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When you buy insurance recently, the most common collateral you buy is the one related to cancer, heart, and brain. In particular, cerebrovascular disease has a great economic impact when it occurs, so many people set high collateral. However, when an accident occurs, the insurance company begins to look at the 'phrase' of the terms and conditions like a microscope. At this time, there is a fierce legal battle between subscribers and insurance companies over what the "cause of the disease" is.

The case to be introduced this time is a ruling on whether bleeding from spongy hemangioma, a type of cerebrovascular deformity, can be regarded as 'intra-brain hemorrhage (I61).

Mr. A, born in 1996, visited the emergency room in 2023 with sudden convulsions and extreme headaches. As a result of a detailed examination, the neurologist gave A the final diagnosis of "unknown intracerebral hemorrhage (I61.9)" and "epilepsy." Mr. A claimed a total of 40 million won in insurance, including the cost of diagnosing cerebrovascular diseases of the insurance he subscribed to.

However, the insurer's position was firm. The logic was that the bleeding in A's brain was only a microbleeding caused by spongy hemangiomas (positive neoplasms), which could not be recognized as an independent "innerbrain hemorrhage (I61). In other words, it was argued that the bleeding of the tumor site in the disease classification system should be viewed as a symptom of the tumor itself.

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However, the court ruled in favor of A. The court pointed out that the neurologist, the attending physician, confirmed intracerebral hemorrhage through sufficient tests such as CT and MRI, and that there is no explicit provision in the terms and conditions that "excluding intracerebral hemorrhage caused by cerebrovascular malformations."

In addition, the court ruled that even if the medical community disagrees on the disease coding method of intramural hemangioma bleeding, the "principle of author disadvantage" should be applied, which should be interpreted in favor of the policyholder when the meaning of the terms and conditions is not clear. In the end, the court ruled that the insurer should pay A the full amount of insurance money.

Han & Yul, a lawyer at Han Se-young's law firm, said, "Insurers often deny the diagnosis of their doctors based on the opinions of third-party medical institutions or internal consultants. However, the court believes that if the doctor's conclusion through sufficient inspection equipment is valid in light of general medical standards, it should be respected."