[요양불승인처분취소][공2006.4.15.(248),618]
[1] In a case where occupational excessive stress overlaps with the main cause of a disease and causes or deteriorates the disease, whether the causal relationship between the occupational and the disease is recognized (affirmative), and the degree of proof and standard of determination of such causal relationship
[2] In a case where a beneficiary of insurance benefits under the Industrial Accident Compensation Insurance Act dies, a successor to such entitlement and a party to a lawsuit seeking cancellation of the disposition for unpaid insurance benefits
[1] The term "occupational accident" under Article 4 subparagraph 1 of the Industrial Accident Compensation Insurance Act refers to a disease caused by a worker's occupational injury while performing his/her duties. Thus, there is a causal relationship between the occupational and the disease caused by death. However, even though the main cause of the disease was performed by the worker, and there is no direct relation with the performance of his/her duties, if the occupational course or stress overlaps with the main cause of the disease and causes the disease, at least there is a causal relationship between them. In addition, such causal relationship does not necessarily have to be proved clearly by medical and natural science, and even if it is presumed that there is a proximate causal relationship between the occupational and the disease in consideration of various circumstances, it shall be deemed that there is proof even if it is presumed that there is a proximate causal relationship between the occupational and the disease, and the existence of a causal relationship between the occupational and the death should be determined based on the health and physical conditions of the worker in question, not the average person.
[2] In a case where a beneficiary of the insurance benefits under the Industrial Accident Compensation Insurance Act dies, the entitlement to the insurance benefits which have not yet been paid to the beneficiary shall not be inherited by the heir according to the inheritance order under the Civil Act, but shall be succeeded by the bereaved family with the priority order under the Industrial Accident Compensation Insurance Act. In this case, in a lawsuit seeking revocation of the disposition with the content that the beneficiary should not pay the insurance benefits, it shall be interpreted that the bereaved family who succeeded to the entitlement to the insurance benefits falls under the category of "a person who succeeds to the legal interest to the legal interest seeking revocation of the disposition" under Article 233 of the Civil Procedure
[1] Article 4 subparagraph 1 of the Industrial Accident Compensation Insurance Act / [2] Articles 4 subparagraph 3, 43-4, and 50 of the Industrial Accident Compensation Insurance Act, Article 46 of the Enforcement Decree of the Industrial Accident Compensation Insurance Act, Article 233 of the Civil Procedure Act
[1] Supreme Court Decision 200Du9922 Decided April 13, 2001 (Gong2001Sang, 1148), Supreme Court Decision 2000Du4538 Decided July 27, 2001 (Gong2001Ha, 1990), Supreme Court Decision 2003Du1284 Decided March 26, 2004, Supreme Court Decision 2003Du12912 Decided September 3, 2004
Plaintiff 1, et al., the taking-off of the deceased Nonparty (Seoul General Law Firm, Attorneys Yellow-hee et al., Counsel for the plaintiff-appellant)
Korea Labor Welfare Corporation
Seoul High Court Decision 2004Nu24006 delivered on September 28, 2005
The part of the judgment of the court below against the plaintiff 2, 3, and 4 shall be reversed, and the judgment of the court of first instance corresponding to that part shall be revoked, and the part of the lawsuit shall be dismissed. The defendant's remaining grounds of appeal shall be dismissed. The total costs of the lawsuit incurred between the plaintiff 2, 3, and 4 shall be borne by the above plaintiffs, and
We examine the grounds of appeal.
1. As to the second ground for appeal
Article 4 subparag. 1 of the Industrial Accident Compensation Insurance Act (hereinafter “Industrial Accident Insurance Act”) refers to an occupational accident caused by a worker’s occupational injury while performing his/her duties. Thus, there is a causal relationship between the occupational and the disease caused by death. However, even though the main cause of the occupational accident is not directly related to the performance of his/her duties and there is no direct relation between the occupational accident and the death, if at least the occupationalro or stress overlaps with the main cause of the disease and causes the disease, at least there is a causal relationship between the occupational accident. In addition, such causal relationship does not necessarily have to be proved clearly in medical and natural science, and it is presumed that there is a proximate causal relationship between the occupational disease and the disease when considering various circumstances, such causal relationship is presumed to exist even if it is presumed that there is a proximate causal relationship between the occupational accident and the existing disease. Furthermore, the existence of a causal relationship between the occupational and the death should be determined based on the health and physical condition of the worker concerned, not the ordinary average person.
