상해보험에서 자살사고에 대한 증명책임의 귀속과 실무상 증명내용에 대한 고찰 - 대법원 2022. 11. 10. 선고 2022다241493 판결을 중심으로 -

Abstract

Accident insurance, which is defined as an insurance accident in the accident insurance clause, requires contingency in the sense of an accident that is not intentional. At the same time, “in case the insured intentionally harms himself” is stipulated as the reason for indemnification of the insurer, and in the proviso that the insured is “in a state where he or she is unable to make free decisions such as mental or physical loss,” the exemption is allowed and the insurance money is paid. stipulated as a reason As such, the structure of the provisions of the accident insurance clause is complicatedly intertwined, and the connotation and extension of the requirements set forth in each reason for payment and reason for exemption are not clearly established, causing various problems regarding the burden of proof. In this paper, we reviewed how to distribute the burden of proof in order to recognize the liability of the insurer when the insured person dies by suicide. In this way, we looked at what was missed by the judgment in question, which only focused on medical findings. Accident insurance clauses stipulate that an accident that occurred intentionally is a reason for exemption from liability of the insurer, so the insurer must prove that the accident occurred intentionally. On the other hand, the state of being unable to make free decisions is a normative level of judgment that is distinguished from intention. Even if the insured was conscious of ending his own life and committed suicide intentionally, the fact that he was in a state of exclusion from free decision-making dilutes the possibility of blame for the insured's intentional death and mitigates the degree of destruction of good faith in the insurance contract. In other words, even though suicide is an intentional accident, it is exceptionally included in the scope of insurance coverage. According to precedent, the state of being unable to make free decisions is determined by comprehensively examining various facts. In the judgment at issue, when the motive for suicide, the method and mode of suicide, the progress of depression, and the greetings sent by the suicide just before suicide were comprehensively reviewed, it can be judged that the insured committed suicide in a state of free decision-making. The target judgment focused only on the fact that the deceased had been diagnosed with a “severe depressive episode” by a specialist during his lifetime, acknowledging the inability to make free decisions without properly examining other factors. The state of inability to make free decisions means what factual factors have influenced the formation process of the inner psychological state and to what extent they are influencing. Therefore, the tendency to rely exclusively on medical findings and to regard them as absolutes is unreasonable. It is necessary to make a comprehensive judgment on the various facts surrounding the suicide.