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TITLE Supreme Court Decision 2008Da78491, 78507 Decided August 19, 2010[Affirmation of Absence of Debt,Insurance Proceeds] [full Text]
Summary
[1] The meaning of ""accident"" as an element of an insurable accident under an accident insurance contract [2] In a case where the insured under an accident insurance contract died from pneumonia caused by the infection due to the medical team's negligence during the laparotomy surgery to remove a retroperitoneum mass, the possibility of treating it as an insurable ""accident"" cannot be ruled out because it cannot be determined with ease that the insured had consented to and foreseen such a result due to the medical team's negligence, and so there was an unforeseeable cause but no intention on the part of the insured was involved [3] In light of the purpose behind the exemption clause in the accident insurance policy that ""loss from surgery, or other medical treatment is not compensated. However, the case caused by injury insured by the company is compensated,"" whether the injury in question occurred due to medical malpractice during the surgery or other medical procedure should be considered at all to determine the application of the above exemption clause (negative) [4] In a case where the insured of an accident insurance was diagnosed with peritoneum cancer and received a laparotomy surgery to remove a retroperitoneum mass and subsequently incurred pneumonia due to infection by medical team's negligence during the process and died, the exemption clause of an accident insurance applies regardless of whether the medical team's malpractice contributed to occurrence of the accident at issue, since that accident occurred by realization of an increased risk of infection from the laparotomy surgery for cancer treatment, which was not to bet compensated by the insurer in the first place
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