Based on these legal principles, examining the reasoning of the judgment of the court below and the judgment of the court of first instance cited by the court below in light of the records, the court below is justified in finding and determining that the deceased Nonparty’s viral viral chronitis, liver infection, and liver infection, which are the injury of this case, constitute occupational accidents caused by occupational routes
The judgment of the court below is not erroneous in the misapprehension of legal principles as to causation of occupational accident. The ground of appeal on this part is without merit.
2. Regarding ground of appeal No. 1
Article 50(1) of the Industrial Accident Insurance Act provides that where a beneficiary of insurance benefits dies, if there are any insurance benefits to be paid, which have not been paid, to the beneficiary, the insurance benefits shall be paid at the request of his/her bereaved family (in cases of bereaved family benefits, other bereaved family members entitled to such benefits). Meanwhile, Article 4 Subparag. 3 of the Industrial Accident Insurance Act provides that “bereaved family members” means the spouse (including a person in a de facto marital relationship), children, parents, grandchildren, grandparents, brothers or sisters of the deceased person, and Article 43-4(1) of the Industrial Accident Insurance Act provides that “The right of entitlement between the bereaved family members provided for in Articles 42(6), 43(2) (limited to lump sum survivors’ compensation benefits) and (4) shall be given in the order of priority among the persons falling under each of the following subparagraphs. In such cases, where the beneficiary of the same priority is two or more persons, the bereaved family members shall be paid in installments to him/her, etc.” Article 40(1)1 of the Industrial Accident Insurance Act provides that “The Insurance Benefits Act shall apply mutatis mutandis to the Insurance Act’s.
In full view of the relevant provisions of the Industrial Accident Insurance Act and the legislative purport thereof, where a beneficiary of the insurance benefits under the Industrial Accident Insurance Act dies regardless of the heir as prescribed by the Civil Act, the entitlement to the insurance benefits that have not yet been paid to him/her shall not be inherited by the heir according to the inheritance order as prescribed by the Civil Act, but shall be succeeded by the heir having the priority in accordance with the order as prescribed by the Industrial Accident Insurance Act. In such cases, in a lawsuit seeking revocation of the disposition that the beneficiary of the insurance benefits should not be paid, it is reasonable to interpret that the heir of the entitlement to the insurance benefits shall be a person who succeeds to the legal interest to the substantive law and succeeds to the legal interest to seek revocation of the disposition, and thus, shall be construed as having taken over the lawsuit as falling under the “other persons who continue to perform the lawsuit by other Acts” under
However, according to the records, it can be known that Plaintiff 1 was a spouse who was supported by the deceased Nonparty at the time of his death. Accordingly, Plaintiff 1’s entitlement to insurance benefits not paid to the Nonparty due to the death of the Nonparty shall be succeeded, and therefore, the remaining Plaintiffs are not entitled to sue in the lawsuit seeking the approval of the medical care in this case. Therefore, the lawsuit in this case by Plaintiff 2, 3, and 4 is unlawful, and the judgment of the court below against the above Plaintiffs cannot be maintained any longer. The allegation in the grounds of appeal assigning this error
3. Conclusion
Therefore, the part of the judgment of the court below against the plaintiff 2, 3, and 4 is reversed, and this part of the case is sufficient to be judged on the basis of the facts duly confirmed by the court below, and thus, the judgment of the court of first instance corresponding to that part is revoked, and the lawsuit is dismissed. The defendant's remaining appeal is dismissed. It is so decided as per Disposition by the assent of all participating Justices
Justices Shin Hyun-chul (Presiding Justice)