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(영문) 부산지방법원 2010.2.3.선고 2009구단1048 판결

요양불승인처분취소청구

Cases

209 Dog-gu 1048 Demanding revocation of Disposition of Non-approval for Medical Care

Plaintiff

Kim A (51 year olds, Females)

Attorney Lee Jae-soo, Counsel for the plaintiff-appellant

Defendant

Korea Labor Welfare Corporation

Representative President Kim D

Litigation Performers E, Duf

Conclusion of Pleadings

January 20, 2010

Imposition of Judgment

February 3, 2010

Text

1. On June 30, 2008, the defendant revoked the disposition of non-approval for oriental medical care for the plaintiff on June 30, 2008.

Purport of claim

The same shall apply to the order.

Reasons

1. Details of the disposition;

가.원고는 주식회사 ◇(이하 '소외 회사'라고 한다) 소속으로 ◆병원 구내식당(이하 '이 사건 식당'이라 한다)에 파견되어 조리사로 근무하던 중 2008. 5. 13. 15:00경 이 사건 식당에서 저녁 환자식을 준비하다가 갑자기 왼쪽 마비증세 등이 나타나 □병원에서 검사 결과 '뇌경색(이하 '이 사건 상병'이라 한다)의 진단을 받고 2008. 5. 28.경 피고에게 요양승인신청을 하였다.

B. Accordingly, on June 30, 2008, the Defendant rendered a disposition not to grant medical care (hereinafter “instant disposition”) to the Plaintiff on the ground that there is no proximate causal relation between the Plaintiff’s work branch and the instant branch.

C. The Plaintiff, who is dissatisfied with the instant disposition, filed a request for review and reexamination in succession, but all of the appeals were dismissed.

[Ground of recognition] Facts without dispute, Gap evidence Nos. 1, 3, 4, Eul evidence Nos. 3, 9, and 10, the purport of the whole pleadings

2. Whether the instant disposition is lawful

A. The plaintiff's assertion

The Plaintiff, while performing a heavy duty exceeding 13 hours a day much more than the statutory working hours on the old age, committed the instant injury and disease, and even though the king aggravated beyond the natural progress, the instant disposition was unlawful.

(b) Fact of recognition;

(1) Details of the Plaintiff’s work

(A) On August 1, 2006, the Plaintiff was affiliated with the non-party company, and was dispatched to the instant restaurant from around that time, and worked as a cook. The details of the duties are dedicated to the establishment of a half-ro, the assignment of the third-story hospital patients, the collection of food plates, and the creation of a special food for patients.

(B) In the instant restaurant, four cooks, other than the Plaintiff, were assigned to the instant restaurant, and two other cooks were assigned to the morning, but the Plaintiff was employed from 06:00 to 20:00. However, the Plaintiff was on the last day from 06:00 to 20:00, and the first day was on the 4-day day off from one month, but on the 2-day day off from December 2007.

(C) Normally, the Aldgs 4, which is created at the instant restaurant, are 5, each of which is about 100 persons, each of which is about 100 persons, and the first instance is about 130 persons.

(D) The Plaintiff’s daily work was around 06:00, around 07:00, from around 07:30 to around 07:00 to around 08:30, the Plaintiff’s daily work was for the delivery of meals and the collection of food board around 08:30; the preparation of meal for the point of occupation; the delivery of meals from around 12:00 to around 14:00; the Plaintiff’s simple work performance and rest from around 16:00 to around 16:0; the Plaintiff’s work was for the aforementioned preparation of meals; and the order of retirement around 20:00.

(E) The Plaintiff received an hourly salary. According to the working conditions of the non-party company, the Plaintiff was paid 13 hours a day on July 2007, 227.5 hours, 4 days of service, 292.5 hours of service on August 2007, 2007, 286 hours of service on September 2007, 286 hours of service on April 4, 2007, 324.5 hours of service on October 2007, 320.5 hours of service on November 2007, 320.4 days of service on April 4, 2007, 36 hours of service on December 206, 2007, 37 hours of service on January 207, 207, 207, 207, 377 hours of service on February 31, 2008, 208, 37 hours of service on August 27, 2008.

(F) The Plaintiff, at his home located in the Busan-dong, Seosan-dong, Busan-dong, to the instant restaurant located in the Nam-gu, Busan-dong.

