부당이득금환수고지처분취소
The judgment below
The part against the Defendant is reversed, and that part of the case is remanded to the Seoul High Court.
The plaintiff.
The plaintiff and the defendant's grounds of appeal are also examined.
1. The court below held that the part of each of the dispositions of this case exceeding the amount equivalent to 60% of the defendant's charges out of the total medical expenses is unlawful on the ground that the defendant, based on Article 58 (2) and Article 57 of the National Health Insurance Act, received insurance benefits related to the above treatment from the defendant on the ground that C, who is the plaintiff's dependent, received damages equivalent to the amount of the medical expenses from D and received insurance benefits from the defendant, was subject to the disposition of this case in which the amount equivalent to 60% of the total medical expenses out of the above insurance benefits were collected by unjust enrichment on three occasions. In light of the facts and legal principles as stated in its reasoning, the defendant is exempted from the obligation to pay insurance benefits only
2.(a)
Article 58 (1) of the National Health Insurance Act provides that "Where a person who has received insurance benefits pursuant to paragraph (1) has already received compensation from a third party, the Service shall not provide insurance benefits to the extent of the amount of compensation therefor, where a cause for insurance benefits has occurred due to an act of the third party and the insured or his/her dependent has provided the insurance benefits to the insured or his/her dependent, the Service shall not provide the insurance benefits to the third party to the extent of the amount of compensation."
The above provision aims to prevent a beneficiary of insurance benefits from being transferred to a third party by double transfer and from evading liability by a third party, and to secure the insurance finance by preventing a third party who is the perpetrator, if he/she is liable to pay the insurance benefits due to the act of the third party.
In light of the above provisions and the legislative intent of Article 58 of the National Health Insurance Act, the damage claim against the third party of the beneficiary of the insurance benefits shall be repaid, exempted, and abandoned.