[2] The case holding that the subrogation of the National Health Insurance Corporation's claim is allowed where a third party who caused the cause of insurance payment under the National Health Insurance Act has caused insurance benefits by intentional or gross negligence where the living together relatives caused insurance benefits

[2] The case holding that the subrogation of the National Health Insurance Corporation's claim shall be allowed where a third party who caused the cause of insurance payment under the National Health Insurance Act has caused insurance benefits by intentional or gross negligence where the living together relatives caused insurance benefits

2. The defendant shall pay to the plaintiff 228,70 won with 5% interest per annum from September 14, 2002 to April 9, 2005, and 20% interest per annum from the next day to the day of full payment.

3. The costs of the lawsuit shall be borne by the defendant in the first and second instances.

4. Paragraph 2 can be provisionally executed.

The following facts may be recognized by adding up the whole purport of the pleading to the statements (including each number) in Gap's 1 through 7.

A. On March 21, 2002, the Defendant: (a) disputed with the wife Nonparty on March 21, 2002; (b) took part in an injury to the her female, such as a fluoral fluor, accompanied by a fluoral plant; and (c) the Nonparty, who was the self-employed insured of the Plaintiff, received out-of-the-counter treatment in the Jeonsung Hospital, which was the Plaintiff’s medical care institution; and (d)

B. On May 15, 2002, the Defendant assaulted the Nonparty again, and the Nonparty, upon suffering from ear, was hospitalized at the former North Korean University Hospital, which was a medical care institution from May 15, 2002, and received outpatient treatment from May 17, 2002 to May 22, 2002, and received the prescription preparation from the said pharmacy on May 28, 2002.

C. After that, the Plaintiff paid to each of the above medical care institutions 228,720 won [the amount excluding the Nonparty himself/herself/herself's medical expenses = 84,10 won (=43,790 won ( June 19, 2002) + 40,320 won ( August 20, 2002)] + 132,680 won ( September 3, 2002) at the Jeonbukbuk University Hospital 11,980 won (=5,930 won ( April 25, 2002) + 6,050 won ( July 5, 2002)];

2. Determination on the cause of the claim

The plaintiff asserts that the plaintiff is liable to pay damages equivalent to the insurance money to the plaintiff who subrogated the non-party pursuant to Article 53 of the National Health Insurance Act, since the non-party suffered an injury due to the defendant's assault and the plaintiff provided insurance benefits.

On the other hand, Article 53(1) of the National Health Insurance Act provides that "if a cause for insurance benefits has occurred due to an act of a third party and has paid the insurance benefits to the subscriber, the Corporation shall obtain the right to claim compensation for such third party within the limit of the expenses to be paid for such benefits." The Supreme Court has held that with respect to "the third party" under Article 53(1) of the National Health Insurance Act, the Corporation and the insured who has provided insurance benefits due to the accident, and those who are not the victim in the health insurance relationship with the victim, shall be liable for damages against the victim. The third party includes not only the perpetrator directly to the victim, but also the person who is liable for damages against the third party's act by law or contract (see Supreme Court Decision 2003Da1878, Aug. 20, 2004).

However, it is difficult to apply the Supreme Court precedents immediately to the following reasons: ① the effect that if the plaintiff, who is an insurer under the National Health Insurance Act, is subrogated to a third party who is a provider of insurance benefits after he/she paid the insurance benefits to the insured, this restriction goes against the effectiveness of the insurance system, namely, relatives living together with the insured who are legally or actually enjoy the insurance benefits; if the insurer permits the subrogation of the insured's relatives living together with the insured to take advantage of the same effect as those of the insured's relatives living together with the insured, it is more reasonable to interpret the same legal doctrine as the insurer's claims for insurance benefits are also applicable to the insurer under the Industrial Accident Compensation Insurance Act, even if he/she intentionally or by gross negligence, and thus, if the relationship between the third party and the insured's spouse is not recognized as an insurer's health insurance benefit, then the third party who is the offender is not entitled to receive the insurance benefits only by intention or gross negligence, and thus, it is also unreasonable to accept the insurance benefits from the third party's life insurance contract.

According to the above facts, the plaintiff's insurance benefits were injured by the non-party. The defendant constitutes a third party who is the non-party's husband but has intention or gross negligence. Thus, the defendant is liable to pay damages in proportion to 228,770 won as tort to the plaintiff who subrogated the non-party pursuant to Article 53 of the National Health Insurance Act, and 5% per annum as prescribed by the Civil Act from September 14, 2002 to April 9, 2005, as the plaintiff seeks after the date of acquisition of the plaintiff's damage claim, as it is after the date of delivery of the copy of the complaint of this case, and 20% per annum as prescribed by the Act on Special Cases concerning the Promotion, etc. of Legal Proceedings from the next day to the date of full payment.

3. Conclusion

Therefore, the plaintiff's claim of this case shall be accepted on the grounds of its reasoning, and the judgment of the court of first instance which has different conclusions shall be revoked unfairly, and it shall be decided as per Disposition by ordering the defendant to pay the above money.

Judges Jeong Chang-nam (Presiding Judge)