The part exceeding KRW 5,296,068 among the disposition taken to recover and notify unjust enrichment of KRW 6,862,170 as of March 6, 2013 against the Plaintiff; the part exceeding KRW 731,994 among the disposition to recover and notify unjust enrichment of KRW 1,037,850 as of March 21, 2013; and the part exceeding KRW 526,998 among the disposition to recover and notify unjust enrichment of KRW 787,120 as of the disposition to recover and notify unjust enrichment of KRW 6,862,170 as of March 6

2. The plaintiff's remaining appeal is dismissed.

3. Of the total litigation costs, 70% shall be borne by the Plaintiff, and the remainder by the Defendant, respectively.

The court's explanation on this part is the same as the entry of the reasoning of the judgment of the court of first instance, and thus, this part is cited in accordance with Article 8 (2) of the Administrative Litigation Act and Article 420 of the Civil Procedure Act.

2. Whether the instant disposition is lawful

A. The plaintiff's assertion

(1) The Plaintiff asserts that: (a) Nonparty 2 was liable to compensate the Plaintiff for damages due to Nonparty 2’s unlawful acts; (b) the Plaintiff did not receive insurance benefits and compensation for losses caused by Nonparty 2; and (c) the Defendant did not exempt Nonparty 2 from its liability, taking into account the liability ratio between Nonparty 2 and the Plaintiff; (b) even if Nonparty 2’s negligence ratio is not a domestic case, the Defendant’s portion to be recovered is merely KRW 731,94 of the medical expenses from January 16, 2012 to March 22, 2012 (i) KRW 1,219,990 of the medical expenses from March 16, 2012 to March 22, 2012 to KRW 60 of the medical expenses from April 5, 2012 to June 28, 2012 to KRW 308,308,3089,36889).

B. Relevant statutes

It is as shown in the attached Form.

C. Determination as to the legitimacy of the instant disposition

(1) Relevant legal principles

Article 58(1) of the former National Health Insurance Act provides that "Where a ground for insurance benefits has been provided to a policyholder or his/her dependent due to an act of a third party, the National Health Insurance Corporation shall obtain the right to claim compensation for damage from such third party to the extent of the expenses incurred in relation to such benefits." Article 58(2) of the same Act provides that "Where a person who has received insurance benefits pursuant to paragraph (1) has already received compensation from a third party, the Corporation shall not provide insurance benefits to the extent of the amount of compensation." The above provision aims to prevent the beneficiary of insurance benefits from being transferred to the insured through the insurance benefits and compensation by a third party and to prevent a third party from evading liability and securing insurance financing.

Meanwhile, in light of the legislative intent and contents of Article 58(2) of the former National Health Insurance Act, if a beneficiary of insurance benefits receives a certain amount of money related to his/her property damage from a third party and either waives or waives the remainder of the claim, or exempt a third party from his/her property damage liability without receiving it at all, the Service is exempted from the obligation to pay insurance benefits within the extent of the real property damage (limited to the extent related to the insurance item) that the beneficiary is entitled to compensation from a third party due to the disaster (see Supreme Court Decision 2005Du7501, Jun. 15, 2007).

Furthermore, if a beneficiary of insurance benefits received a certain amount of money related to his/her own property compensation from a third party, the Corporation is exempted from the obligation to pay insurance benefits within the limit of the amount that the beneficiary received from a third party pursuant to Article 58(2) of the former National Health Insurance Act. The scope of exemption from the obligation to pay is limited to the scope that the Corporation can recover from a third party, i.e., the part that corresponds to the ratio of fault of the third party out of the insurance benefits paid by the Corporation to the Corporation (i) the Corporation still should be deemed to bear the obligation to pay insurance benefits for the part that corresponds to the ratio of negligence of the beneficiary, (ii) if the Corporation is exempted from the obligation to pay insurance benefits exceeding the limit of the amount that the beneficiary can receive from a third party, there is an unfair result that the beneficiary should additionally pay the insurance benefits, and (iii) the meaning of the above Supreme Court Decision 2018(2) appears to be that the scope related to the insurance benefits items is

(2) Determination

As seen earlier, in the above Seoul High Court case 2009Na17587, which was brought by Nonparty 1 against Nonparty 2, the ratio of Nonparty 2’s negligence was recognized as 60%, and the above ratio of negligence was also applied not only to the portion of the medical expenses in the early stage but also to the part of the future medical expenses. Thus, Nonparty 1 also received compensation from Nonparty 2 for the part equivalent to 60% of the medical expenses incurred after the closing of argument in the above case, barring special circumstances

In light of the above relevant legal principles, the defendant is exempted from the obligation to pay insurance benefits with respect to 60% (the part equivalent to 60% of the negligence ratio in the lawsuit and 2, i.e., the part for which the defendant can seek reimbursement against the non-party 2) of the defendant's charges (this refers to the situation where the plaintiff requires much more medical expenses than the anticipated one after the closing of argument in the case, and the scope of the non-party 2's liability is not waived or exempted on the condition that he received a certain amount from the non-party 2, but the disposition in the case is determined by the judgment, on the ground that the scope of the non-party 2's liability becomes final and conclusive by the judgment. However, even if the ratio of the tortfeasor's negligence was not a waiver or exemption of the plaintiff's claim, the scope of the defendant's liability for the perpetrator's compensation can be determined in accordance with the ratio of the tortfeasor's negligence established by the judgment.

However, the first instance court held that the disposition of this case was lawful without asking whether the part equivalent to 60% of the total medical expenses of Nonparty 1 (the principal's charges + the defendant's charges + the non-benefit medical expenses) constituted the insurance benefits item of the defendant and on the premise that the defendant does not have an obligation to pay the insurance benefits. However, as seen earlier, the exemption of the defendant from the obligation to pay the insurance benefits is limited to 60% of the defendant's charges belonging to the insurance benefits item. As such, the defendant's exemption from the obligation to pay the insurance benefits is limited to 60% of the defendant's charges. Thus, the part exceeding 5,296,068 won (the defendant's charges 8,826,780 x 60% x 60% of the defendant's charges x the defendant's charges 1,037,850 won x 731,94, 979 x 298 x 970% of the defendant's charges.

Therefore, the plaintiff's claim of this case is reasonable within the above scope of recognition, and the remaining claims are without merit.

3. Conclusion

Therefore, the plaintiff's claim of this case is justified within the scope of the above recognition, and the remaining claim is dismissed as it is without merit. Since the judgment of the court of first instance is unfair with some different conclusions, it is so decided as per Disposition by accepting part of the plaintiff's appeal.

[Attachment]

Judges Lee Jong-hun (Presiding Judge) (Presiding Judge)