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(영문) 부산고등법원 2017.10.25. 선고 2017누53 판결

재요양불승인처분취소

Cases

2017Nu53 Revocation of Disposition of Non-approval for Additional Medical Care

Plaintiff Appellant

(A) The person taking charge of the action of the deceased A)

G

Defendant Elives

Korea Labor Welfare Corporation

The first instance judgment

Ulsan District Court Decision 2012Guhap2324 Decided January 16, 2014

Judgment before remanding

Busan High Court Decision 2014Nu175 decided October 22, 2014

Judgment of remand

Supreme Court Decision 2014Du14587 Decided July 11, 2017

Conclusion of Pleadings

October 11, 2017

Imposition of Judgment

October 25, 2017

Text

1. The plaintiff's appeal is dismissed.

2. The plaintiff shall bear the total costs of the lawsuit after filing the appeal.

Purport of claim and appeal

The judgment of the first instance shall be revoked. The defendant's disposition of non-approval for additional medical care rendered to the deceased A (hereinafter referred to as "the deceased") on February 21, 2012 shall be revoked.

Reasons

1. Details of the disposition;

On November 4, 1997, the deceased was employed and worked in B Co., Ltd. (hereinafter referred to as the "B") on November 4, 1997, and was returned to the emergency department of Absin hospital on March 10, 200 on the following day after he was returned to the emergency department of Absin hospital. As a result of the diagnosis, the deceased was found to be the first injury and disease on the left-hand side (hereinafter referred to as the "the first injury and disease in this case"). The deceased received the approval of the medical care for the first injury and disease in this case on August 9, 200, and was judged as the disability grade 9 after the completion of the medical care on August 9, 202.

On October 19, 201, the Deceased was diagnosed by the RoI test at C Hospital as a result of the RoI test conducted at the CRI test. Accordingly, on January 9, 2012, the Deceased filed an application for additional medical care with the Defendant on the ground of the foregoing diagnosis. However, on February 21, 2012, the Defendant issued to the Deceased on the ground that “the deceased’s application for additional medical care is not recognized as a requirement for recognition of additional medical care and a proximate causal relation is not recognized” (hereinafter “instant disposition”).

The Deceased filed the instant lawsuit on September 28, 2012, but died on November 5, 2015 while the lawsuit was pending, and the Plaintiff, as his spouse, took over the instant legal proceedings.

[Reasons for Recognition] Facts without dispute, entry of Eul Nos. 1, 2, 5, and 6 (including paper numbers; hereinafter the same shall apply), the purport of the whole pleadings

2. Whether the instant disposition is lawful

A. The plaintiff's assertion

Since the first wound occurred on March 10, 200 to the deceased on October 19, 201 after the outbreak of the first wound in this case, it is difficult to view that the injury was different from each other even if there were different parts of the outbreak, and the risk factor is the same, so the injury in this case should be deemed to have occurred on the extension line of the first wound in the past. Accordingly, since there is a medical proximate causal relation between the two, the disposition of this case on a different premise is unlawful.

(b) Fact of recognition;

The reasons why this Court is used for this part are as follows. Thus, the reasoning of the first instance judgment is as stated in Article 8(2) of the Administrative Litigation Act and Article 420 of the Civil Procedure Act, except when used or added as follows.

[Supplementary or added parts]

The reasoning of the judgment of the court of first instance is as follows: (b) part of Article 2-2 of the Reasons for the judgment of the court of first instance; and (c) each "Plaintiff" shall be changed to

○ The following is added between conduct 18 and 19 of the first instance judgment.

“D) Around October 19, 201, at the time of hospitalization at C Hospital due to the outbreak of the instant injury, the degree of 82km for the body body of the Deceased and 140/90mHg for blood pressure.

○ The 7th written judgment of the first instance court and the 6th and the 7th written judgment are followed as follows.

[Ground of recognition] Gap evidence Nos. 2, 3, 6, and 7; evidence Nos. 2, 3, 6, and 7; result of physical examination commissioned to the director of the Incheon Bag Hospital at the court of first instance; result of the entrustment of medical record appraisal and fact inquiry;

C. Relevant statutes

Attached Form 3 is as listed in the "relevant Acts and subordinate statutes".

