[1] The degree of proof of "the insured's intentional harm to himself/herself" as the insurer's exemption from liability

[2] The meaning of "injury" as a risk guaranteed by an accident insurance, and the burden of proof on the apparentness and causal relationship of the accident (=the claimant for insurance)

[3] Whether an insurer may be exempted from liability to pay the insured amount by terminating the insurance contract even if there is no causation between the breach of duty of disclosure and the occurrence of the insurance accident (negative)

[4] In a case where the issue was whether the insured Party A was liable to pay insurance proceeds for the occurrence of an insurance accident, in the event that the insured Party A was found to die in an outdoor condition after drinking alcohol after drinking alcohol, the case holding that the insurance company B was liable to pay insurance proceeds for the above insurance accident, on the ground that the insured Party A suffered an injury as a "emergency and remote accident" under the insurance contract and died directly as a result, and that it did not have any effect on the occurrence of the insurance accident, although the insured Party A was in violation of the duty of disclosure at the time of entering into the insurance contract

[1] Where the general insurance clause of an insurance contract provides for "the case where the insured intentionally injures himself/herself" as the insurer's reason for exemption, the insurer is responsible to prove the facts constituting the above reason for exemption in order to be exempted from liability to pay the insurance proceeds. In this case, the insurer must prove the facts of the surrounding circumstances to the extent that there is no reasonable doubt about the existence of objective physical evidence, such as the statement of intent to commit suicide, or about the possibility of not committing suicide in ordinary sense.

[2] A risk guaranteed in an accident insurance refers to physical damage caused by an unexpected accident from the outside. As such, the cause of the accident refers to that the cause of the accident acts from the outside of the body of the insured, and is excluded from the internal cause, such as physical disease. The applicant bears the burden of proof as to the causal relationship between the external nature of the accident and the result of injury or death.

[3] Where the policyholder or the insured has failed to notify material facts intentionally or by gross negligence at the time of the insurance contract, or has made false notification, the insurer may be exempted from the liability to pay the insured amount by cancelling the insurance contract even after the occurrence of the insured events. However, when it was proved that the occurrence of the insured events was not affected by the duty of disclosure, that is, when the occurrence of the insured events is not acknowledged, the insurer may not be exempted from the liability to pay the insured amount even if the

[4] In a case where the issue was whether the insured Party A was liable to pay insurance proceeds for the occurrence of an insurance accident, in case where: (a) the insured Party A was injured by “a sudden and remote accident” as stipulated in the insurance contract; (b) died as a result; and (c) the insured Party A did not properly notify the fact that he was treated by urology at the time of the conclusion of the insurance contract; but (d) it did not affect the occurrence of the insurance accident; (b) the insurance company B was liable to pay insurance proceeds from the above insurance accident.

[1] Article 659(1) of the Commercial Act, Article 288 of the Civil Procedure Act / [2] Article 737 of the Commercial Act, Article 288 of the Civil Procedure Act / [3] Articles 651 and 655 of the Commercial Act / [4] Articles 651, 655, 659(1), and 737 of the Commercial Act, Article 288 of the Civil Procedure Act

[1] Supreme Court Decision 2001Da49234 Decided March 29, 2002 (Gong2002Sang, 999) / [2] Supreme Court Decision 2001Da27579 Decided August 21, 2001 (Gong2001Ha, 2047) / [3] Supreme Court Decision 2010Da25353 Decided July 22, 2010 (Gong2010Ha, 1656)

[Defendant-Appellee] Insurance Co., Ltd. (Attorney Dong Dong-soo, Counsel for defendant-appellee)

Defendant (Law Firm Han, Attorneys Choi Jong-soo et al., Counsel for the defendant-appellant)

March 4, 2011

1. The plaintiff's claim is dismissed.

2. The costs of lawsuit shall be borne by the Plaintiff.

On February 27, 2010, the Nonparty confirmed that there is no obligation of the Plaintiff to pay insurance money to the Defendant under an insurance contract as stated in the attached Table with respect to an accident that died in a state where the Nonparty died in a state where he was frighted from 18-10 Yari, Yari-ri, Yari-ri, Yari-ri, P

1. Basic facts

A. On September 3, 2009, the Plaintiff concluded an insurance contract with the Nonparty (hereinafter “the deceased”) as indicated in the attached list between September 4, 2009 and September 4, 2037 (hereinafter “instant insurance contract”).

