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(영문) 서울고등법원 2017.08.25 2017누40268

진폐보험급여부지급처분취소

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1. The plaintiff's appeal is dismissed.

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

Purport of claim and appeal

The first instance court.

Reasons

1. Details of the disposition;

A. The Plaintiff, from April 1961 to January 1, 1991, performed coal collection work at the Korea Coal Corporation Hamba, etc.

B. From October 12, 2015 to October 14, 2015, the Plaintiff filed an application for medical care for pneumoconiosis on the ground that the medical examination for pneumoconiosis conducted by an Ansan Hospital of the Korea Workers’ Compensation and Welfare Service was diagnosed as having a noise level of 1/0 that the noise level of the pneumoconiosis constituted Type 1.

C. On January 6, 2016, the Defendant rendered a disposition to pay the site price of pneumoconiosis insurance benefits (hereinafter “instant disposition”) on the ground that the Plaintiff constitutes symptoms of pneumoconiosis type (0/1) and minor cardiopulmonary function (F1/2) as a result of the review by the Pneumoconiosis Review Committee.

【Legal basis for recognition】 Evidence Nos. 1, 2, and 1 of Evidence No. 1, the purport of the whole pleadings

2. Whether the instant disposition is lawful

A. As seen earlier, although the result of the medical examination for pneumoconiosis conducted with the Plaintiff as a result of the medical examination for pneumoconiosis conducted against the Plaintiff, it is merely suspected that the pneumoconiosis type (0/1) is nothing more than the symptoms (0/1), the instant disposition should be revoked as it is unlawful.

B. Determination 1) If a person intends to be recognized as a medical care or disability grade due to a pneumoconiosis, he/she shall meet the criteria prescribed in attached Table 11-2 of the Enforcement Decree of the Industrial Accident Compensation Insurance Act (based on the criteria for determining the degree of cardiopulmonary function, criteria for determining the degree of cardiopulmonary function, criteria for determining the pneumoconiosis disability grade, and criteria for recognition of the subject of medical care). According to the above criteria, the criteria for recognition of the subject of medical care pursuant to a complication, etc. are cases where the pneumoconiosis type is at least Type 1, and (i) active tuberculosis due to a complication of pneumoconiosis, plesying infection caused by infection, engine infection, expansion of engine, scarcity, scarcity, scarcity, and pulmonary heart (applicable only where the cardiopulmonary function is at least the scarcity disorder), and (ii) where the high level of cardiopulmonary function(F3) due to pneumoconiosis is confirmed, and (iii) where the sum of the area of large scoke is more than 1/2 of the right termination.