D. Determination

1) Further medical care under the Industrial Accident Compensation Insurance Act is identical to the first medical care and its nature, except that the relevant injury or disease occurs after the completion of the medical care or that the relevant injury or disease occurred due to the merger. Therefore, the requirements for additional medical care do not meet the requirements for the first medical care, except that the first medical care is provided after the completion of the first medical care. Therefore, in order to be subject to additional medical care, there is a medical opinion that there is a proximate causal relation between the first injury or disease branch which applied for additional medical care in addition to the requirements for the medical care, and that the medical treatment would be expected by the aggravation of the symptoms compared to the injury or disease condition at the time of the completion of the medical care or the payment of disability benefits (see, e.g., Supreme Court Decisions 2002Du1762, Apr. 26, 2002; 2014Du14532, Mar. 12, 2015).

In addition, the medical proximate causal relationship here refers to not only the relationship of condition against the injury or disease for which the first injury or disease applied for the medical care is relatively significant in light of the empirical rule, but also the method and degree of proof is not necessarily required to be proved by direct evidence, and it is sufficient if it is proved to the extent that it can be inferred by indirect facts based on the health and physical condition of the relevant worker, and it is not sufficient to recognize a proximate causal relationship merely because the first injury or disease is likely to cause recurrence, aggravation, aggravation, or other mergers, as well as that the first injury or disease applied for the medical care is not clearly denied from the medical perspective (see, e.g., Supreme Court Decisions 96Nu18755, Mar. 28, 1997; 2002Du8091, Dec. 10, 2002).

2) In the instant case, examining the following circumstances revealed by the above facts of recognition in light of the legal principles as seen earlier, it is insufficient to deem that the instant injury and disease occurred due to the recurrence or aggravation of the first injury and disease of this case, and thus, it cannot be deemed that a proximate causal relation exists between the first injury and disease of this case.

① Although there was a medical opinion that there is possibility of a recurrence of brain color, “re-exploit” means that the brain color might result in a re-explosion on another part, and it cannot be viewed as “re-exploitation of the brain that was the first part of the injury and disease in this case.” However, the first injury and disease in this case is the brain color that occurred in the left-hand brain color, and the injury and disease in this case is the same as the name of the disease in this case, and each side of the injury and disease is different from the brain structure, and the brain disease in this case, which was the cause of the first injury and the brain disease in this case, which was the cause of the injury and disease in this case, is entirely different from the body of the blood, and it is difficult to regard the first injury and disease in this case, which was the cause of the injury and disease in this case as the re-exploitation of the injury and disease in this case.

② Although the general cause of the injury and disease was old, high blood pressure, urology, urology, finite, heart disease, blood response disorder, chinite, smoking, drinking, etc., medical opinion was presented that the occurrence of the injury and disease in this case may cause multiple hazards, such as old, high blood pressure, urology, urology, finite disease, blood response disorder, chinite, smoking, drinking, etc. However, with respect to the cause of the injury and disease in this case, the deceased could be seen as related to high blood pressure, and thus, the cause of the injury and disease in this case may be considered to be relatively high blood pressure, rather than whether there was a causal relationship with the cerebr of brain in 200 and nine years after the outbreak of the disease in this case. (c) In light of the medical opinion that the first cause of the injury and disease in this case could have been presented as a medical pressure of the deceased in this case, it can be seen that the first cause of the injury and disease in this case can be seen as a medical pressure of the disease in this case.

③ Meanwhile, around October 19, 201, at the time of the outbreak of the instant injury, there is no difference between the body weight of the deceased around 82 km and the blood pressure from B to 140/90m Hgm2 at the time of the outbreak of the instant injury, and the degree of 81 km and the blood pressure 140/90m Hg from the body body at the time of being identified solely with high blood pressure and rain. It is difficult to view that the blood pressure, which is the existing disease of the deceased, was properly managed at the time of the instant injury.

④ Since the completion of the first injury and disease of this case, the injury and disease of this case occurred more than nine years since the completion of the medical care. Among them, the Deceased did not perform his duties. It is difficult to deem that the first injury and disease of this case was worse due to reasons other than B or other duties.

3) Therefore, it is reasonable to view that the instant injury and disease is not subject to additional medical care under Article 51 of the Industrial Accident Compensation Insurance Act. Thus, the Defendant’s disposition that did not approve the deceased’s application for additional medical care is lawful.

3. Conclusion

Therefore, the plaintiff's claim shall be dismissed as it is without merit. Since the judgment of the court of first instance is justified, the plaintiff's appeal is dismissed. It is so decided as per Disposition.

Judges

The presiding judge, judges and grandchildren;

Judges Kim Jong-chul

Judge Guo- Provision

Attached Form

A person shall be appointed.