구상금
1. The part against the defendant in the judgment of the first instance shall be revoked;
2. The plaintiff's claim against the above cancellation portion is dismissed.
3.
1. Facts of recognition;
A. C, etc. suffered from each traffic accident from around 2013 to 2014, and was provided medical treatment, such as pharmacological surgery, upon request by the Defendant to “B,” which was operated by the Defendant.
The plaintiff is an insurer who has concluded a comprehensive motor vehicle insurance contract with each of the above traffic accident damage vehicles.
B. From around 2013 to 2014, the Defendant filed a claim with the Health Insurance Review and Assessment Service (hereinafter “Review and Assessment Service”) for review of motor vehicle insurance medical fees involving C, etc., and the Review and Assessment Service recognized the full amount of the medical fees claimed by the Defendant as motor vehicle insurance medical fees (hereinafter “instant review and Decision”). The Plaintiff did not raise any objection to the said review and Decision, and paid the full amount of the medical fees to the Defendant from around 2013 to 2014.
C. On June 2014, the Review and Assessment Service (the Defendant) notified the Plaintiff of the results of the review that “a violation of the Guidelines for the Establishment, Use, and Joint Use of Posium (Korean Medical Policy-2457, May 26, 2009)” (hereinafter referred to as “the Notice of Recovery”), and on June 30, 2014, the Review and Assessment Service sent the Defendant a notice of the same content to the Defendant on June 30, 2014.
[Ground of recognition] Unsatisfy, Gap evidence 1, 5, Eul evidence 3 (including a tentative number), the purport of the whole pleadings
2. The Plaintiff’s objection to the review and decision of this case was accepted, and the Defendant was notified by the Review and Assessment Service of the result of reducing KRW 1,418,790 of the expenses of the medical care, or received the instant recovery notice for the expenses of the medical care. Therefore, the Defendant’s claim for the payment of the expenses of the relevant medical care is made unfairly applying the standard of medical care insurance.
Therefore, the defendant is against the plaintiff.