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화재보험의 사기적 청구 및 보험금청구권 상실범위에 관한 연구
전재중(Jae-joong Jeon),최영휘(Young-Hwee Choi) 서울대학교 법학평론 편집위원회 2011 법학평론 Vol.2 No.-
사기적보험금 청구를 이유로 한 보험금청구권 상실의 범위와 관련하여 대판 2006다72093 이전에는 대법원 및 하급심 판결에서 공히 계약단위 혹은 증권단위로 보험금청구권상실 여부를 판단하여 오다가 위 대법원 판결 이후 현재 국내 상하급심의 재판 기준은 ‘허위청구를 한 보험목적물에 국한하여 일부만 상실한다는 입장이 주류를 이루고 있다. 그런데 이러한 일부 상실의 기준에서 그 ‘일부’의 범주를 무엇을 기준으로 할 것인지에 대하여는 실무적으로 논란의 여지가 않은데 그 후 판결 실무에서는 보험청약서상의 보험목적물 명세란 부호를 기준으로 하고 있다. 따라서 동일한 보험목적물에 대하여 동일한 보험료를 지급한 사안에서 부호를 통합하여 기재한 보험사는 전부 상실, 부호를 나누어서 기재한 보험사는 일부 상실이라는 비합리적 결과가 나오기도 하였다. 그러나 보험모집인이 청약서의 보험목적물 명세를 기재하면서 부호의 범위를 넓게 하는가, 좁게 하는가에 따라 보험금청구권상실의 범위를 정하는 것은 합리성이 없을 뿐만 아니라 영미, 일본, 호주 등 국제적으로 어떤 나라에서도 보험금청구권 상실에서 그 상실범위를 다시 논의하는 예는 없고, 전부 계약단위 혹은 증권단위로 하고 있고 보험금청구권 상실의 근거인 신의칙의 법리도 계약단위로 보아야 한다는 점에서 보험금청구권 상실 여부는 계약 단위로 판단되어야 한다. 그리고 재물보험의 상당부분은 국제재보험에 재출재되는데 국내 보험계약의 해석과 국제재보험계약의 해석기준이 다를 경우 매우 어려운 문제가 발생하게 된다는 점에서도 국제기준에 맞게 계약단위 혹은 증권단위로 보험금청구권 상실 여부를 판단하는 쪽으로 기준이 개선되어야 한다. 이에 대하여 계약자 보호의 요구가 거론되는데, 일부상실의 경우 부호별 청구권 상실은 더 용이하게 인정된다는 점에서 어느 쪽이 계약자에게 유리하다고 보기도 어렵고, 오히려 보험금청구권 상실의 요건을 엄격하게 해석함으로서 계약자를 보호하는 것이 법적 안전성과 계약자보호를 동시에 도모하는 방안이라 하겠다.
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田在重 大韓法醫學會 1994 대한법의학회지 Vol.18 No.2
In this age of increasing automobile accidents, a corresponding increase in malpractice suits as a result of such accidents appears to be an inevitable phenomenon. Although apportioning blame and liability may be an inconsequential exercise to the injured plaintiff whose foremost concern is to recover, it is an important issue for the insurance companies which are saddled with the onus of paying off the damages resulting from such lawsuits. Although such legalissues have been addressed in neighboring Japan for the past twenty to thirty years, Korea has only recently begun exploring the potentially explosive problem of medical malpractice suits. When injury occurs as a result of an automobile accidents, and the injury is then compounded and aggravated by medical malpractice, the plaintiff may claim joint and several liability against both the party directly responsible for the automobile accident itself, and the doctor who later performed a negligent medical procedure or misdiagnosed the injury. Although it has been relatively easy to collect damages for the automobile accident itself, it has been difficult to collect damages from the doctor since the plaintiff traditionally bore the burden of proving negligence and causation. This is a major practical obstacle to asserting claims against doctors, and plaintiffs as such normally confine their law suits to the party directly responsible for the accident (who, for all intents and purposes, will ultimately be the insurance company). Because insurance companies are lialbe for the entire damage award regardless of how negligence is apportioned, it is rarely in their interest to zealously pursue a medical malpractice claim. In the event that such a claim is made, the insurance company will most likely file a cross-action against the doctor in question, such cases, however, have been few and far berween. Thus far, there have been two major legal issues dealing with automobile accidents and medical malpractice resulting therfrom : (1) the issue of causation when the injury has been aggravated through improper and negligent treatment of the afflicted patient, and (2) once joint liability is established, how to apportion the blame between multi-defendants for purposes of damages. Because of legal precedents and scholarly opinions which recognize automobile accidents and medical malpractice resulting therefrom as one and the same (i. e. an indivisible injury), it is the current practice to presume joint liability in such cases. In order to reinforce such legal custom, the Korean Supreme Court has rendered a decision whereby a party injured by an automobile accident who later develops an additional medical ailment and/or the injury worsens, then the court will presume, barring exceptional circumstances, that there is causation between such new injury and the doctor's negligent treatment. In short, there will be a rebuttable presumption in favor of recognizing causation in order to give medical malpractice suits more teeth before a court of law. Once joint liability is established, it will be up to the defendants to apportion liability amongst themselves. Insurance companies are expected to exploit this ruling which alleviates their burden of satisfying a vital element of a medical malpractice suits ; accordingly, such ruling may act as a catalyst to opening the floodgates to such malpractice suits. Because this is still a relatively underdeveloped area of law in Korea, it behooves us to thoroughly examine the impact it will have in the areas of law, medicine, and insurance poliiies.
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전재중 大韓法醫學會 1997 대한법의학회지 Vol.21 No.2
Medical records and expert opinion are very important in resolving various issues of law. This importance has increased recently as the result of growing number of cases before the courts. Unfortunately, however, the present situation is far less satisfactory, and particularly go with respect to medical reports and expert opinions, The problem is twofold, first, doctors are totally unable to investigate fully the medical history of a patient, when the patient is assigned for their evaluation. Medical records are not available to doctors, except when the records exist at the very hospital where the evaluation takes place. Second, lawyers cannot obtain independent counsel from doctors even for a fee. General criticism is that korean doctors are very much reluctant to give their opinion even when there exists a genuine conflict of medical opinions.
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