entered into a separate insurance premium and a non-paid disaster death agreement (hereinafter “instant special agreement”).

B. Article 16 of the Clause of this case provides that when the insured dies during the insurance period or becomes disabled by not less than 80% of the total disability payment rate, the general death insurance proceeds shall be paid. Article 10 of the Clause of this case provides that the insured shall additionally be paid when the insured dies due to a disaster or becomes disabled by not less than 80% of the total disability payment rate during the insurance period, and the disaster classification table of the same Clause provides that "accidents subject to 1.0-Y84)" shall be an contingent accident corresponding to the Korean Standard Disease Classification (S0-Y84) in the Korean Standard Disease Classification (S0-Y84) and Article 2 (1) 1 of the Infectious Disease Prevention Act shall be excluded from the above accident.

3. We examine the above facts in light of the legal principles as seen earlier. While the instant special agreement is added to the instant special agreement, it is a type of accident insurance belonging to the insurance type of insurance business under Article 3 of the Insurance Business Act, which differs from the instant special agreement, which is a type of life insurance, and accordingly differs from the nature of the insurance, and accordingly is a separate insurance contract which differs from the insurance risk, insurance money, and insurance premium. Accordingly, Article 12(1)1 of the instant special agreement must be understood in relation to Article 10 of the instant special agreement regardless of the content of the instant special agreement. Article 10 of the instant special agreement provides that, regardless of the content of the instant special agreement, the time a disaster directly causes a death or a disability with at least 80% of the total disability payment rate, and thus, suicide or self-injury by intention does not constitute a disaster. Thus, Article 12(1)1 of the instant special agreement provides that Article 12(1)1 of the instant special agreement shall not apply if it is interpreted as a non-applicable provision from the beginning.

However, in order to say that a clause that exists strictly does not deny its validity under the Regulation of Terms and Conditions Act, but simply is an infinite provision that is not subject to the interpretation of the terms and conditions, it should be clear that it is an infinite provision that is not subject to the provision, even if it is based on the average customer's understanding possibility. Thus, it cannot be viewed as such under Article 12 (1) 1 of the Terms and Conditions.

Rather, according to the average customer's understanding possibility, the above provision does not constitute an accident that is an insurance accident as stipulated in Article 10 of the Clause of the instant Special Agreement, in principle, because suicide or self-injury intentionally lacks contingent capacity. However, there is sufficient room to understand to the effect that if the insured was in a situation where he/she was unable to make a free decision due to mental illness, etc., and where the insured was in a situation where the aggregate disability payment rate is at least 80% due to suicide or injury after the lapse of two years from the date of commencement of guarantee, it shall be included in the insurance accident, and thus,

여기에 '정신질환 등으로 자유로운 의사결정을 할 수 없는 상태에서 자신을 해친 경우'가 재해사망보험금 지급사유에 해당할 수 있다는 것은 확고한 대법원의 입장이므 로(대법원 2006. 3. 10. 선고 2005다49713 판결 등 참조) 이와 나란히 규정되어 있는 '보장개시일부터 2년이 경과된 후에 자살하거나 자신을 해침으로써 합산 장해지급률이 80% 이상인 장해상태가 되었을 떄'에 관하여도 마찬가지로 해석하는 것이 일반적인 관념에 부합하는 점, 고의에 의한 자살 또는 자해에 대하여는 이 사건 특약 약관 제12조 제1항 제1호 본문의 규정이 아니더라도 상법 제659조 제1항, 제732조의2, 제739조의 규정에 의하여 보험자가 면책되도록 되어 있어 이 사건 특약 약관 제12조 제1항 제1 호 중 보험계약 당사자 간의 합의로서 의미가 있는 부분은 면책사유를 규정한 본문이 아니라 책임 부담사유를 규정한 단서라는 점을 보태어 보면, 위와 같은 해석이 합리적이고, 이것이 약관 해석에 관한 작성자 불이익의 원칙에도 부합한다(대법원 2016. 5. 12. 선고 2015다243347 판결 참조).

4. Nevertheless, the lower court determined otherwise, that the proviso to Article 12(1)1 of the Terms and Conditions of the instant special agreement is merely an erroneous indication, and thus there is no room to apply the instant special agreement to the occurrence of a disaster as an insured event. In so determining, the lower court erred by misapprehending the legal doctrine on the interpretation of the terms and conditions of the insurance contract, thereby adversely affecting the conclusion of the judgment.

5. Therefore, the lower judgment is reversed, and the case is remanded to the lower court for further proceedings consistent with this Opinion. It is so decided as per Disposition by the assent of all participating Justices on the bench.

Justices Kim In-bok

Justices Park Jae-hee in charge

Justices Park Young-young

Justices Kim Jong-il