[간병료부당이득금결정등][미간행]
Plaintiff (Attorney Yoon-sung et al., Counsel for the plaintiff-appellant)
Korea Labor Welfare Corporation
September 3, 2008
1. On February 7, 2007, the Defendant rendered a decision of unjust enrichment against the Plaintiff on nursing fees and the disposition of notice of payment shall be revoked.
2. The costs of the lawsuit are assessed against the defendant.
The same shall apply to the order.
1. Details of the disposition;
A. On June 7, 1994, the Plaintiff received steel and night disease charges from the Defendant from May 7, 1997 to October 31, 2006, when receiving medical care due to the fall accident, i.e., the lower half of the year, 6, 7 around the year, 197, i.e., the steel and night disease charges.
B. However, on January 25, 2007, the defendant was notified of the result of the deliberation that "the physical force of the solar shoulder, the hacker, and the hacker's hacker's hacker's hacker's hacker's hacke is normal, and the hacker's hacker's hacker's hacker's hacker's hacker's hacker's hacker's hacker's hacker, but the hacker's hacker's hacker's hacker's hacker's hacker's hacker's hacker's hacker's hackor's hacker's hackor's hacker's hacker's hacker's hacker's hacks
C. Accordingly, on February 7, 2007, the Defendant: (a) notified the Plaintiff on January 1, 2004 ( February 11, 2004) through October 31, 2006 ( November 6, 2006 on the payment date) of the nursing fees paid by the Plaintiff from the Defendant as unjust enrichment; (b) however, (c) the Defendant did not receive insurance benefits by fraudulent or other unlawful means; (d) notified the Plaintiff of the decision to collect KRW 18,782,02,00 as unjust enrichment (hereinafter “instant disposition”).
[Ground of recognition] Facts without dispute, Gap evidence 1, Eul evidence 3 through 5, Eul evidence 7-2, Eul evidence 8, the purport of the whole pleadings
2. Whether the instant disposition is lawful
A. The plaintiff's assertion
(1) The Plaintiff is currently serving in the rehabilitation department of an affiliated hospital of the ○○ University (hereinafter “○○ University Medical Center”). The Plaintiff is in need of another person’s assistance in moving to the boundary of the main unit of the hospital, and is subject to a bar-time disease on the ground that he/she has difficulty in bathing and treating urine urines as well as disorder in controlling urine and urines, and thus has difficulty in treating urine urines.
(2) At the time when the Defendant decided to pay the charge for the night illness to the Plaintiff, the employee of the Defendant confirmed the Plaintiff’s condition, examined the Defendant’s advice and the Plaintiff’s need to pay the charge for the night illness, and then decided to pay the charge for the night illness. Therefore, this cannot be deemed as unjust enrichment received without any legal ground.
(b) Related statutes;
It is as shown in the attached Form.
(c) Fact of recognition;
(1) Circumstances of the instant accident and medical care
(A) On June 7, 1994, the Plaintiff was faced with a crashed accident at the New Staff Training Council of Non-Party 1, and received emergency medical treatment at △△ Hospital after being diagnosed of “Habrostosis, 6, 7 drillings and light damage, 7 square meters, neutical brupt, neutical brutosis, neutical brutosisum, brutitis, brutitis, grostitis, eutism, frutivity, limited ventilation, and waste collection.”
(B) After that, from September 4, 1995, the hospital in △△ Hospital and Mandong University Hospital received hospital treatment from the hospital in △△△ Hospital, and the Defendant was paid KRW 62,984,140,00 in advance of 4 years of disability pension after receiving treatment on January 13, 1998.
(C) On April 2, 1998, the Plaintiff received the approval from the Defendant for re-treatment, and was hospitalized in the Seoul Special Self-Governing Province Hospital, and received the hospital treatment from the Defendant. From February 26, 2001, the Plaintiff was under hospital treatment from the ○○ Medical Center up to the present day, and obtained the approval from the Defendant on June 5, 2002.
(D) From May 4, 1997 to October 31, 2006, the Plaintiff received steel and night-time illness fees from the Defendant on the grounds of “influence in independent conduct, daily life action and controlling ties and urines, prevention of bathing, paralysis, etc.” However, from November 2006, the Plaintiff was refusing to pay steel and night-time illness fees, and thus receiving ordinary nursing charges.
(2) Defendant’s opinion on advice
(A) Bilateral Hospital of the University of Bright and Nonparty 2
Although the upper branch has minor paralysis, it is judged to be complete inasmuch as a person maintaining a certain degree of sports function is able to drive a short-distance motor vehicle with wheelchairs moving, it is determined as a complete horse cost. When referring to the medical records, etc. of the ○○○○○○ medical department (the date of March 2, 2001, September 2, 2003, November 12, 2004), it is determined that the neological paralysis phenomenon is fixed without a big change in comparison with the present state, and it is deemed reasonable that the ordinary nursing disease is reasonable because it is accompanied by the minor paralysis and the upper part of the body, but there is a physical function of the upper part.