B. The general terms and conditions incorporated into the terms and conditions of the instant insurance contract provide that ① in the event the insured suffers bodily injury due to a sudden and unexpected accident during the insurance period, the insured shall be compensated for such bodily injury (Article 14(1)); ② the insured shall not be compensated for damage caused by the insured’s intentional act or suicide (Article 15(1)1 and 4); and ③ Meanwhile, in the event the insured suffered bodily injury and died within two years from the date of the accident as a direct result, the amount of the death insurance (Article 16(1)) shall be paid.

다. 망인은 2010. 2. 25. 집을 나가 돌아오지 아니하다가, 2010. 2. 27. 16:20경 공주시 사곡면 화월리 산 18-10 야산에서 앞으로 웅크린 채 엎어져 있는 시체 상태로 발견되었다(이하 ‘이 사건 사고’라 한다). 망인의 시체 주변에는 빈 4홉 소주병 2병과 귤껍질이 널려 있었다.

D. The Defendant, as the deceased’s spouse, claimed payment of the general injury death benefit to the Plaintiff after the instant accident, as the beneficiary of the instant insurance contract.

[Reasons for Recognition] Facts without dispute, Gap 1 to 3 evidence, Gap 5 evidence, the purport of the whole pleadings

2. Determination as to the claim

A. The parties' assertion

(1) Plaintiff

The instant accident is not a death caused by injury, but an accident caused by suicide or heart disease of the deceased, who is the insured, and falls under the grounds for exemption from payment prescribed in the terms and conditions of the instant insurance contract, or does not fall under the “emergency and remote accident” among the requirements for the insurance accident. However, even though the deceased was treated as urology, the Plaintiff’s termination of the instant insurance contract because it did not notify the Plaintiff of the fact that the deceased was treated as urology, and thus, the Plaintiff did not have an obligation to pay the insurance to

(2) Defendant

The Deceased’s death of the body temperature, etc. from outdoor in the state of 0.35% alcohol concentration, and the instant accident constitutes “emergency and incidental accidents.” Moreover, the Deceased’s treatment for urology cannot be deemed as an important matter, and there is no causal link between the breach of the duty of disclosure and the instant insurance accident. As such, the Plaintiff is liable to pay the Defendant insurance money based on the insurance contract of this case.

B. Determination

(1) Whether the deceased died of suicide or not

Where a general insurance contract provides that "the insured intentionally injures himself/herself" as an exemption of the insurer's liability for the payment of insurance proceeds, the insurer is responsible to prove the facts constituting the exemption of the above exemption of the insurer. In this case, it is necessary to prove the existence of objective physical evidence, such as a note that expresses his/her intention to commit suicide, or to prove the facts of the surrounding circumstances clearly to the extent that there is no reasonable doubt about the possibility of not committing suicide in ordinary sense (see Supreme Court Decision 2001Da49234, Mar. 29, 2002).

According to the evidence Nos. 11, 12, 13, 48, and 1 evidence Nos. 7-11, 12, 13, 48, and 1 of this case, it can be acknowledged that the deceased was under a mental treatment due to a mix uneasiness. However, it is difficult to readily conclude that the deceased was under a suicide by disregarding his business failure without any witness in the situation before and after the accident. Moreover, unless there is no objective evidence to presume that the deceased committed suicide, even with all evidence submitted by the plaintiff, it is difficult to view that the surrounding circumstantial facts have been proved clearly to the extent that there is no reasonable doubt about the possibility that the death of the deceased was not a suicide from the common sense of ordinary people.

Therefore, the plaintiff's assertion that the death of the deceased was caused by suicide is without merit.

(2) Whether the deceased died of bodily injury

As a risk guaranteed in an accident insurance, injury refers to physical damage caused by an unexpected accident from the outside. Thus, the cause of the accident refers to the act that the cause of the accident acts from the outside of the body of the insured, is excluded from the internal cause, such as physical disease, and the causal relationship between the external nature of the accident and the result of the injury or death is the burden of proof for the claimant (see Supreme Court Decision 2001Da27579 delivered on August 21, 2001).

