Daebeop "Discounted medical expenses, not subject to indemnification for loss insurance."

2024.11.24. PM 12:20
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The Supreme Court ruled that medical expenses discounted by medical institutions for reasons such as acquaintance discounts cannot be considered as the subject of insurance claims.

The Supreme Court sent the case back to the Seoul High Court on the 31st of last month, breaking the original ruling that insurance company A lost the plaintiff in a lawsuit against Choi to confirm the absence of a debt.

The Supreme Court judged that it was against the principle of the non-life insurance system to give benefits beyond compensating for the insured's losses.

Choi signed an insurance contract with A in 2005 with a special agreement that "compensates the entire cost of surgery, etc., borne by the insured under the National Health Insurance Act."

Choi received inpatient treatment at an oriental medicine hospital in Seoul for five years from January 2016 and claimed insurance money, but refused to pay for the discount of 18 million won for an acquaintance of Company A.

Company A filed a lawsuit saying it was not responsible for paying the insurance money, and the first trial ruled in favor of Company A, saying, "The special contract insurance money should be calculated based on the actual medical expenses, not the medical expenses before the discount."

However, the second trial reversed its judgment, saying that it should be interpreted in favor of subscribers because the expression of "pay by the insured" in the special agreement is ambiguous.



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