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(영문) 서울중앙지방법원 2019.01.25 2018나49248
보험금
Text

1.The judgment of the first instance shall be modified as follows:

The defendant shall pay to the plaintiff KRW 2,349 as well as to the plaintiff on September 1, 2017.

Reasons

1. Facts of recognition;

A. On March 13, 2007, the Defendant entered into a contract with the Defendant on March 13, 2007 with the Plaintiff, the beneficiary of the maturity refund and the beneficiary of the follow-up disability insurance (hereinafter “instant insurance contract”) with the statutory heir, the beneficiary of the death insurance from March 13, 2007 to March 16, 16,00 to March 13, 2058 (hereinafter “instant insurance contract”). Among them, the coverage related to the medical expenses incurred in the course of disease (hereinafter “the instant special agreement on medical expenses incurred in the course of disease”). The main contents of the special agreement applicable thereto are as follows:

1. Medical care costs for a disease: 100,00 won [the compensation shall be paid not later than 30 days in total within the limit of 365 days from the date of outbreak where the medical treatment was provided to a hospital or clinic (excluding oriental medical hospitals, oriental medical clinics, dental clinics/wons) due to a disease] [1] our company (hereinafter referred to as the "company") provides the insured (hereinafter referred to as the "insured") listed in the insurance policy (insurance Policy)] / [1] Where the insured (hereinafter referred to as the "insured") under the insurance policy (Insurance Policy) has received medical treatment to a hospital or clinic (excluding oriental medical hospitals, oriental medical clinics, dental clinics, dental clinics, and dental clinics) due to a disease that occurred during the insurance period of the special insurance policy, the following expenses for medical care costs for the disease patients (excluding oriental medical hospitals, oriental medical clinics, dental clinics) shall be compensated for:

(1) Expenses for medical examination: Medical examination fees, examination fees, radiation fees, medication and prescription fees, main feed, private-school medicine fees, mental therapy fees, treatment fees, materials materials expenses, ggners, and designated medical treatment expenses. ② Expenses for outpatient surgery: Medical treatment expenses, / [4] Company shall compensate for an amount calculated by multiplying the amount obtained by deducting 5,000 won for the expenses to be borne by the insured under the National Health Insurance Act (which refers to the medical care benefits prescribed in the National Health Insurance Act) from among the expenses prescribed in paragraphs (1) and (2) per day of outpatients by 100,000 won for the expenses to be borne by the insured under the National Health Insurance Act.

The application of the above amount of deduction shall be one day.

(hereinafter omitted)

B. The Plaintiff on January 2017

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