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(영문) 대법원 2020.10.29 2019다267020
보험계약 존재확인의 소
Text

The appeal is dismissed.

The costs of appeal are assessed against the Plaintiff.

Reasons

The grounds of appeal are examined.

1. Review of the reasoning of the lower judgment and the record reveals the following facts.

On November 14, 2015, the Plaintiff concluded the instant insurance contract with the Defendant, the insured, the beneficiaries of the disability insurance proceeds, and the beneficiaries of the death insurance proceeds, respectively, based on a selective contract that guarantees the payment of the fixed amount of insurance proceeds in the event of injury, death or disability, medical expenses, daily allowances for hospitalization due to injury or disease.

B. Although it is possible for the Plaintiff to receive hospital treatment, the Plaintiff was convicted of having been convicted of having been convicted of having been convicted of having received insurance money, such as a large amount of medical expenses for hospitalization, than the insurance money actually payable by eight insurance companies including the Defendant, by means of long-term hospitalization, etc.

(hereinafter referred to as “related criminal case”). (c)

The defendant filed a lawsuit against the plaintiff for the return of unjust enrichment on the ground of the fraudulent fraud of insurance money paid during the period in which a public prosecution was instituted in the relevant criminal case, and the judgment became final and conclusive.

The Plaintiff claimed insurance money of this case against the Defendant on the ground that the special agreement on guaranteeing medical expenses for hospitalization (hereinafter “instant special agreement”) during the instant insurance contract is subject to the payment of insurance money. Of the criminal facts found guilty in the relevant criminal case, the amount obtained by the Plaintiff from the Defendant’s claim for insurance money is equivalent to KRW 11,045,855 in total.

E. On July 27, 2018, the Defendant notified the Plaintiff of the termination of the instant insurance contract based on Article 14(1)1 and 3 of the General Terms and Conditions of the instant insurance contract, and Articles 653 and 659 of the Commercial Act, on the ground that the Defendant was found guilty in the relevant criminal case.

F. Article 14(1) of the General Terms and Conditions of the instant insurance contract provides the insured or the contractor’s intent.

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