[2] Whether the National Health Insurance Corporation's payment of insurance benefits to the insured constitutes a non-debted payment (negative)

[2] In light of the public nature of the health insurance as a public and social security nature of the health insurance and its characteristics as a compulsory insurance for the entire nation, the National Health Insurance Corporation should provide the health insurance benefits once when the injury to the health insurance subscriber occurs. Thus, even if the National Health Insurance Corporation provided the insurance benefits for the injury whose health insurance benefits are limited due to an occupational accident pursuant to Article 48(1)4 of the National Health Insurance Act, it cannot be deemed as a non-debt payment under Article 742 of the Civil Act.

2. The defendant's remaining appeal is dismissed.

3. The costs of appeal are assessed against the defendant.

The defendant shall pay to the plaintiff 6,236,870 won and 1,280 won among them from October 20, 1998; 2,678,080 won from March 27, 1999; 1,390,750 won from January 5, 200; 424,510 won from December 10, 200; 463,250 won from September 8, 2001 to the delivery date of a duplicate of complaint; and 25% per annum from the next day to the full payment date.

2. Purport of appeal

The judgment below is revoked. The plaintiff's claim is dismissed.

There is no dispute between the parties, or the following facts may be acknowledged in light of the overall purport of the arguments in Gap evidence 1, 5, 7, 12 through 16, 18, 2-1 through 7, 3-1, 2, 4-1 through 4, 6-1 through 6, 8-1 through 5, 8-5, and 9-1 through 7:

(a)Eins, an employee of the Defendant, suffered injuries, such as cage cages and scarkes, by dumping straws from the second floor of the defendant's place of business located in Daegu Dong-gu, Daegu-gu, 3,000 on December 23, 1991, and making up the floor away from the floor;

(b)The injury of this kind of injury constitutes an occupational accident, resulting in treatment and recuperation in accordance with the industrial accident compensation insurance to which the defendant was enrolled at the time. On June 30, 1998, the Korea Workers' Compensation & Welfare Service (Korea Workers' Compensation and Welfare Service) continued treatment of this kind of injury, but cannot expect medical effects, and treat it as it appears that its symptoms have been fixed, and did not provide medical care compensation in accordance with the industrial accident compensation insurance;

C.However, from July 1, 1998 to May 2, 2001, this paper, however, acquired the qualification of a local medical insurance policyholder and received medical treatment for the injury from the Plaintiff’s designated medical care institution, such as Daegu Veterans Hospital, Sejong Branch, Solar, etc., which is the Plaintiff’s designated medical care institution, until May 2, 2001. As to this, the Plaintiff paid 2,678,080 won on March 26, 199, 200, 390 won on January 4, 200, 424,510 won on December 9, 200, and 463,250 won on September 7, 201, to the above designated medical care institution.

(d)Afterward, upon filing an application for additional medical care with the Korea Workers' Compensation and Welfare Service, the Korea Workers' Compensation and Welfare Service approved the re-medical care period from May 12, 2001 to the date of re-medical care for these species.

2. Determination:

A.(1)Article 81(1) of the Labor Standards Act provides that an employer shall provide necessary medical care at his/her expense or bear necessary medical care costs when an employee suffers from an occupational accident or disease. Article 90 of the same Act provides that an employer shall be exempted from liability for compensation to the extent of its value if a person entitled to receive compensation receives money or goods equivalent to accident compensation under this Act under the Civil Act or other Acts and subordinate statutes for the same reason. Article 48(1)4 of the National Health Insurance Act provides that an employer shall not be eligible for insurance benefits or benefits under other Acts and subordinate statutes due to an occupational or occupational accident. Meanwhile, Article 48(1) of the Industrial Accident Compensation Insurance Act provides that an insured shall be exempted from liability for accident compensation under the Labor Standards Act for the same reason if the beneficiary received or is entitled to receive insurance benefits under this Act.

(2) According to the above facts, the defendant is obligated to pay medical care compensation under Article 81(1) of the Labor Standards Act to Lee Jong-sung. The defendant received medical care compensation from the Korea Workers' Compensation & Welfare Corporation from the time of the accident to June 30, 1998 due to industrial accident compensation insurance in which the defendant joined the Lee Jong-sung, and the defendant was exempted from the medical care compensation liability for the above period under Article 90 of the Labor Standards Act and Article 48(1) of the Industrial Accident Compensation Insurance Act. However, with respect to the treatment of Lee Jong-sung from July 1, 1998 to May 12, 2001 due to the completion of the medical care by the Korea Workers' Compensation and Welfare Service's medical care compensation for the above period, the defendant still has the responsibility for medical care compensation under Article 81(1) of the Labor Standards Act with respect to the above period, and the defendant did not pay the above insurance benefits to the plaintiff within the insurance benefits without any legal liability for the above insurance benefits.

B. Defendant’s assertion and judgment

(1) On this issue, the Defendant’s right to claim for compensation of unjust enrichment under the Labor Standards Act is extinguished unless it is exercised for three years. Since the Lee Jong-sung did not claim for compensation of unjust enrichment against the Defendant since June 30, 1998, the Defendant’s duty to claim compensation of unjust enrichment has expired due to the completion of the extinctive prescription. However, since the Plaintiff’s claim premised on the Defendant’s obligation to claim compensation of unjust enrichment is asserted as not reasonable, the Plaintiff’s claim of this case is not subrogated to the Defendant’s right to claim for compensation of unjust enrichment, but did not exercise the insurance benefits as to the benefits accrued without legal cause, even if the Defendant did not receive the insurance benefits as to the injury of the same class caused by occupational accidents, it is sought to return unjust enrichment pursuant to Article 741 of the Civil Act. Since the extinctive prescription period of the right to claim for compensation of unjust enrichment under the Civil Act is ten years, it is apparent in the record that ten years have not elapsed from the payment date

(2)In addition, the defendant asserts that the defendant can not claim the return of the insurance benefits to the defendant because he was aware that he did not receive insurance benefits under the National Health Insurance Act even though he was unable to do so due to occupational accidents. Thus, according to Article 1 of the National Health Insurance Act, the purpose of this Act is to improve public health and promote social security by providing the insurance benefits for the prevention, diagnosis, treatment, rehabilitation of diseases and injury, childbirth and death, and improvement of health of the people. Article 5 of the same Act provides that all citizens are insured or dependent, and Articles 39 and 41 of the same Act provide medical care benefits such as medical treatment in the case of injury of the insured. Article 43 of the same Act provides that the plaintiff should bear a certain portion of the insurance benefits at his own expense, and since Article 43 of the same Act provides that the plaintiff cannot be viewed as being obliged to pay the insurance benefits without delay according to the result of the examination by the Institute of Health Insurance Review and Assessment (Claim for Medical Care Benefit Costs) under the above Article 48 of the National Health Insurance Act.

3. Conclusion

Therefore, as the defendant seeks from 6,236,870 won and 1,280 won among them from November 17, 1998, 2,678,08 won from March 27, 1999 to 1,390, and 424,510 won from January 5, 200, and 424,510 won from December 10, 200, 463,250 won from September 8, 2001 to November 24, 2001, the delivery date of a copy of complaint of this case, and the remaining part of the court below's appeal against the defendant is dismissed as the plaintiff's remaining part of this case's damages for delay calculated at a rate of 25% per annum as stipulated in the Act on Special Cases Concerning the Promotion, etc. of Legal Proceedings, and as such, the remaining part of the court below's appeal against the defendant is dismissed as it has no reason to dismiss the plaintiff's remaining part of this case's damages.

Judges Park Jong-ho (Presiding Judge)