(G) At around 15:00 on May 13, 2008, the date of the instant injury and disease, the Plaintiff had a certificate of influence on the left side and the arms while dealing with the main apparatus to make a pup for the instant restaurant, which led to the division of horses and the left side.

(H) On the other hand, on September 27, 1951, the Plaintiff was a 163cm in height with 163cm in body, 69km in body, did not drink and tobacco. On November 26, 2007, the result of the health examination conducted on November 26, 2007, was measured as non- full-time 1, and the blood pressure was measured as 189/113mm in Hg, so the Plaintiff was judged as suffering from a disease, but did not control the blood pressure or undergo hospital treatment.

(2) Medical opinions

(A) The Plaintiff’s (Eigue Hospital MaC) declared anti-blood drugs, brain protective agents, and blood improvement agents, etc. by moving to the left-hand marbing state, and whether it is a disability is a subsequent evaluation, and hospitalized treatment is required due to a pedestrian impossibility condition.

(b) Defendant’s advice

1. Advice on branch offices: It is not recognized as a whole in accordance with the criteria, and there is no special circumstance.

2. Advice of the branch office: A state of low blood pressure control, which does not prove overwork, seems naturally occurring.

3. Advice on branch offices: there is no matter pertaining to occupational accidents.

4. Advice on branch offices 4. It is reasonable to see that the branch offices are overwork, overtime work, or stressed.

5) Advice on branch offices: there is no objective evidence to prove the relevant conditions under the criteria for recognition of brain cerebrovascular diseases.

6. 6. Consultation on branch offices: There is no matter to recognize the division in considering the ability of work.

7. Advice on branch offices: It is difficult to recognize it as a matter of law because it does not meet the criteria of excessive workloads.

8) Main Advisory Service: In reference to the Plaintiff’s data, the Plaintiff is recognized as a patient who applied for medical care in brain color, but has not been recognized as a clear occupational course or stress prior to the outbreak, etc. Therefore, the Plaintiff’s brain color is determined to have occurred due to the natural and transitional aggravation of existing diseases (the symptoms of high blood pressure) and risk factors (the apparent symptoms are not revealed). Therefore, the Plaintiff’s brain color will not be related to his/her duties.

[Ground of recognition] Gap evidence Nos. 5, 6, Eul evidence Nos. 3, Eul evidence Nos. 4-1 through 7, Eul evidence Nos. 6-1 through 4, Eul evidence Nos. 7 through 10, fact inquiry results against the head of the Busan Regional Headquarters of the National Health Insurance Corporation, and the purport of the whole pleadings

C. Determination

(1) The "occupational accident" under Article 5 subparagraph 1 of the Industrial Accident Compensation Insurance Act refers to an accident caused by an employee's occupational accident while performing his/her duties, so there is a proximate causal relation between the employee's occupational accident and the accident. In this case, the causal relation between the employee's occupational accident should be proved by the assertion. However, the existence of a proximate causal relation between the employee's occupational accident and the accident should be determined on the basis of the employee's health and physical conditions, not by the average person, but by the average person. In addition, the degree of proof of causal relation should not be clearly proved by medical and natural science, and it should be proved even if there is a proximate causal relation between the employee's occupational accident in light of all the circumstances (see, e.g., Supreme Court Decision 2005Du8009, Nov. 10,

(2) As to the instant case, the following circumstances revealed in the foregoing recognition, namely, ① the Plaintiff had worked for a period of 5 months prior to the outbreak of the injury or disease, i.e., e., 1 more than 13 hours a day as a day off at one month, and 2) the Plaintiff appears to have performed excessive duties as an aged woman aged 56. In particular, the Plaintiff’s work on April 8, 2008, which was on the first half of April 2008 and continued 27 consecutive days until his work on May 6, 2008, 3) the injury or disease occurred in the course of performing its duties, 4) the Plaintiff was judged to have been subject to high blood pressure as a result of the health examination conducted on November 26, 2007, but it seems that there were no special stress or stress on the Plaintiff’s performing its duties, and 5) the Plaintiff’s work that could have aggravated due to stress or stress on the Plaintiff’s work.

(3) Therefore, since proximate causal relation between the Plaintiff’s business branch of this case is recognized, the Defendant’s disposition of this case based on a different premise is unlawful.

3. Conclusion

Therefore, the plaintiff's claim of this case is reasonable, and it is decided as per Disposition by the assent of all participating Justices.

Judges

Judges Yang Dong-soo