Text
1. The Plaintiff against the Defendant and the Defendant are integrated insurance of non-dividend-free dividends that was concluded on April 29, 2010.
Reasons
1. Basic facts
A. On April 29, 2010, the Defendant concluded an insurance contract with the Plaintiff to pay insurance money, such as expenses for diagnosis of cerebrovascular diseases (hereinafter “instant insurance contract”). Under the terms and conditions of payment of expenses for diagnosis of cerebrovascular diseases, the Defendant stated “the amount of insurance coverage when it is diagnosed and confirmed as cerebrovascular diseases.”
B. On January 26, 2015, the Defendant: (a) filed a medical certificate stating the Defendant’s name on February 16, 2015 (hereinafter “the instant medical certificate”); (b) on February 23, 2015, the Defendant filed an appeal for symptoms, such as two pains, and (c) received hospitalized treatment until February 16, 2015; and (d) on February 23, 2015, the C Hospital physician D issued a medical certificate stating that “The patient is in need of continuous medicine law, stability cost, and other treatment from the date of outbreak of the patient’s disease under the name of the Defendant.”
C. On February 25, 2015, the Defendant claimed expenses for diagnosis of cerebrovascular diseases under the special terms and conditions of the instant insurance contract on the basis of the instant diagnosis to the Plaintiff.
In relation to the definition and determination of brain cerebrovascular diseases, the terms and conditions of the instant insurance contract stipulate as follows with regard to the determination of the definition and determination of the cerebrscular diseases.
1. The term "cerebrovascular disease" in this Special Terms and Conditions refers to a disease specified in attached Table 15 [Attachment 15] (Classification Table of cerebrovascular Disease) in the classification of the fifth Korean Standard Medical Disease.
(2) The diagnosis and confirmation of cerebrovascular diseases must be conducted by a person with a certificate of qualification (other than dentists) of a hospital under Article 3(2) of the Medical Service Act or of a medical institution deemed equivalent thereto, and this diagnosis shall be conducted together with a medical and neological examination, e-mail-e-mail e-mail e-mail e-mail.