(B) ○ University Hospital Ma○ University Hospital N.S. and Professor non-party 3
The field checkout and supervision of the upper branch are normal, 75% (god + 75%), 50% (fairly fair, in particular, 1, 2 balance), and the state of complete finishing, which were maintained after March 5, 2003, and it is judged that the standing strength except the function of 1, 2 balance is considerably maintained, and it is possible to be a general guard.
(다) ▲▲병원 신경외과 과장 소외 4
In the medical record on September 2, 2003, the exercise forces of both shoulders, knife, and knife are normal, and the knife of both knife is fair, and the knife of both knife is fair, there is no knife of the above opinion in the state of movement at present, and the movement of abandonment is maintained, while the knife movement is in the state of complete knife, the knife is certain degree of learning and the knife is maintained and the knife is not maintained.
(D) Non-party 5, professors and non-party 1 of ○ University Hospital
Although minor marina opinions are expressed on both sides, a number of sports functions are maintained, and a person is able to move wheelchairss and drive a short-distance motor vehicle, and the complete horse condition is not complete. When referring to the inspection records of the medical records, etc. of the ○○○○○ medical records (the date of March 2, 2001, September 2, 2003, November 12, 2004), it is judged that the neological marinaism is fixed without a big change, and it is deemed that the ordinary nursing disease is reasonable because it is accompanied by the minor marina expenses and the upper part of the body.
(마) ■■정형외과의원 원장 소외 6
It is recognized as being subject to general nursing because it is possible to function as a sports center, so it is possible to lead a daily life to a certain extent, and it has been maintained for about three years in the state of complete paralysis.
(바) ★★정형외과의원 정형외과 전문의 소외 7
In the field of medical records attached to the above branch, it is judged that the movement of the field of field and the field of supervision is good condition, the movement of the field and the field of supervision, the movement of the field of handout and the field of handout, and the state of handout is considered to have no big difference between the state of handout in 2003 and 2004.
(3) The result of the commission of appraisal of medical records against the non-party 8 at the Madle University Madle University
The Plaintiff’s level of physical paralysis is “the level of flag of body,” which is confirmed by the standard glagological examination records and verte damage, etc. The same record is recorded without any changes in neological records as of Mar. 10, 200; Jun. 10, 2002; Mar. 5, 2003; Mar. 8, 2003; Sep. 2, 2003; Nov. 12, 2004; the instant erogate, erobbbow movement is normal; the instant erogate, erogate, eros, and son’s son’s erogical examination records and spine damage; the Plaintiff’s erogical examination records do not fall under the first 6th degree of erogical examination records; and the Plaintiff’s erogical examination records do not fall under the total level of 10th erogic disease.
(4) The fact-finding and fact-finding inquiry about the non-party 9 of the major medical professional in ○○ major medical doctor's rehabilitation department
(a) Diagnosis name and degree: Neither 6 nor lower-grade pathy, neutism and breathy, neutism, nephalosisism, neutism before 6-7, and leutism, leutism, leutism, and leutical disorder;
(B) The Plaintiff, on its own initiative, was unable to use force between body independently, and the Plaintiff also reduced the ability to maintain the state of body without support for body.
(C) Where auxiliary equipment is not used, the driver can alone drive a wheel, wheel chairs, and the driver can do so under the seat of the wheel, but the driver can do so. However, the driver can not do so on his own, even if he can do so with swel, swel and swel using swel, swel and sweld, sweld, sweld, sweld, sweld in the seat of the wheel, and then can not do so on his own, after the sweld, sweld, sweld, sweld, sweld, and sweld under the influence of the wheel.
(d) It is independently impossible to move out of the bed, and the assistance of others is required in the process of speaking, and a part of urines using a carter may be available while they are seated in the wheelchairs during a low time, but if they are sarbly of the need, they must undergo a carter’s urology that is caused by another’s aid.
(E) In the night, it is very difficult to change the body above alone, and in the case of the Plaintiff, there is a need to attend urology due to the career of self-galinology, and thus, it requires a steel night disease during a life period.
(F) A large number of cases where a voluntary catus catus catus occurs due to a catus disorder, a large number of cases where the catus catus is accompanied by a severe catal and saturine catus. An independent catus catus should be held independently, but in the above case, it is very difficult to maintain an independent catus and a catus catus catus catus in the light, and it is difficult to have a catus catus for the catus to enter the catus because it is difficult to enter the catus due to severe catral catum in the light of the fact that the Plaintiff, who started with the catus catus catus, started with the catus catus
(5) Results of the commission of physical appraisal and supplementation of the director of the University Hospital
(a) The extent of the sentence and its degree: Malabro (including spathy, exercise, and spacence), nephalinosis, nephalinosis, anti-functional part of autonomous boundary, anti-functional part of air brupty, anti-debris and vegetable infections, 6-7 renals of 6-7 and 7 conical frames, light diameters, limited ventilation disorder;
(B) Without using assistive devices, the Plaintiff may alone do so, such as communication and social recognition, the operation of wheelchairs, the operation of wheelchairs with a seated wheel chairs, the actions to sit, the wheeling, the actions to sit, the steering on the wheel, the steering on the wheel, the steering on the wheel, the steering on the wheel, the steering on the wheeling, the steering on the wheeling, the steering on the wheel, the steering on the wheel, the steering on the wheel, the steering on the wheel, the wheeling on the wheel, the steering on both sides, the wheeling on the wheel, the urging on the wheel, the urging on the wheel, the urging on the wheel, the after-hand after-hand treatment action, etc., which alone cannot be done.