The plaintiff asserted that the accident of this case was caused by the heart of the deceased's heart and the heart disease caused by the high level of connection with the heart, and that it was not caused by injury. However, in light of the following circumstances acknowledged by comprehensively taking into account the overall purport of the arguments as follows, the deceased may be presumed to have died of the death of the deceased due to the pulmonary suppression caused by the pathal suppression action or the death of the body temperature due to the outdoor disorder in the main condition (it is reasonable to deem that the death of the deceased was the above external factors even if the heart disease of the deceased contributed to the death of the deceased).

① The Deceased dysty dynasty was dynasty in Yansan, and the blood alcohol concentration at the time of autopsy was 0.35%.

② At the time of the autopsy, the Deceased was found using a stroke-mm with a stroke disorder or stroke-m with a stroke disorder, and the stroke-m was found at the time of the autopsy, and it seems that the stroke-m was likely to suppress the function of the stroke-m with alcohol and the stroke-m.

③ In light of the possibility that the deceased, who had a habitive wall required for diving upon withdrawal of alcohol, drinked alcoholic beverages more than the average amount of alcohol in the night, and was locked as they were, on February 25, 2010, and February 26, 2010, the lowest temperature in the Daejeon District was 12.3 x, 7.1 x, respectively, and both days were fright, there is a possibility that the deceased might have died due to an outdoor low temperature and damp exposure, regardless of being under the influence of alcohol. (4) Although the deceased was discovered at a low level and high level, even in the case of a person without a heart disease, it is difficult to readily conclude that there is a possibility of an acute disease as an independent heart of the deceased due to a cause of an acute death, even in the case of a person without a heart disease.

Therefore, it is reasonable to view that the deceased died as a direct result of the injury after suffering from an injury as “a sudden and friendly accident” under the insurance contract of this case.

(3) Termination of an insurance contract due to breach of duty of disclosure and existence of an obligation to pay insurance money

Where a policyholder or the insured fails to notify important matters intentionally or by gross negligence at the time of the insurance contract, or makes a false notification, the insurer may be exempted from the liability to pay the insured amount by cancelling the insurance contract even after the occurrence of the insured events: Provided, That when it has been proved that the occurrence of the insured events was not affected by the duty of disclosure, that is, when the causal relationship between the fact of the violation of the duty of disclosure and the occurrence of the insured events is not acknowledged, the insurer may not be exempted from the liability to pay the insured amount even if the insurance contract is terminated (see Articles 651 and 655 of the Commercial Act, and Supreme Court Decision 2010Da25353, Jul.

Despite the fact that the deceased had been continuously treated as “insulgin-nurine urine with no sulmatosis” from February 5, 2009 before the date of the conclusion of the instant insurance contract, the fact that the plaintiff was unaware of the fact that there was no dispute between the parties to the instant insurance contract that there was no medical treatment for urology, etc. within the last five years at the time of the conclusion of the instant insurance contract (this is presumed to be an important matter by Article 651-2 of the Commercial Act because the plaintiff respondeds to the matters asked in writing). The fact that the legal brief dated November 4, 2010 to the effect that the plaintiff terminated the instant insurance contract on the grounds of the violation of the above duty of disclosure is clearly recorded on the record

However, the reason for the death of the deceased, i.e., the cause of the death of the deceased, which was acknowledged as above in the urology that the deceased did not notify, i.e., the urology, and without any substantial causal relationship between the death or the physical temperature due to the pulmonary suppression based on the pulmonary function suppression action, was obvious in light of the empirical rule and the fact that the deceased violated the duty of disclosure was not affected by the occurrence of the insurance accident of this case. Thus, even if the insurance contract of this case was terminated in violation of the duty of disclosure, the plaintiff is liable to pay

3. Conclusion

Thus, the plaintiff's claim seeking that the insurance premium payment obligation under the insurance contract of this case does not exist in relation to the insurance accident of this case is dismissed as there is no ground.

[Attachment] Insurance Contract: omitted

Judges Kim Il-il (Presiding Judge)