A court has ruled that if someone received hundreds of procedures to remove corns and calluses that were not covered by the insurance policy and collected tens of millions of won in payouts, that person must return part of the money to the insurer.
According to legal sources on the 7th, the Supreme Court's Third Division, presided over by Justice Oh Seok-jun, upheld a lower court ruling that dismissed a lawsuit filed by policyholder A against an insurer seeking insurance benefits. In a separate suit in which the insurer sought the return of 34.94 million won from A, the court affirmed the lower court's order for A to return 17.84 million won.
The case goes back to 2016. At the time, A signed an insurance contract that provided 300,000 won per surgery for illness. From Sept. 26, 2016, to Nov. 5, 2020, A underwent cryo-coagulation procedures at several hospitals 379 times to remove corns or calluses, then claimed benefits for 114 of those procedures and received a total of 34.93 million won. Payment for the remaining procedures was denied.
Before this case, in Sept. 2017 the insurer filed a civil lawsuit against A, arguing that A had taken out the policy to fraudulently obtain benefits, that the contract was void, and that it should recover the 17.1 million won already paid. The court dismissed all of the insurer's claims, and the decision was finalized by the Supreme Court in Feb. 2020.
A then sued the insurer to collect unpaid benefits. The insurer countered that the insurance contract with A was void and that all benefits must be returned.
All three levels of court—the first instance, the appeals court, and the Supreme Court—found that the insurer did not need to pay benefits. The policy provided that benefits would not be paid for skin conditions such as freckles, warts, acne, and hair loss due to aging, and corns and calluses were deemed conditions of the same nature.
On whether the insurance contract was void, the appellate court and the Supreme Court differed. The appellate court, noting a change in circumstances such as a surge in A's number of surgeries and amount of benefits received after the earlier lawsuit, held that the validity of the contract could be relitigated in this case and found the contract void as contrary to good morals and other social order.
However, the Supreme Court held that even if A's number of surgeries increased, the res judicata effect of the prior ruling—which found the contract valid—could not be overturned. A change in circumstances that defeats res judicata is recognized only when new facts arise. Mere supplementation of evidence or shifts in legal interpretation are insufficient to overturn it.
Accordingly, excluding the scope covered by res judicata, the court recognized A's obligation to return only the remaining amount of 17.84 million won.