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(영문) 서울행정법원 2013.8.21.선고 2012구단20000 판결

요양급여불승처분취소

Cases

2012Gudan20000 Revocation of Disposition of Non-performance of Medical Care Benefits

Plaintiff

1. Maximum○○;

2. White○○.

The plaintiffs' Address Jeonju-si Songsan-si 12-8

원고들 소송대리인 법무법인 더 쌤

[Defendant-Appellee]

Defendant

Korea Labor Welfare Corporation

Representative Shin Young-chul

Litigation Performers Kim Sang-deok, Postal Affairs Residents

Conclusion of Pleadings

July 24, 2013

Imposition of Judgment

August 21, 2013

Text

1. The Defendant’s disposition of non-approval of medical care benefits rendered to the deceased Matrine on May 25, 2012 is revoked.

2. The costs of the lawsuit shall be borne by the defendant.

Purport of claim

The order is as set forth in the text.

Reasons

1. Details of the disposition;

A. On January 1, 2010, the deceased Choi-si (hereinafter referred to as "the deceased") entered the work sports team of the Pyeong-gun Office and served as a chron player, and on April 9, 2012, he/she applied for medical care benefits to the Defendant on the following grounds: (a) he/she was infected with a virus in a state where the physical strength has been deteriorated due to continued training and athletic exercise; (b) he/she was infected with a virus; and (c) he/she was infected with a virus; and (d) he/she applied for a viral viral tyrosis and overall liveral tyrosis (hereinafter referred to as "the injury").

B. As to this, the Defendant, on May 25, 2012, issued a notice of non-approval of medical care (hereinafter “instant disposition”) on the grounds that the causal relationship between the deceased’s occupational stress and the instant injury and stress.

C. The Deceased died on June 4, 2012, and the Plaintiffs, as the parents of the Deceased, were bereaved family members pursuant to Articles 5 subparag. 3 and 81 of the Industrial Accident Compensation Insurance Act, and the instant disposition became subject to the previous trial without going through the procedure of the previous trial.

【Uncontentious facts, Gap’s entries in Gap’s evidence 1, 4, and 7, and the purport of the whole pleadings; 2. Claims and judgments

A. Summary of the plaintiffs' assertion

Since the work of the deceased is mainly exposed to outdoor, training and vision, and the injury and disease of this case occurred under the aggravation of physical resistance and immunity function due to excess, the injury and disease of this case was caused during the performance of his duties, and thus, there is a proximate causal relation between the deceased’s work and the injury and disease.

B. The facts of recognition (1) the Deceased’s work form, etc. (a) was born in 1992, and (b) on January 1, 2010, the Deceased had been appointed as a player of the Clock Stick Team at work at work of the Pyeongtaek-gun Office. On January 1, 2010, the Deceased had been on training and sports team belonging to the Clock Team and been engaged in activities as a player. The Deceased had been on a group life in a way of training and sports, and on a way of lodging with the players belonging to the Clock Team at the lodging located within the Glyeong-gun Agency. (b) The Deceased trained trained 7 minutes a day and 30 minutes a day during the six-day period of time a week, and the Deceased was on a day by the Deceased on January 1, 2011.

9. From April 2, 201 to March 26, 2012, the details of participation in training and competitions are as follows:

(C) On March 20, 2012, the Deceased was held from March 20 to March 23, 2012, and since around 10 days prior to the 10th anniversary of the Presidential Gamyeong-gun, the deceased was unable to conduct the exercise properly due to their innate donation and hairs, etc., and when the deceased appealed to the supervisor of the Gmsan Team but did not undergo other medical treatment, the deceased was on March 20, 2012, and was released to the private 4 km on March 20, 2012, and was still on the way (a) the major medical opinion (a) the doctor’s opinion on the doctor’s opinion (the results of the inquiry about the Gancheon-gun Hospital of Korea University) (a).

