Open Decision Ledger · Civil obligations & remedies
Ambiguous policy wording on death after the insurance period
Supreme Court, Apr. 2, 2026, 2025Da211789 (judgment)
Case name: 보험금[상해보험계약의 약관에서 ‘피보험자가 보험기간 중 교통재해로 인하여 사망하였을 때’ 교통재해 사망보험금을 지급하기로 정하였는데, 피보험자가 보험기간 중 교통사고를 당한 후 보험기간 종료 후에 비로소 사망한 사건]
Official text on the National Law Information Center
Question
Where a policy clause pays a traffic-disaster death benefit when the insured 'dies as a result of a traffic disaster during the insurance period', and the insured was hit by a car within the period but died only after it expired, must only the disaster within the period be required under Article 5(2) of the Act on the Regulation of Terms and Conditions?
Holding
It must. A policy clause is read objectively and uniformly from the standpoint of the average customer, and where it remains objectively ambiguous with each reading reasonable, it is read in the customer's favour. Here 'during the insurance period' can modify the whole predicate, or only 'traffic disaster', and both readings are objective and reasonable, so Article 5(2) applies and only a disaster within the period is required. The insured was in a temporary state of disability until death and died as a direct result of the in-period accident, so the insurer must pay both death benefits.
Summary of the holding, verbatim
위와 같은 해석을 거친 후에도 약관조항이 객관적으로 다의적으로 해석되고, 그 각각의 해석이 합리성이 있는 등 당해 약관의 뜻이 명백하지 아니한 경우에는 고객에게 유리하게 해석하여야 한다.
Unofficial English translation
Where, even after undergoing an interpretation as set forth above, the policy provision is objectively ambiguous and each such interpretation is reasonable, so that the meaning of the policy provision is unclear, it must be interpreted in favor of the customer.
Disposition
Reversed and remanded Stated in the decision
원심판결을 파기하고, 사건을 서울중앙지방법원에 환송한다.
Unofficial English translation
The judgment of the court below is reversed, and the case is remanded to the Seoul Central District Court.
Form of the test
Elements stated Stated in the decision
보험약관은 신의성실의 원칙에 따라 해당 약관의 목적과 취지를 고려하여 공정하고 합리적으로 해석하되, 개개 계약 당사자가 기도한 목적이나 의사를 참작하지 않고, 평균적 고객의 이해가능성을 기준으로 보험단체 전체의 이해관계를 고려하여 객관적·획일적으로 해석하여야 한다.
Unofficial English translation
Insurance policy terms must be interpreted fairly and reasonably in accordance with the principle of good faith, taking into account the purpose and intent of the relevant policy terms, but without regard to the purposes or intentions pursued by the individual contracting parties, and must be interpreted objectively and uniformly on the basis of the comprehensibility of an average customer, in consideration of the interests of the insured group as a whole.
Factors
- 평균적 고객의 이해가능성을 기준으로
- ‘보험기간 중’이라는 문구가 서술어에 해당하는 ‘사망하였을 때’를 수식하는 것으로 보아
- ‘보험기간 중’이라는 문구가 ‘교통재해’만을 수식하는 것으로 보아서 보험기간 중 교통재해가 발생하고 보험기간 종료 후 사망한 경우 역시 사망보험금 지급사유라고 해석하는 것도 충분히 가능하고
- 약관의 규제에 관한 법률 제5조 제2항이 규정하는 작성자 불이익의 원칙이 적용되어
- 일시적 장해상태에 있다가 보험기간 중에 발생한 교통사고를 직접적인 원인으로 사망하였다고 보이므로
Unofficial English translation
• on the basis of the comprehensibility of an average customer,
• viewing the phrase "during the policy period" as modifying the predicate "when the insured dies,"
• it is also entirely possible to interpret, viewing the phrase "during the policy period" as modifying only the term "traffic accident," that a case in which a traffic accident occurred during the policy period and the insured died after the expiration of the policy period likewise constitutes a ground for payment of the death benefit, and
• the principle of interpretation against the drafter set forth in Article 5 (2) of the Act on the Regulation of Terms and Conditions applies, and
• since the insured was in a state of temporary disability and then is deemed to have died with the traffic accident that occurred during the policy period as the direct cause,
Relation to precedent
Follows earlier decisions Stated in the decision
대법원 2011. 4. 28. 선고 2011다1118 판결, 대법원 2018. 7. 24. 선고 2017다285109 판결
Unofficial English translation
Supreme Court Decision 2011Da1118 decided April 28, 2011, Supreme Court Decision 2017Da285109 decided July 24, 2018
Decisions referred to
[1] 대법원 2011. 4. 28. 선고 2011다1118 판결, 대법원 2018. 7. 24. 선고 2017다285109 판결
Burden of proof
Not addressed Not in the decision
Open question and revisit condition
How long after the insurance period may a death occur and still be treated as caused directly by a traffic disaster suffered within it, given that Article 18(4) measures a worsened disability state or death by the period in which benefits can still be received, two years from the disaster where the contract has lapsed?
