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(영문) 수원지방법원 2016.06.02 2013가단28243
보험금
Text

1. The Defendant’s KRW 4,430,00 and the Plaintiff’s annual rate of KRW 6% from January 11, 2013 to June 2, 2016.

Reasons

1. Basic facts

A. On February 6, 2006, the Plaintiff entered into a non-payment long-term health insurance contract (hereinafter “instant insurance”) with the Defendant and the insured, B, the beneficiary, and the insurance period on February 6, 2043. The content relating to hospitalization is as follows.

Special agreement of hospitalization: 20,000 won per day exceeding 3 days and 20,000 won per 4 days when a person is hospitalized for at least four days due to a disease or accident (120 days: 10,000 won per day exceeding 3 days and per 4 days when he/she is hospitalized for at least four days due to a serious disease: Adult disease: 30,000 won per day exceeding 3 days when he/she is hospitalized for at least four days due to an adult life disease (120 days limit).

B. The fourth serious disease and adult living disease as stipulated in the terms and conditions of the instant insurance are as follows.

§ 15(1) In this Agreement, the term "fourth-class disease" means a disease specified in attached Table 3 [The Schedule for the Classification of the Fourth Standard Disease Disease Death (Type I)].

Article 16(1) In this Agreement, the term "sexual life diseases" means diseases specified in the attached Table 4 [The Schedule of Gender Inhuman Specific Diseases (Type 2, Type 3)] in the Fourth Standard Disease Classification.

C. B received hospitalized treatment at each hospital over four occasions as indicated below (hereinafter “instant hospitalized treatment”), and the Plaintiff claimed insurance payment to the Defendant.

The Defendant paid all the insurance proceeds to pay the insurance proceeds of KRW 860,000 on August 26, 201, and KRW 1,290,000 on December 22, 2011 with respect to the hospital treatment set forth in No. 1 as indicated in No. 201, the Defendant paid the insurance proceeds of KRW 860,000 on August 26, 201, and KRW 1, and the major illness set forth in No. 1 falls under adult living diseases. Accordingly, in accordance with the content of the instant insurance coverage, the Defendant paid KRW 2,00,000 ( KRW 40,000 on the date of hospitalization - 43 days on the date of hospitalization) 】 50,000 on the basis of the content of the instant insurance coverage.

On December 22, 2011, KRW 3,850,000 was paid respectively with regard to the entry Nos. 2.

The number of hospitalization days is appropriate for the major hospital name (Classification Number) of medical institutions.

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