암보험금의 지급과 약관해석의 쟁점- 유암종의 암해당 여부에 대한 작성자불이익 원칙의 적용을 중심으로 -

Abstract

Insurance policy are a type of ordinary transaction terms and conditions and the Act on the Regulation of Terms and Conditions apply to it. Therefore, in interpreting the insurance terms and conditions, if the meaning of terms and conditions is not clear, it shall be construed in favor of customers (Act on the Regulation of Terms and Conditions Article 5, Paragraph 2) and as there are many insurance subscribers, the terms and conditions must be interpreted objectively and should not be construed differently depending on the insurance subscriber (Act on the Regulation of Terms and Conditions Article 5, Paragraph 1). The Supreme Court has also ruled based on the rule of being in favor of customers in order to protect customers if the contents of the terms and conditions are unclear or suspicious and excluding when it is interpreted restrictively guilt of the drafter of the terms and conditions, it shall be interpreted objectively and uniformly. The insurance policy of Korea describes various pledges with unclear terminology. Due to such unclear terms and conditions, there are continuing cases in which the duty to pay insurance is recognized according to ‘Contra Proferentem (guilt of the drafter)’. In the recent case of carcinoid, the Supreme Court judged to pay insurance to the subscriber according to Contra Proferentem. This ruling is on a specific matter and therefore has the issue in which a few matters must be reviewed before applying to all carcinoid, and therefore, this study reviewed the issues through similar cases that actually occurred. In the event that a disease not classified as cancer is classified as cancer through the revision of the Korean Standard Classification of Diseases (KCD), current cancer insurance terms and agreements include it in its coverage. Therefore, once carcinoid, which was classified a borderline tumor, is classified as cancer by changing the KCD, it would be feasible not to apply the insurance claim right statute of limitations, and in this case, the insurer must pay interests on delays from the initial date of claim. And when diagnosed as unclear malicious potential carcinoid tumor (M8240/1), it would correspond to cancer only when receiving another diagnosis as M8240/3. A rational criteria to judge whether to pay insurance for all carcinoid is needed in the future, and the terms and conditions should be revised in the near future to judge whether it corresponds to cancer according to the KCD that is effective as of the date of diagnosis confirmation.