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(영문) 대법원 2012. 2. 9. 선고 2011두25661 판결

[요양불승인처분취소][미간행]

Main Issues

[1] Whether an existing disease, which is not directly related to the business, becomes worse due to an accident, etc. that occurred in connection with the business, or becomes worse due to the symptoms (affirmative), and the burden of proof as to the causal relationship and the degree of proof

[2] The case holding that the court below erred by misapprehending the legal principles on the ground that there is sufficient ground that the injury and disease in the king, which was caused by the accident, was caused by the reduction of the work site floor at the construction site of a new building and applied for medical care at the hospital, but the Korea Labor Welfare Corporation did not grant medical care on the ground that there is no proximate causal relation with the occupational accident, and it can be deemed that the injury and disease in the king, which was caused by the king, rapidly aggravated to the extent that it should not be directly treated beyond the natural progress due to the shock of the accident, and thus, it can be seen that it constitutes occupational accident

[Reference Provisions]

[1] Article 5 subparagraph 1 of the Industrial Accident Compensation Insurance Act / [2] Article 5 subparagraph 1 and Article 40 of the Industrial Accident Compensation Insurance Act

Reference Cases

[1] Supreme Court Decision 2009Du6186 Decided July 9, 2009

Plaintiff-Appellant

Plaintiff (Attorney Han-soo et al., Counsel for plaintiff-appellee)

Defendant-Appellee

Korea Labor Welfare Corporation

Judgment of the lower court

Seoul High Court Decision 2010Nu26638 decided September 23, 2011

Text

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

Reasons

The grounds of appeal are examined.

1. In order to constitute “occupational accident” subject to the Industrial Accident Compensation Insurance Act, a causal relationship between the business and the disaster is recognized. However, even if the accident is an existing disease that is not directly related to the business, if it becomes worse or becomes worse due to an accident that occurred in connection with the business, the causal relationship between the business should be deemed to exist, and if the aggravated part is not restored or worse and symptoms are fixed, it should be treated as occupational accident until the symptoms are fixed. The above causal relationship must be proved by the assertion, but it is not necessarily required to establish medical and natural medical evidence, and if it is presumed that there is a proximate causal relationship between the business and the disease in light of all the circumstances such as the health condition, outbreak, details of the disease at the time of employment, and the progress of the treatment, it can be viewed that there is evidence if there is a proximate causal relationship between the business and the disease. Furthermore, unlike disability benefits that mainly ensure the ability of the worker lost from occupational accident to a certain level, it should be compared to the degree of the ability to recover the disease caused by occupational accident, and thus, it should be compared with the symptoms of 2900.

2. 원심판결의 이유에 의하면, 원심은 그 채택 증거에 의하여 원고가 이 사건 상병에 관하여 치료를 받은 경위, 원고가 그 상병의 원인이라고 주장하는 이 사건 사고의 발생에 관한 관련자들의 사실확인, 이 사건 상병에 관한 의학적 소견 등에 관한 판시사실을 인정한 다음, 원고가 2008. 9. 11. 이 사건 상병에 관하여 진찰을 받으면서 부상시기를 내원 6주 전이라고 진술하여 이 사건 사고발생일이라고 주장하는 2008. 8. 20.과 맞지 않은 점, 부상의 경위를 설명하면서 위 신축공사 현장에서의 작업 도중 발생하였다는 점을 구체적으로 언급하지 않은 점, 만일 위 사고로 이 사건 상병에 따른 통증이 발생하였다면 그로부터 3주간이나 별다른 치료를 받지 않은 채 이 사건 상병을 견뎠을 리 없다는 등의 사정을 들어, 과연 원고가 주장하는 바와 같이 2008. 8. 20.에 이 사건 사고가 발생하였는지 의심스럽고, 이 사건 상병의 내용도 퇴행성 변화에 불과할 뿐 통상의 정도를 넘어 악화되었다고 볼 수 없다는 이유로 이 사건 상병에 대한 원고의 요양신청을 승인하지 않은 피고의 처분이 적법하다고 판단하였다.

3. However, the lower court’s determination is difficult to accept.

A. First of all, according to the confirmation document by Nonparty 1 and 2, who did not clearly reject the judgment of the court below, the above persons engaged in work with the plaintiff or as employees of the above contractor of construction work, who made work with the plaintiff at the construction site of the construction site of the "Jin Livestock" located in Ycheon-si, Ycheon-si, Ycheon-si, and confirmed that the plaintiff was at the work site of the construction site of the construction site of the construction site of the construction site of the construction site of the construction site of the construction site of the construction site of August 208, and the defendant confirmed the fact that he was at the hand and shoulder, etc. while being at the work site of the construction site of the construction site. The defendant accepted the above confirmation and accepted the medical treatment of the part of the accident of this case as alleged by the plaintiff while accepting the above confirmation, and merely did not recognize the causal relationship between the "the part of the front part of the front part of the front part of the construction site of the construction site of this case", and the "the causal relationship between the above accident.

Nevertheless, the court below rejected the credibility of the evidence submitted by the plaintiff without permission by giving excessive meanings to minor disagreements that the defendant did not know the issue, and by raising a subjective or conceptual suspicion that is not based on objective empirical rules. Thus, this cannot be deemed unlawful beyond the limit of the principle of free evaluation of evidence given to the court below as to the fact-finding. The ground of appeal pointing this out has justifiable grounds.

B. Next, in light of the records, we affirm that the court below's adoption of the defendant's advisory opinion and the opinion on the appraisal of medical records at the court of first instance and the court below to the effect that the injury and disease in this case did not seem to have been due to the change of emerculation, and that the injury and disease in this case did not occur due to the accident in this case, by adopting the plaintiff's opinion on the appraisal of medical records at the court of first instance and the court below.

However, even according to the opinion of the expert opinion of the court below on the other hand, it is sufficiently recognized that the symptoms, such as pains, etc., caused by the accident of this case, have been revealed that the accident of this case, and in light of the above legal principles, after the accident of this case, the plaintiff complained of the pains caused by the disease of this case, and went through medical treatment such as surgery, it can be deemed that the disease of this case, which the plaintiff had been a king, has aggravated rapidly to the extent that it should not immediately go beyond natural progress due to the shock caused by the accident of this case, and therefore, it is sufficient to deem that the disease of this case, which the plaintiff applied for medical care benefits, constitutes an occupational accident.

Nevertheless, the court below determined that the injury of this case did not constitute an occupational accident which has a proximate causal relation with the plaintiff's business on the ground that it was difficult to view that the injury of this case was caused by the accident of this case or that it was rapidly aggravated beyond natural progress. Such judgment below erred by misapprehending the legal principles on occupational accident, thereby affecting the conclusion of the judgment. The ground of appeal pointing this out has merit.

4. Therefore, the lower judgment is reversed, and the case is remanded to the lower court for further proceedings consistent with this Opinion. It is so decided as per Disposition by the assent of all participating Justices on the bench.

Justices Kim Nung-hwan (Presiding Justice)