(C) The Plaintiff is entirely in need of assistance from another person, and there is a urine disorder so that he/she can not receive urology on his/her own with his/her own will, and he/she must regularly urine urine by using a camera at intervals of 4 to 6 hours a day due to urine urine urine or urine urine urine, etc.
(D) As a representative disability, there is a chronic urine disorder, such as chronic urine, urine, urine, dynasium, and dynasium due to one’s own intention, and urines should be used every 3-4 days for urine, and urines should be used for urine, and urines should be entirely used for urine treatment after urines.
(E) It is deemed that comprehensive rehabilitation treatment, such as pharmacologic treatment, physical therapy, work therapy, etc., is necessary to prevent mergers, such as bathing, cardio-unlawful surgery, pulmonary and hyeingitis, pulmonary color, pulmonary dyeing, and dyeculosis, etc.
(F) Since it is deemed difficult to independently perform catherter urology, etc. without another person’s aid to prevent the occurrence of a cathosa, it is deemed necessary to continuously engage in catheral disease during a life period.
(6) Medical knowledge of gymarma;
It is classified into the total damage under the condition that the upper part, the body, the non-permanent exercise or the sense function is lost solely or together, and the luminous, the register and the sexual function is also lost, and it is classified into the total damage under the damaged level or the partial reduction under the damaged level or the physical function is preserved.
(7) According to the classification of the U.S. D. D. D. D. D. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M
(8) Guidelines for handling affairs concerning standards for nursing fees;
According to the Defendant’s guidelines for handling affairs related to the payment of nursing fees (hereinafter “management guidelines”), Article 24(3) of the Enforcement Rule of the Industrial Accident Compensation Insurance (wholly amended by Labor Ordinance No. 304, Jul. 1, 2008; hereinafter “Enforcement Rule”) of the Enforcement Rule of the Industrial Accident Compensation Insurance (wholly amended by Labor Ordinance No. 304, Jul. 1, 2008) provides that whether nursing expenses need to be provided due to the concept indicating the father and the scope of marina shall be separately reviewed and determined by the classification of the United States
[Ground of recognition] In the absence of dispute, Gap evidence Nos. 2, 6, 7, 8, 10, Eul evidence Nos. 1, 4, 7, 8, and 11, Eul evidence Nos. 1, 4, 7, 8, and 11 (including additional numbers) as a result of the entrustment of the examination of medical records with respect to the Gusl University Gusl University Gusl University Gusl University's Gusl University's Gusl University's rehabilitation department, the results of the examination
D. Determination
(1) According to Article 40(4)5 of the Industrial Accident Compensation Insurance Act (wholly amended by Act No. 8373 of Apr. 11, 2007), Article 24(1) and Article 24(3) of the Enforcement Rule of the Industrial Accident Compensation Insurance Act (wholly amended by Act No. 8373 of Apr. 11, 2007), with respect to persons who are unable to move without any other person’s assistance due to the real name, etc. of two snows (Article 1(2)2), persons who need to take appropriate measures from time to time due to video, etc. with at least 35 percent of the body size (Article 1(5)5), persons who need to change their body from time to time to time to prevent bathing (in cases of spawnium, including persons who are in the place of origin) and other similar conditions, and who are in the medical treatment at all impossible without any other person’s assistance.
(2) In the instant case, it is deemed that the Plaintiff’s transfer of outpatient treatment is a satisfy, as there is no dispute between the parties concerned.
6) According to the above facts, it is reasonable to recognize the scope of the Plaintiff’s 4 medical treatment records as follows: (a) it is difficult to use the Plaintiff’s 6th climatic function solely or jointly; (b) it is difficult to use the Plaintiff’s climatic function for the Plaintiff’s 3rd clithic clithic clithic clithic clithic clithic clithic clithic clithic clithic clithic clithic clithic clithic clithic clithic clithic clithic clithic clithic clithic clithic clithic clithic clithic clithic clithic clithic clithic clithic clithic clithic clithic clithic clithic c.
Thus, the plaintiff's act constitutes a person who is in transit with a gymnasium and is subject to a gymnasium at night. Thus, the disposition of this case that the plaintiff regarded as a person subject to a general gymnas
3. Conclusion
Therefore, the plaintiff's claim of this case is reasonable, and it is decided as per Disposition by admitting it.
Judges Kim Ho (Presiding Justice)