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(영문) 대법원 2015.03.20 2012다88945

부당이득금반환

Text

The judgment below

The part against the Defendants is reversed, and that part of the case is remanded to the Panel Division of the Seoul Central District Court.

Reasons

The grounds of appeal are examined.

1. Article 12(1) of the former Guarantee of Automobile Accident Compensation Act (amended by Act No. 11690, Mar. 23, 2013; hereinafter “Automobile Accident Compensation Act”) provides that “In cases where an insurance company, etc., or the victim under the latter part of Article 10(1), or the patient involved in a traffic accident becomes aware of the occurrence of a traffic accident due to a request, etc., the insurance company, etc. shall, without delay, notify the medical institution that treats the relevant patient involved of the intention to pay medical fees and the limit of the payment thereof.” Article 12(2) of the same Act provides that “a medical institution in receipt of notice from an insurance company, etc. of the intention to pay medical fees and the limit of the payment thereof from the insurance company, etc. under paragraph (1)

In addition, Article 19(1) of the same Act provides that "If a claim for payment under Article 12(2) is deemed to have been made unfairly by the automobile insurance standard, the insurer, etc. may file a petition for review with the Council on Disputes over Medical Fees under Automobile Insurance within 60 days from the date such claim for payment is made, and Article 19(3) of the same Act provides that "If the insurer, etc. who has received the claim for payment of medical fees under automobile insurance under Article 12(2) fails to file a request for review within

In light of the contents and purport of the above provisions, in order to consider that there has been an agreement on medical fees covered by automobile insurance with an insurance company and a medical institution pursuant to Article 19(3) of the Automobile Loss Act, medical institutions need to be notified of the intention to pay medical fees covered by automobile insurance and the limit of payment from the insurance company, etc. under Article 12(1) of the Automobile Loss Compensation Act