The remand judgment will show how the causal requirement is applied on the medical record. An amendment to Article 5(2) of the Act on the Regulation of Terms and Conditions or to Article 730 of the Commercial Act, or a later decision refining the reading of 'during the insurance period', would require this entry to be read again.
Cross-family AI independent reading & axis check
6 of 8 axes matched GPT-6 Astra (OpenAI, codex CLI) · 2026-10-24
A reader from another model family (GPT-6 Astra), given the official text but not the primary reading, agreed on 6 of the 8 axes; the readings differed on axis 4 (form of the test), axis 8 (open question and revisit condition).
Axis 4 (Form of the test): Primary “Elements stated” vs Independent “Existing test applied”
Both readings record the burden axis as not mentioned, so the flag may reflect that one reader treats the contra proferentem rule as allocating interpretive risk to the insurer, while the other sees no proof-burden point addressed.
위 약관조항은 객관적으로 다의적으로 해석되어 약관조항의 뜻이 명백하지 아니한 경우에 해당하므로 약관의 규제에 관한 법률 제5조 제2항이 규정하는 작성자 불이익의 원칙이 적용되어Axis 8 (Open question and revisit condition): Primary “How long after the insurance period may a death occur and still be treated as caused directly by a traffic disaster suffered within it, given that Article 18(4) measures a worsened disability state or death by the period in which benefits can still be received, two years from the disaster where the contract has lapsed?” vs Independent “Would the same benefit remain payable if the insured had entered a permanent disability state before dying after the policy period?”
The primary asks how long after expiry a death may still be treated as directly caused by an in-period accident under the policy's two-year rule, while the independent asks whether benefits remain payable if a permanent disability arose before a post-expiry death.
위와 같은 해석을 거친 후에도 약관조항이 객관적으로 다의적으로 해석되고, 그 각각의 해석이 합리성이 있는 등 당해 약관의 뜻이 명백하지 아니한 경우에는 고객에게 유리하게 해석하여야 한다.Raw responses and comparison record: Protocol · Blind readings (JSONL) · Axis comparison (JSONL) · SHA-256 (JSON)
Lower-court contrast & scope of application
Lower-court reading vs. Supreme Court holding
Lower-court context: The Seoul Central District Court, in its judgment of 16 April 2025 (2024Na65647), dismissed the claim because the death occurred only after the insurance period ended. It held that the traffic disaster and the death are separate insured events, that on an average customer's understanding the policy pays either a maturity congratulatory amount or a death benefit depending on whether the insured was alive when the period ended, so the wording is not ambiguous. It also reasoned that the plaintiff's reading would expose the insurer to liability for a long period after the agreed term, and that no clause for death within 180 days of the disaster could be applied by analogy.
Supreme Court standard: The Supreme Court held that the reading below could not be accepted. 'During the insurance period' can reasonably be read as modifying only 'traffic disaster', and Article 18(4), which, once a disability grade has been set, measures a worsened state including death by the period in which benefits can still be received, two years from the disaster where the contract has lapsed, supports that reading. The clause is objectively ambiguous and contra proferentem requires only a disaster within the period. On causation, given the death five months after the accident in intensive care, the direct cause following the surgery for traumatic haemorrhage, and the treating doctor's statement, the Court found the insured died as a direct result of the in-period accident. The judgment was reversed and remanded for misreading the law on the grounds for payment.
Distinguishing conditions
- A case in which the clause, read objectively, is not open to two equally reasonable readings, so that its meaning is clear.
- A case in which the insured died within the insurance period, so that no ambiguity rule is needed.
- A death after the period that was not caused directly by the traffic disaster suffered within it.
Record verification notes
Set the wording relied on, here Article 17(iii) of the general policy clause and Article 11 of the traffic-disaster death special agreement, against the two readings the Court weighed, and note that Article 18(4) supports the wider one. Then trace the medical chain from the accident to the direct cause of death, and check whether the file fixes any limit for death after a disaster within the period.
