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(영문) 창원지방법원 2019.11.13 2018구단1344

요양불승인처분취소

Text

1. The plaintiff's claim is dismissed.

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

Reasons

1. Summary of disposition;

A. On July 6, 2017, the Plaintiff filed an application for medical care benefits with the Defendant on the ground that “the Plaintiff, on January 18, 2017, went beyond the process of manufacturing goods at the workplace (hereinafter “instant accident”) and was diagnosed with “satise and tensions on the left side”, and filed an application for medical care benefits with the Defendant on September 5, 2017, for the medical care of “the instant injury” (hereinafter collectively referred to as “the instant injury”).

B. Accordingly, on October 18, 2018, the Defendant rendered a disposition of refusal of medical care (hereinafter “instant disposition”) to the Plaintiff on the ground that “it is difficult to recognize the proximate causal relationship between the instant accident and the injury and disease in the instant case.”

C. The Plaintiff dissatisfied with the request and filed a request for reexamination with the Industrial Accident Compensation Insurance Reexamination Committee, but the judgment dismissing the Plaintiff’s request was rendered on September 20, 2018.

[Ground of recognition] Facts without dispute, Gap evidence Nos. 1, 2 (including additional numbers), Eul evidence Nos. 1, 3, 6, and 7, the purport of the whole pleadings

2. Whether the disposition is lawful;

A. The plaintiff's assertion is unlawful in the disposition of this case which was not approved for medical treatment despite the diagnosis of the injury and disease of this case due to occupational accidents.

B. (1) Determination (1) As to whether the instant accident occurred, the following circumstances recognized by the Health Team, the result of the medical record appraisal review conducted by the B Hospital Head of this Court, and the purport of the entire pleadings, namely, ① the appraiser’s opinion that “it is difficult to recognize the causal relationship between the instant accident and the instant injury and disease,” and ② the appraiser’s opinion that “it is presumed that the instant accident and the instant injury and disease have occurred beyond the external appearance,” and the Defendant’s medical opinion that is replaced by the Defendant’s medical opinion, can be deemed to have occurred.