logobeta
본 영문본은 리걸엔진의 AI 번역 엔진으로 번역되었습니다. 수정이 필요한 부분이 있는 경우 피드백 부탁드립니다.
텍스트 조절
arrow
arrow
(영문) 서울남부지방법원 2017.05.12 2016가단218076
부당이득금
Text

1. The Defendant shall pay to the Plaintiff KRW 12,280,00, and KRW 5% per annum from April 13, 2016 to May 12, 2017, and complete payment from the next day.

Reasons

1. Facts of recognition;

A. At around November 17, 2008, the Defendant concluded with the Plaintiff, the insurer, a non-paid franchise insurance (insurance policy number: B) with the following content.

(1) Compensation (provisional) expenses for hospitalization of a disease: 50% of the subscription amount per day for hospitalization, 16% of the subscription amount per hospitalization, 100% of the subscription amount per day for hospitalization, and 16% of the subscription amount per day for hospitalization, where treatment is provided due to a disease for more than one day from November 17, 2008 to November 17, 2064: 16 days; 16% of the subscription amount per day for hospitalization, where diagnosis and confirmation of 16 days for hospitalization, and where treatment is provided due to a disease for more than 4 days: 50% of the subscription amount per day for hospitalization, 50% of the subscription amount for more than 61 days, 10% of the subscription amount for hospitalization, additional payment, 121 days or more, 10% of the subscription amount for more than 91 days, and 20% of the subscription amount per day for more than 181 days.

B. The Defendant received insurance proceeds of KRW 22,170,000, including the sum of KRW 6,000,500 under the name of expenses for hospitalization of a disease, 3,500,000 under the name of expenses for hospitalization of a disease, and KRW 12,670,00,00 under the name of expenses for hospitalization of a disease, in a way that he/she was hospitalized for a long time more than the actual period of hospitalization and received a written confirmation of hospitalization by claiming insurance proceeds by deceiving the Plaintiff and claiming insurance proceeds, along with the documents attached thereto. From February 21, 2011 to March 25, 2013, the Defendant received insurance proceeds of KRW 14,00 under the name of expenses for hospitalization of a disease.

C. On September 26, 2014, the Defendant was sentenced to a suspended sentence of two years in prison in October 10, 2014 for the instant act of receiving insurance proceeds.

In the process of investigation of the above criminal case, the Health Insurance Review and Assessment Service examined the appropriateness of the defendant's hospitalization and presented an opinion that the appropriate period of hospitalization is seven days for each hospitalization period.

E. The plaintiff's insurance money amounting to seven days of proper hospitalization period of the Health Insurance Review Board.

arrow