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(영문) 대구지방법원 2015.02.06 2014나15239
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

The defendant.

Reasons

1. Basic facts

A. On July 14, 200, the Plaintiff entered into an insurance contract with the Defendant, between July 14, 2000 and July 14, 2050, under which the policyholder and the insured were the Plaintiff, and the insurance period were the Plaintiff, from July 14, 2000 to July 14, 205, under which the insurance amount of the prime contract was KRW 20 million, and entered into an insurance contract with the Defendant as indicated in the separate sheet (hereinafter “instant insurance contract”).

B. On May 7, 2013, the Plaintiff asserted “disease” and “disaster” simultaneously with the Defendant on December 31, 2012, based on the circumstance where the Plaintiff was involved in the accident, and claimed insurance proceeds for diagnosis, surgery, and hospitalization. The Defendant determined that the surgery claimed by the Plaintiff was not for treatment of disability caused by a disaster, but for treatment of a disease caused by a satching change, and that the Plaintiff paid 5.88 million won in total the surgery allowances and hospitalization allowances to the Plaintiff according to the women’s age insurance.

C. On June 5, 2013, the Plaintiff again filed a claim with the Defendant for a disaster relief insurance proceeds under the instant insurance contract. On June 21, 2013, the Defendant rejected payment of the disaster relief insurance proceeds under the instant insurance contract on the ground of the reasons for determination under the said Paragraph (b).

[Ground of recognition] Facts without dispute, Gap evidence 1, 7, Eul evidence 1, 4, and 5 (including branch numbers), the purport of the whole pleadings

2. On December 31, 2012, the Plaintiff asserted that he/she was hospitalized in B on January 2, 2013 along with the existing disease (hereinafter “instant accident”) and discharged the instant accident on January 26, 2013 after receiving medical treatment for 25 days.

The instant accident constitutes “disaster” as stipulated in the terms and conditions of the instant insurance contract, and the Defendant amounted to KRW 10 million for a disaster surgery insurance proceeds under the instant insurance contract to the Plaintiff.

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