From the official text
Points at issue
[1] 보험약관의 해석에서 작성자 불이익의 원칙 [2] 갑이 피보험자를 배우자인 을로 하여 병 보험회사와 체결한 상해보험계약의 약관에서 ‘피보험자가 보험기간 중 교통재해로 인하여 사망하였을 때’ 교통재해 사망보험금을 지급하기로 정하였는데, 을이 보험기간 중 교통사고를 당한 후 보험기간 종료 후에 비로소 사망한 사안에서, 위 약관조항은 객관적으로 다의적으로 해석되어 약관조항의 뜻이 명백하지 아니한 경우에 해당하므로 약관의 규제에 관한 법률 제5조 제2항이 규정하는 작성자 불이익의 원칙이 적용되어, 보험금 지급사유로 보험기간 중 교통재해가 발생하였을 것만을 요구하고 그로 인한 사망까지 발생할 것을 요구하지는 않는다고 해석함이 상당하므로, 병 회사는 갑에게 보험약관에 따른 교통재해 사망보험금을 지급할 의무가 있다고 한 사례
Unofficial English translation
[1] The principle of interpretation against the drafter in the interpretation of insurance policy terms [2] In a case where, under the policy terms of an accident insurance contract that A concluded with insurance company C designating the insured as A's spouse B, it is stipulated that the death benefit for traffic accidents shall be paid "when the insured dies as a result of a traffic accident during the policy period," and where B was involved in a traffic accident during the policy period but died only after the policy period had expired, the above policy provision falls under the case where it is objectively ambiguous and the meaning of the policy provision is unclear, so the principle of interpretation against the drafter set forth in Article 5 (2) of the Act on the Regulation of Terms and Conditions applies, and it is reasonable to interpret the provision as requiring, as a condition for payment of the insurance benefit, only that a traffic accident occurred during the policy period, and not requiring that death resulting therefrom occurred as well, and accordingly company C has an obligation to pay A the death benefit for traffic accidents under the insurance policy terms
Summary of the holding
[1] 보험약관은 신의성실의 원칙에 따라 해당 약관의 목적과 취지를 고려하여 공정하고 합리적으로 해석하되, 개개 계약 당사자가 기도한 목적이나 의사를 참작하지 않고, 평균적 고객의 이해가능성을 기준으로 보험단체 전체의 이해관계를 고려하여 객관적·획일적으로 해석하여야 한다. 위와 같은 해석을 거친 후에도 약관조항이 객관적으로 다의적으로 해석되고, 그 각각의 해석이 합리성이 있는 등 당해 약관의 뜻이 명백하지 아니한 경우에는 고객에게 유리하게 해석하여야 한다. [2] 갑이 피보험자를 배우자인 을로 하여 병 보험회사와 체결한 상해보험계약의 약관에서 ‘피보험자가 보험기간 중 교통재해로 인하여 사망하였을 때’ 교통재해 사망보험금을 지급하기로 정하였는데, 을이 보험기간 중 교통사고를 당한 후 보험기간 종료 후에 비로소 사망한 사안에서, 평균적 고객의 이해가능성을 기준으로 위 약관조항의 문언을 살펴보면, ‘보험기간 중’이라는 문구가 서술어에 해당하는 ‘사망하였을 때’를 수식하는 것으로 보아 보험금 지급사유로 보험기간 중에 교통재해뿐 아니라 그로 인한 사망까지 발생할 것을 요구한다고 해석하는 것도 객관성과 합리성을 가지지만, ‘보험기간 중’이라는 문구가 ‘교통재해’만을 수식하는 것으로 보아서 보험기간 중 교통재해가 발생하고 보험기간 종료 후 사망한 경우 역시 사망보험금 지급사유라고 해석하는 것도 충분히 가능하고 그러한 해석의 객관성과 합리성도 인정되는바, 위 약관조항은 객관적으로 다의적으로 해석되어 약관조항의 뜻이 명백하지 아니한 경우에 해당하므로 약관의 규제에 관한 법률 제5조 제2항이 규정하는 작성자 불이익의 원칙이 적용되어, 보험금 지급사유로 보험기간 중 교통재해가 발생하였을 것만을 요구하고 그로 인한 사망까지 발생할 것을 요구하지는 않는다고 해석함이 상당하고, 제반 사정에 비추어 을은 사망 전까지 일시적 장해상태에 있다가 보험기간 중에 발생한 교통사고를 직접적인 원인으로 사망하였다고 보이므로, 병 회사는 갑에게 보험약관에 따른 교통재해 사망보험금을 지급할 의무가 있는데도, 이와 달리 본 원심판단에 법리오해 등의 잘못이 있다고 한 사례.
Order
원심판결을 파기하고, 사건을 서울중앙지방법원에 환송한다.
Unofficial English translation
The judgment of the court below is reversed, and the case is remanded to the Seoul Central District Court.
Provisions referred to
[1] 약관의 규제에 관한 법률 제5조 / [2] 상법 제730조, 약관의 규제에 관한 법률 제5조
Read 2026-10-24 · Cross-read 2026-10-24. All quotes matched against the official text. The Chinese-character placeholders the court used for anonymised parties are given in their Korean readings, and parenthetical Chinese-character glosses are omitted.
Every entry is published only after all quotes have been matched character by character against the official text, and audited by an independent second reading from a different model family across all eight axes. Both agreed axes and text-grounded interpretive divergences are recorded openly. The ledger is a research record, not an assessment of the court or advice on any matter.
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