진폐보험급여부지급처분취소
1. The plaintiff's claim is dismissed.
2. The costs of lawsuit shall be borne by the Plaintiff.
1. The Plaintiff was engaged in dust-proof operations in the coal mine, and the Defendant filed a claim for pneumoconiosis insurance benefits with the Defendant, but the Defendant conducted a diagnosis with the Plaintiff from October 14 to October 15 of the same month, and on December 10, 2014, on the ground that the Plaintiff’s symptoms constitute “mick-type: Mad-type (0/1), cardiopulmonary function (F0), and non-activity-pulmonary tuberculosis (hereinafter “instant disposition”).
[Ground of recognition] Unsatisfy, Gap 1-3 evidence
2. Whether the disposition is lawful;
A. The Plaintiff’s pneumoconiosis type of the Plaintiff’s assertion falls under Type 1 (1/0), and the instant disposition taken on a different premise should be revoked as it is unlawful.
B. For the diagnosis of pneumoconiosis under the Industrial Accident Compensation Insurance Act, it is necessary to examine the pneumoconiosis review committee on the result of the health examination. The determination of the type of pneumoconiosis of the worker in question, whether there exists a merger, and the degree of cardiopulmonary function of the worker in question shall determine whether to pay medical care benefits
According to the Enforcement Decree of the same Act, the determination of pneumoconiosis and the determination criteria of insurance benefits are determined, and the progress of pneumoconiosis shall be determined by reading the chest simple radiation, and if it is merely a suspicion of pneumoconiosis disease, it is not subject to all insurance benefits in principle, and it is only subject to medical care benefits and nursing benefits only if active pulmonary tuberculosis is merged.
C. The records of evidence Nos. 2 and 3 alone are insufficient to recognize that the Plaintiff’s pneumoconiosis type constituted above Type No. 1. Rather, in light of the results of the written evidence Nos. 1 and 3 and the results of the medical record appraisal entrusted to the head of the Seoul Hospital of the Macheon National University, it is reasonable to view that the Plaintiff’s pneumoconiosis type constitutes a medical certificate, and that the Plaintiff’s symptoms of active tuberculosis do not appear.
Therefore, the defendant's disposition of this case, which was made on the same premise, is legitimate.
3. The plaintiff's claim is without merit.