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(영문) 서울고등법원 2011. 5. 25. 선고 2010누45240 판결

[장해등급결정처분및부당이득징수결정처분취소][미간행]

Plaintiff, Appellant

Plaintiff

Defendant, appellant and appellant

Korea Labor Welfare Corporation

Conclusion of Pleadings

May 4, 2011

The first instance judgment

Seoul Administrative Court Decision 2010Gudan2961 Decided November 25, 2010

Text

1. The defendant's appeal is dismissed.

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

Purport of claim and appeal

1. Purport of claim

The defendant's change of the disability grade (class 10) against the plaintiff on April 19, 2009 and the disposition of unjust enrichment collection shall be revoked.

2. Purport of appeal

The judgment of the first instance is revoked. The plaintiff's claim is dismissed.

Reasons

1. Details of disposition;

원고는 2007. 11. 19. 업무상 재해로 ‘좌측 제2수지 원위지 절단, 제3수지 원위지관절 절단, 제4수지 원위지 절단’ 상해를 입고, 피고로부터 요양승인을 받아 2008. 7. 15. 치료를 마친 후 피고에게 장해급여를 청구하였다. 피고는 2008. 8. 4. 원고 장해는 원위지절관절 운동가능범위가 제2, 3, 4수지 모두 0도로 산업재해보상보험법 시행령(2010. 7. 12. 대통령령 제22269호로 개정되기 전의 것, 이하 시행령이라고 한다) 제53조 제1항 [별표 6](이하, [별표 6]이라고 한다) 제13급 제8호에서 정한 ’한쪽 손의 둘째손가락 끝관절을 굽혔다 폈다 할 수 없게 된 사람‘ 및 제14급 제8호에서 정한 ’한쪽 손의 엄지손가락과 둘째손가락 외의 손가락 끝관절을 굽폈다 폈다 할 수 없게 된 사람‘에 각각 해당한다고 결정한 다음, 장해등급 제14급은 조정, 준용 대상이 아니므로 장해등급 제13급 제8호로 판정하는 결정(이하, 이 사건 제1차 처분이라고 한다)을 하였다.

The Plaintiff completed medical treatment with the approval of re-treatment from the Defendant from October 29, 2008 to January 9, 2009 for the purpose of the “compact of cutting off off the part of the third balance of revenues and expenditures and cutting off the part of the fourth balance of revenues and expenditures.” On August 4, 2008, the Defendant paid KRW 1/2 or more of the normal movement scope (100 degrees), since the Plaintiff’s disability on August 4, 2008 is limited to not less than 1/2 of the normal movement scope (10 degrees), it constitutes class 8 Subparagraph 4 of the [Attachment Table 6] (hereinafter “pre-revision disposition”). After deducting the number of days of disability benefits corresponding to class 13 applicable mutatis mutandis to the previous disability grade, the Defendant paid KRW 25,83,93,97.

C. On April 9, 2009, the defendant decided that the second left-hand balance is not subject to additional medical care, and the disability grade was already determined at the time of the first medical care, so the disability judgment after additional medical care should be limited to the left-hand balance of 3,4. The third and fourth left-hand balance falls under class 9 of the disability grade as "the person who has failed to properly exercise his fingers other than his fingers and second fingers," and the second left-hand balance falls under class 8 of the disability grade of 11. The defendant decided that the disability grade of the plaintiff was applied mutatis mutandis by adjusting the second left-hand balance of 2, 12,936,970 won which was changed to 10 and paid as unjust enrichment (hereinafter referred to as the "disposition in this case").

[Ground of recognition] Facts without dispute, Gap evidence 1, Gap evidence 2-1, Gap evidence 3, the purport of the whole pleadings

2. Whether the disposition is lawful;

A. The plaintiff's assertion

The Plaintiff’s disability status falls under class 4 of class 8 [Attachment 6] and thus, the instant disposition is unlawful, since it falls under subparagraph 4 of class 8 of class 6, including two fingers.

B. Relevant statutes

It is as shown in the attached Form.

C. Determination

(i) Determination of disability grades;

The fact that the plaintiff cut off the left-hand part of 3, 4 balance of 3, 4 balance of 4 balance from the end end of the year (the second balance of 2) due to occupational accidents is not disputed between the parties, and the fact that the second balance of 2 balance of 40 degrees of 40 degrees of 40 degrees of normal (the first balance of 100 degrees of 100 degrees of normal) is based on the results of the court's entrustment of physical examination by the court of first instance (the president of the Korea University University) and the entire purport of the pleading.

According to the above facts, the 3 and 4 balance on the left-hand side was lost by at least 1/2 from the second balance of revenues to the end end, and the 2nd balance on the left-hand side was limited by at least 1/2 of the exerciseable area of the first balance of the Industrial Accident Compensation Insurance Act (hereinafter referred to as the "Enforcement Rule") pursuant to Article 48 [Attachment 5] of the Enforcement Rule of the Industrial Accident Compensation Insurance Act (hereinafter referred to as the "Enforcement Rule"), and the 8th grade 4 of the disability grade prescribed in [Attachment 6] under subparagraph 4 of [Attachment 6] of [Attachment 6] of Article 8 of the Enforcement Rule of the Industrial Accident Compensation Insurance Act (hereinafter referred to as the "Enforcement Rule").

