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(영문) 대법원 2019.07.25 2018두42634

미지급보험급여부지급처분취소

Text

The judgment below is reversed and the case is remanded to Seoul High Court.

Reasons

The grounds of appeal are examined.

1. As to the grounds for the disposition that the deceased failed to comply with the application for medical care for pneumoconiosis and the procedure for determination thereof, the lower court determined that the rejection of a claim by A was unlawful solely on the ground that the deceased's failure to comply with the criteria prescribed by the pneumoconiosis disability grade (Grade VII) other than the pneumoconiosis disability grade (Grade I), on the ground that the deceased's wife, who is the wife of the deceased B (hereinafter referred to as the "the deceased"), falls under the criteria prescribed by the pneumoconiosis disability grade (Class VII) and other pneumoconiosis disability grade (Class I), the defendant should examine whether the deceased's failure to comply with the criteria determined by the pneumoconiosis disability grade (Class VII) determined and the decision on the insurance benefits was made.

In light of the relevant legal principles and records, such determination by the court below is just, and contrary to the allegations in the grounds of appeal, the court below did not err by misapprehending the legal principles on the requirements of claim

2. As to the grounds for disposition for which the extinctive prescription expires

A. Article 112(1)1 of the former Industrial Accident Compensation Insurance Act (amended by Act No. 15665, Jun. 12, 2018; hereinafter “Industrial Accident Insurance Act”) provides that the extinctive prescription expires unless the right to receive insurance benefits under the Industrial Accident Insurance Act is exercised for three years.

The extinctive prescription is run from the time it is possible to exercise its right (Article 112(2) of the Industrial Accident Insurance Act, Article 166(1) of the Civil Act), and the extinctive prescription of the right to receive insurance benefits under the Industrial Accident Insurance Act shall run from the time when the occupational accident of the affected worker falls under the requirements for payment of insurance benefits provided by the Industrial Accident Insurance Act and the defendant can claim

In cases of pneumoconiosis compensation annuities under Articles 91-3 and 91-8 of the Industrial Accident Insurance Act, pneumoconiosis disability conditions, such as the type of pneumoconiosis and the degree of cardiopulmonary function of pneumoconiosis workers, etc.