- In general, viral viral chrons and liverers, such as viral chronological diseases, virals, and viral chrons;

- there is no connection with credit, such as there is no past history of infections in the middle-aged boundary;

- It is determined that there is a correlation between the viral brain infection and the patient's immunity, and at least 10 days prior to the internal organ infection;

- The deceased is judged not to be infected by direct external factors due to the lack of evidence such as fratitis, and the possibility of physical causes is reduced. Thus, naturally, virus infections occurred, and the possibility of having reached cerebral infections is deemed to be reasonable due to the decline of the deceased's immunodeficiency power. The deceased's usual physical condition was the state of a state health. Accordingly, the possibility that cerebral infections were likely to have occurred due to excessive physical work is reasonable (b) the defendant's opinion.

- It is the opinion that it is difficult to recognize a viral viral viral viral viral viral viral viral viral liverral liverral viral liverral viral viral viral terral terral viral terral viral terral viral terral terral viral ter

- viral brain infection is infected by air in the medium of powder, such as most others, due to chronological diseases, and the Deceased did not have spathnosis.

- There is a causal link between immunodeficiency disorder and injury or disease caused by the deceased’s sense of donation, stress, mental and physical skin, pressure, etc.

- Not later than 10 days prior to the outbreak of cerebral infections, infections and virus infections themselves were naturally induced and, considering that the deceased was a sound and healthy exercise player, the infections caused to cerebral infections without being finished to the extent of a minor hysium, is a major factor in the state of immunity due to mental disorder and stress without sufficient rest and appropriate medical measures.

【In the absence of any dispute over the grounds for recognition, the entries in Gap evidence 2 through 29, the entries in Eul evidence 1 and 2, and the request for the examination of the medical records to the Gicheon-gu Hospital in the Egrative Hospital in the Egrative Hospital in the Republic of Korea, the result of the inquiry into the Gicheon-gu Hospital in this Court, and the purport of the whole

C. Determination

(1) "Occupational accident" under Article 5 subparagraph 1 of the Industrial Accident Compensation Insurance Act means an employee's injury, disease, disability, or death caused by an occupational reason, and there is a proximate causal relation between the employee's occupational disease and the disease. In this case, the causal relation between the employee's occupational disease should be proved by the assertion. However, if the main cause of the disease does not have a direct relation with the work and at least theromatic stress overlaps with the main cause of the disease, and causes or worsens the disease, the causal relation should be deemed to exist between the occupational disease and the disease. The causal relation does not necessarily have to be proved clearly by medical and natural science, and in light of all circumstances, there is a proximate causal relation between the work and the disease when it is presumed that there is a proximate causal relation between the occupational disease and the disease. In addition, the existence of a causal relation between the work and the disease should be determined on the basis of immunodeficiency disease's medical stress or stress, etc. as long as it is not an average worker, but it should be determined on the basis of medical stress or stress of the worker in question.

(3) In light of the foregoing, the deceased returned to the instant case, and the following facts recognized as such, i.e., healthy young people of 20 years of age at the time of the outbreak of the instant injury: (a) the deceased had physical conditions and physical strength to the extent that he could work as a national team leader; (b) the deceased did not have any spacifies related to the instant injury branch; and (c) the deceased did not have any other person who could cause the instant injury; (d) the deceased had continued to be tension with the tension and training from around September 201 to March 2012 by continuing to undergo treatment and training; and (e) the deceased did not have any other physical stress and spacific force after 201, which led to the death of the deceased, due to stress and spacific force during his training.

(4) Ultimately, as long as brain infection virus is deemed rapidly activated due to the decline of the body of the deceased due to the above overwork or stress, there is a proximate causal relation between the deceased’s work and the injury and disease of this case, and the disposition of this case which did not recognize it shall be revoked as it is unlawful.

3. Conclusion

Therefore, the plaintiffs' claim of this case is justified, and it is so decided as per Disposition.

Judges

Judges Cho Byung-gu