2015Da254392 (Mains) Confirmation of the existence of an obligation

2015Da254408 Insurance proceeds

ASEAN life insurance company

1. A;

2. B

3. C.

4. D;

Defendant Counterclaim Plaintiff 2 through 4 are minors, and a legal representative parent A

Busan High Court (Chowon) 2015Na21526, 1195 decided November 26, 2015

June 23, 2016

The judgment below is reversed, and the case is remanded to Busan High Court.

The grounds of appeal are examined.

1. A standardized insurance contract shall be interpreted fairly and reasonably in light of the purpose and purpose of the standardized insurance contract in accordance with the principle of trust and good faith, and it shall be interpreted objectively and uniformly based on the average customer's interest, regardless of the intended purpose or intent of the individual contracting party, taking into account the interests of the entire insurance organization. Even after the aforementioned interpretation, if the meaning of the standardized insurance contract is not clear, such as where the standardized insurance contract is different from one another and it is reasonable to interpret each other, it shall be interpreted favorably to customers (see, e.g., Supreme Court Decision 2015Da24347, May 12, 20

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

A. On October 23, 2007, the deceased, who is the inheritee of the Defendants, subscribed to the Plaintiff’s standard type insurance contract for non-dividendd life insurance (hereinafter “instant prime contract”) with the deceased as the deceased, whose heir is the beneficiary at the time of death, and separately paid the additional premium, and also subscribed to a special agreement for non-dividendd disaster death (hereinafter “instant special agreement”).

B. Article 14 of the Clause of this case provides that when the insured is in a state of disability with a rate of 80% or more of the total disability during the insurance period, general death insurance proceeds shall be paid. Article 10 of the Clause of this case provides that when the insured is in a state of disability with a rate of 80% or more of the total disability payment due to a disaster specified in the Disaster Classification Table during the insurance period, the insured shall additionally be paid the insurance proceeds for death from a disaster. The Clause of this case provides that "accidents subject to the coverage" shall be "1. Korea Standard Disease Disease and Private Classification (S0-Y84)", "An insured person with an intention to commit suicide (X60-X84)" shall be excluded from the above accident. Further, Article 16 (1) of the Clause of this case and Article 12 (1) of the Clause of this case provides that "An insured person with an intention to recover from a mental disease without any further consideration or with no exception to the termination of the contract, the insured shall not be obliged to independently from the contract."

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 main contract, it is different from the instant main contract, which is a kind of accident insurance belonging to the insurance type of insurance business under Article 3 insurance business under the Insurance Business Act, which is a separate insurance contract that differs from the nature of the insurance, and accordingly 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 main contract. Article 10 of the instant special agreement provides that the time when a disaster directly causes a death or a disability exceeding 80% of the total disability payment rate is caused by intention or self-injury, and thus, it 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 provides that if the cause for the payment of insurance money only applies to the case where the cause for payment occurred under Article 10 of the instant special agreement, it does not exist.

However, in order to simply deny the validity of the specific terms and conditions that exist strictly by the Regulation of Terms and Conditions Act, it should be understood that the terms and conditions should be interpreted as an infinite provision that is not subject to the provision even if it is based on the average customer's understanding possibility. Thus, Article 12 (1) 1 of the Terms and Conditions cannot be viewed as the same.

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,

In addition, the Supreme Court has interpreted that "a case of undermining himself/herself while he/she is unable to make a free decision due to mental illness, etc." may fall under the cause for payment of disaster death insurance proceeds (see, e.g., Supreme Court Decision 2005Da49713, Mar. 10, 2006). Thus, it conforms to the general concept that "in case of suicide after the lapse of two years from the date of commencement of the term "in case where the total disability payment rate is at least 80% due to suicide or harm to himself/herself," and that "in case of suicide or self-injury by intention, even though the provisions of the main sentence of Article 12 (1) 1 of the terms of the special agreement of this case are excluded from the insurer pursuant to the provisions of Articles 659 (1), 732-2 and 739 of the Commercial Act, the part between the parties as an insurance contract under Article 12 (1) 1 of the special agreement of this case, and therefore, it conforms with the principle 20131 (25).

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 erroneous as to the Plaintiff’s use of the former standardized terms and conditions of life insurance as it is in the process of establishing the terms and conditions of the instant Special Agreement, and there is no room for applying the instant special agreement to the death, etc. caused by a disaster as an insured event. In so determining, the lower court erred by misapprehending the legal

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 Jae-young

Justices Lee In-bok, Counsel for the appeal

Justices Kim Yong-deok

A person shall be appointed.