2) Determination on the Defendant’s assertion

A) The Defendant asserts that since the additional medical care for the Plaintiff was given to the Plaintiff for the treatment of the remaining 3 and 4 revenues and expenses, the second left-hand balance of the second left-hand balance of the second left-hand balance cannot be changed to class 13 and class 8 of the grade of the second left-hand balance of the second left-hand balance of the Plaintiff, and that the disability grade should be re-determined only for the third and fourth balance of the remaining-hand

Article 60(2) of the Industrial Accident Compensation Insurance Act provides that where the state of disability is improved or aggravated after receiving additional medical care, the disability grade should be determined again, and the disability grade corresponding to the state of disability that has improved or aggravated. In such a case, whether the scope of disability to be determined again is limited to “a disability that has improved or aggravated after receiving additional medical care,” and whether “other disability in the event of first medical care without receiving additional medical care” is included.

With respect to the criteria for determining disability grades, Article 46(1) of the Enforcement Rule provides that the disability grade shall be determined by “the disability department” which has been classified by autopsyologically, and “the disability department” which has been divided by biochemically disabled group, and Article 46(2) of the Enforcement Rule provides that the disability department shall be determined by the disability department, and Article 57(2) of the Act and Article 53(1) of the Enforcement Decree shall be determined by the disability department. Accordingly, Article 48 of the Enforcement Rule, which provides for the detailed criteria for determining disability grades by physical parts pursuant to Article 57(2) of the Act and Article 53(1) of the Enforcement Decree, provides for the criteria for determining disability grades by physical parts and by disability department.

In a comprehensive interpretation of the above legal provisions, the determination of a disability grade is determined by the parts of the disability and the parts of the disability. As such, in a case where the state of the disability was improved or aggravated after the medical treatment for the injury was completed, the scope of the disability grade re-determination is, in principle, limited to “the disability that was improved or aggravated compared with the previous one after receiving additional medical care.” Therefore, in a case where there are not less than two disabilities in which the parts of the disability and the parts of the disability have been affected by additional medical care, if additional medical care was provided for only a certain one of them, a new disability grade is determined for the disability that was improved or aggravated compared with the previous one, after receiving additional medical care, and then the final disability grade is determined by adjusting the existing disability grade for the disability that did not have been re-medical care and the disability grade under

However, in cases where additional medical care has been provided for a part of the same disability parts and that of the same disability parts, the first disability grade has been conducted with respect to the said disability parts and that of the said disability parts and that of the said disability parts and that of the said disability parts and that of the said disability parts are re-determined the criteria for the disability grade as in cases where the said disability parts and the said disability parts are re-determined due to their improved or aggravated status compared with the previous disability parts. This legal doctrine applies mutatis mutandis in [Attachment 6] but where where the said disability parts are not specifically determined in [Attachment 6] where the disability grade is applied mutatis mutandis in accordance with Article 53(3) of the Enforcement Decree, where the said disability grade is determined after adjusting the respective disability grades with respect to two or more disabilities belonging to the said disability parts and the said disability parts are determined by applying mutatis mutandis only in cases where additional medical care is applied mutatis mutandis, and where additional medical care is not applied mutatis mutandis in cases where two or more different disabilities exist, the said disability grade shall not be re-determined to the two or more parts of the said disability parts.

In the first disposition of this case, the Plaintiff’s left-hand obstacles belonging to the same grade of disability and the same grade of disability are classified into two obstacles of “second grade of 2,00,000,000 won part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part part

Defendant’s assertion is without merit.

B) The Defendant asserts that Article 20 [Attachment 2] of the Industrial Accident Compensation Insurance Act, which was enacted pursuant to Article 47(2) of the Enforcement Rule of the Industrial Accident Compensation Insurance Act, provides that where the cause of personality is suspected in the course of measuring the physical sense of body part-time exercise, the physical part-time exercise should be followed. According to the court of first instance, according to the result of the physical part-time examination of the court of first instance, the physical part-time exercise scope of the party 2 balance 1 balance 60 degrees, the left-hand balance of the Plaintiff 2 does not constitute a limited person with more than half of the physical part-time exercise area.

According to the result of the physical examination by the court of first instance (the president of the Guro University Hospital), the appraiser actively cooperated in the measurement of the scope of movement without the intention of reducing the scope of movement intentionally at the time when the plaintiff was to undergo physical examination, and the defendant himself recognized the second balance of the left at the time of the change of the previous medical care, and thereafter, the problem of the method of determining the disability grade after the additional medical care was pointed out, and led to the disposition of this case. In light of the above, it is difficult to deem that the cause of personality was involved in the measurement of the scope of physical examination by the second balance of the left side (the result of the physical examination commission stated that it does not affect the second balance of the previous medical care after receiving the additional medical care, and it is not different).

Defendant’s assertion is without merit.

3. Conclusion

The instant disposition is unlawful. The first instance judgment is consistent with this conclusion, and the Defendant’s appeal is dismissed.

[Attachment]

Judges Kim Jong-dae (Presiding Judge)