Insurance Lawsuit | A Case of Being Sued by an Insurance Company but Obtaining Dismissal

The specialized attorney personally took up the consultation as soon as the client requested it. The facts of the case, as ascertained, were as follows.

The client was engaged in manual labor and, given that the nature of the occupation carried a high likelihood of illness, wished to take out insurance.

While looking into insurance, the client signed up, in a casual frame of mind, for the insurance at issue in this case, which he had come across through a home shopping advertisement.

The client subsequently suffered an industrial accident at work and developed a serious illness, and thereafter he continued to be introduced to insurance products by the insurance company in this case and signed up for several additional policies.

While continuing to receive inpatient treatment due to the industrial accident, the client claimed hospitalization expenses from the insurance company in this case, but the company abruptly refused to pay the hospitalization expenses, stating that it would seek the opinion of a physician.

Thereafter, the insurance company filed the insurance lawsuit at issue in this case, asserting that the client was wrongfully claiming insurance proceeds, and sought confirmation that the insurance contract was void and the return of approximately 30 million won in insurance proceeds received to date.

The client, who was actually receiving inpatient treatment due to the industrial accident, felt aggrieved and came to the firm's insurance attorney to seek assistance in defending the insurance lawsuit.

The insurance company that filed the insurance lawsuit stated that the client, beginning with hospitalization for an illness arising from an industrial accident, had repeatedly been hospitalized at and discharged from hospitals over a long period and had received approximately 80 million won in insurance proceeds.

The insurance company argued that the client's hospitalization periods were mostly excessive and that the client had also received large sums of insurance proceeds from other insurance companies.

It also argued that the client paid a monthly premium of approximately 500,000 won, but that, according to the insurance company's review, the client had no particular occupation and therefore lacked the ability to pay the premiums.

In addition, it argued that the client repeatedly was hospitalized and discharged several times under the same diagnosis, and that the fact that he went out and consumed alcohol during the hospitalization period was discovered, so the insurance contract in this case had been concluded for the purpose of unlawfully obtaining insurance proceeds.

Accordingly, the insurance company filed this insurance lawsuit seeking to declare the insurance contract between the client and the company void and to recover the insurance proceeds that had been unjustly received.

Among insurance lawsuits, a lawsuit for payment of insurance proceeds is a lawsuit filed by the policyholder against the insurer where the insurer refuses to pay the insurance proceeds.

Through this lawsuit, the policyholder can recover the insurance proceeds that the insurer is wrongfully refusing to pay.

Among insurance lawsuits, an action for confirmation of non-existence of debt is a suit filed by an insurer against a policyholder, asserting that the insurer has no obligation to pay insurance proceeds.

As in this case, when an insurer determines that a policyholder has wrongfully received insurance proceeds, the insurer may, through this suit, decline to pay the insurance proceeds.

Among insurance lawsuits, an insurance contract termination lawsuit is a lawsuit in which, if the policyholder failed to disclose an important matter, the insurer may terminate the contract within one month from the date it became aware of that fact and within three years from the date the contract was concluded.

A policyholder who did not explain in detail a disease they had at the time of the insurance contract may face an insurance contract termination lawsuit from the insurer.

The attorney emphasized that the insurance contract in this case was legitimate.

The client was a manual laborer who took out the insurance to prepare for health risks.

The client in fact came to suffer a serious illness due to an industrial accident, and to prove this, the attorney submitted a medical certificate and photographs depicting the client's current situation.

The attorney emphasized that the client's income data submitted by the insurer in bringing this insurance lawsuit did not reflect the client's actual income.

The insurer argued that, according to tax office records, the client had almost no income and therefore lacked the ability to pay the premiums, yet entered into this insurance contract with the aim of obtaining insurance proceeds.

However, the client had been receiving a salary of more than 2 million won per month, and the employer had simply reported it as lower than the actual salary.

To prove this, the attorney submitted the wage data reported during the processing of industrial accident compensation insurance after the industrial accident occurred.

The attorney emphasized that the client's hospitalization was for the purpose of treating illness and was therefore medically justified.

While it was true that the client repeatedly underwent admission and discharge on several occasions, this was all done in accordance with the medical judgment of the attending physician.

To prove this, the attorney submitted the client's specific surgical history and medical records.

In addition, although the insurer claimed that the client had consumed alcohol during the hospitalization period and that this hospitalization was aimed at obtaining insurance proceeds, the attorney emphasized that the client had consumed alcohol only once and in a small amount.

On these points, the attorney requested that the insurer's claims be dismissed in their entirety, on the grounds that the client was in a situation requiring continuous treatment and had not maliciously exploited the insurance system.