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1. The plaintiff's appeal is dismissed.
2. The costs of appeal shall be borne by the Plaintiff.
Purport of claim and appeal
The first instance court.
Reasons
1. Facts of recognition;
A. On October 17, 2005, the Plaintiff entered into an Rober Health Insurance Contract (hereinafter “instant contract”) containing the following terms and conditions (hereinafter “instant terms and conditions”) with the Defendant.
Article 13 (Types and Grounds for Payment of Subsidy Insurance Money) (1) The communications agency shall pay insurance money agreed upon to the beneficiary (beneficiary) when any of the following causes occurs to the beneficiary (insured) during the insurance period:
(See Table 1. “The Standard Table for Payment of Insurance Money”
3. Deposits for hospitalization: Attached Table 4 (Ad Hoc of Disease and Disaster Classification) as shown in the annexed Table of this case;
When he/she is hospitalized for a direct purpose due to a disease or disaster (hereinafter referred to as "disease or disaster") as determined by the Regulations.
4. Long-term hospitalization installment: Article 14 (Detailed Provisions concerning the Payment of Insurance Money for Elimination of Long-Term Hospitalization when hospitalized directly for at least 31 days due to disease or disaster) No. 14 (No. 5) shall apply to hospitalization installment and long-term hospitalization benefits:
1. In the case of the payment of hospitalization, 120 days per hospitalization shall be paid at the maximum limit, and the payment of long-term hospitalization shall be 90 days per hospitalization at the maximum limit;
2. Where hospitalization is made twice or more due to the same disease or disaster, it shall be deemed as one time hospitalization and the provisions of subparagraph 1 shall apply after adding up the days of each hospitalization; and
However, even in the case of hospitalization due to the same disease or accident, the hospitalization commenced after the lapse of 180 days from the date of discharge of the final hospitalization for which the hospitalization payment or the long-term hospitalization payment was paid shall be deemed to be a new hospitalization.
B. The Plaintiff was hospitalized at the hospital following ① and received insurance proceeds from the Defendant as indicated in the following table in the content of the payment of the insurance proceeds.
It is not based on the medical examination and treatment of the hospital's name, but by the medical doctor's final written diagnosis, hospitalization certificate, medical opinion, etc.