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(영문) 서울행정법원 2020.07.08 2019구단66005

요양급여 승인 취소처분의 취소

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1. The plaintiff's claim is dismissed.

2. The costs of lawsuit shall be borne by the Plaintiff.

Reasons

1. Details of the decision to revoke approval for medical care benefits;

A. Determination on approval of medical care benefits and receipt of insurance benefits (1) The Plaintiff (B male) is a worker working as a road repair staff in the Busan Metropolitan Government C-gu Office, and on June 25, 2013, the Plaintiff was subject to the implementation of the blood static and dives inserted surgery at D Hospital on June 26, 2013, by suffering from the “alley-one-one executive fluorial fluorial fluorial fluorial fluor

(2) On July 12, 2013, the Plaintiff filed an application for medical care benefits with the Defendant on July 4, 2013, stating that “The Plaintiff was found to have moved back to the lower end with heavy equipment while carrying out sewerage dredging operations on the rear side of the F Fire Fighting House located in E, and turned back to the lower end, but was faced with an accident attributable to the upper end of the stone with a stone.” However, on July 12, 2013, the Plaintiff was approved medical care from the vice governor of Busan East-do, to which the Defendant belongs.”

③ By July 14, 2014, the Plaintiff received the total amount of 44,941,480 won of the insurance benefits (=medical care benefits + KRW 11,097,570 + temporary disability benefits + KRW 23,73,660 + Disability benefits KRW 10,110,250).

B. On June 28, 2017, the Defendant received the information that “the Plaintiff was subject to an accident during the road repair work and was actually subject to the approval of occupational accidents, such as the Plaintiff’s scam at the time of her scam.” In fact, the Plaintiff’s investigation was conducted on the Plaintiff’s illegal receipt of medical care benefits. On December 26, 2017, the Defendant notified the head of Busan Dong-dong Vice Governor, who belongs to the Defendant, of the result that the instant accident was not an occupational accident.

② On January 11, 2018, the Vice-Governor of Busan Dong-dong, who belongs to the Defendant, applied for medical treatment against the Plaintiff on the ground that the Plaintiff was suffering from an occupational accident on June 25, 2013, but recognized the fact that the circumstances of the accident were falsely reported and obtained the approval for the medical care for industrial accidents.