Kim & Chang successfully defended a life insurer (the “Defendant”), in a lawsuit where a policyholder (the “Plaintiff”) filed a claim against the insurer arguing that the Plaintiff will not have to pay premiums for about 30 years to come, pursuant to a clause in the policy on the “state of bodily impairment involving at least 50%” of the applicable body part.¹ 

The Plaintiff had entered into four life insurance policies, including a whole life insurance policy, with the Defendant (collectively, the “Policies”).  The Plaintiff, as the insured and policyholder, had an oophorectomy of both ovaries in the course of treating endometrial hyperplasia.  After the surgery, the Plaintiff requested the Defendant to confirm that she needed not pay any more premium for the remaining term of about 30 years (approximately worth KRW 1.5 billion in aggregate) because she was in the “state of impairment involving at least 50%” of the relevant body part/organ, as set out in the Policies.

The key legal issues in this case were (i) whether the purpose of oophorectomy was treatment or prevention, and (ii) whether the waiver of premium is available only when the “state of impairment” has resulted from a treatment of medical conditions, or also when the medical procedure has been performed as a preventive measure. 

Our Representation

By consulting external medical experts and engaging our attorneys who had worked as healthcare professionals (including MDs) prior to their career as attorneys, we were able to conduct an in-depth review of factual circumstances and medical evidence.  While the surgeon for the operation responded that “the oophorectomy was for treatment” to a factual inquiry sent by the court, we identified all relevant factual details by focusing on the key issues of contention and requested the Korean Medical Association (“KMA”)  to examine and interpret the relevant medical records.  As a result, we received a favorable interpretation from the reputable KMA and successfully overcame the Plaintiff’s arguments.  By substantiating that the oophorectomy was performed mainly as prevention, and not as medical treatment, we successfully convinced the court that the surgery did not justify exemption of premium.