보험급여부지급처분취소
1. The plaintiff's claim is dismissed.
2. The costs of lawsuit shall be borne by the Plaintiff.
1. The Plaintiff, who was the mother of the instant disposition network B (the deceased on October 2, 2015, hereinafter “the deceased”), claimed a nursing fee against the Defendant for the period from December 15, 2012 to October 2, 2015, the deceased was receiving medical care in the East Sea Hospital due to pneumoconiosis.
On March 3, 2016, the Defendant rendered a decision to pay nursing fees to the Plaintiff on April 26, 2015, excluding the period of treatment for middle-term patients from April 27, 2015 to October 1, 2015, for the remainder of the period (hereinafter referred to as “dispute period”) after the Deceased was awarded a fright to dump dump on April 26, 2015, with the exception of the period of treatment for middle-term patients.
(hereinafter referred to as the “instant disposition”). [Ground of recognition] A without dispute, Gap evidence Nos. 1, Eul evidence Nos. 1 and 2, and the purport of the whole pleadings
2. Whether the disposition is lawful;
A. The Plaintiff’s assertion that the pneumoconiosis has aggravated since 2008, and since 2012, it cannot be said that the Plaintiff’s actions necessary for daily life cannot be blickly performed, and that the Plaintiff’s assertion obtained assistance from another person. As such, the Plaintiff’s allegation constitutes a person prescribed in Article 11(2) Subparagraph 8 of the Enforcement Rule of the Industrial Accident Compensation Insurance Act, and the instant disposition is unlawful.
B. The evidence Nos. 3 and 4 alone is insufficient to recognize that the deceased’s act necessary for daily life is an object of nursing as “a person whose body is very rough and weak due to occupational disease” (Article 11(2)8 of the Enforcement Rule of the Industrial Accident Compensation Insurance Act), and there is no other evidence to acknowledge it otherwise.
Rather, according to the result of this court's entrustment of the medical record appraisal of the Seoul Hospital, it can only be seen that the deceased's pneumoconiosis was at a level that does not interfere with daily life.
The instant disposition cannot be deemed unlawful.
3. We cannot accept the Plaintiff’s claim for conclusion.