보험급여부지급처분취소
1. The Defendant’s disposition to pay pneumoconiosis insurance benefits payable to the Plaintiff on August 30, 2017 is revoked.
2. The costs of the lawsuit are assessed against the defendant.
1. Details of the disposition;
A. The Plaintiff, who was engaged in dusty work at the Korea Coal Corporation's Do Mining Center, applied for medical care benefits for pneumoconiosis to the Defendant.
B. From May 11, 2017 to March 13, 2017, the Plaintiff undergone a precise diagnosis of pneumoconiosis (hereinafter “detailed diagnosis of pneumoconiosis of this case”) at B Hospital. In the chest video examination, the pneumoconiosis type was 0/1 opinion.
C. On August 30, 2017, the Defendant determined the Plaintiff’s pneumoconiosis-type symptoms (0/1) as a result of the review by the Pneumoconiosis Review Board on the diagnosis of pneumoconiosis, and rendered a disposition to grant the Plaintiff an approval for the non-approval of pneumoconiosis medical care (hereinafter “instant disposition”).
[Ground of recognition] Facts without dispute, Gap evidence 1, 2 (including additional number), Eul evidence 1, the purport of the whole pleadings
2. Whether the instant disposition is lawful
A. Although the Plaintiff’s alleged pneumoconiosis type No. 1 corresponds to the Plaintiff’s beneficiary of pneumoconiosis insurance benefits, the Defendant’s disposition based on the different premise is unlawful.
(b) as shown in the attached Form of the relevant statutes.
C. Determination of Gap evidence Nos. 3 and 4, each of the following circumstances revealed by adding the overall purport of the arguments as a result of the appraisal commission with respect to the Samsung Seoul Hospital head of this Court and the Chairperson of the Korea Cinematographic Medical Center Chairperson of this Court, i.e., (the Chairperson of the Korea Cinematographic Medical Center) presented that the Plaintiff’s pneumoconiosis type is diagnosed as Type No. 1 (p/q, density: 1/0) after reviewing the images at the time of the precise diagnosis of the pneumoconiosis of this case, and (ii) this court’s appraisal commission (P/q, density: 1/1), but after examining the images at the time of the precise diagnosis of the pneumoconiosis of this case on March 10, 2016, the Plaintiff’s pneumoconiosis type is diagnosed as a medical certificate (concentration:0/1 degree). However, around February 28, 2017, immediately before the precise diagnosis of the pneumoconiosis of this case was conducted, according to the Plaintiff’s diagnosis opinion that the pneumoconiosis type of pneumoconiosis of this case would be diagnosed as Type No. 1 (p/1/1/1/1/1).