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(영문) 대법원 2017. 7. 11. 선고 2014두14587 판결

[재요양불승인처분취소][미간행]

Main Issues

Requirements for the subject of additional medical care under the Industrial Accident Compensation Insurance Act / Meaning of proximate causal relation in medical science, and methods and degree of proof thereof

[Reference Provisions]

Article 51 of the Industrial Accident Compensation Insurance Act

Reference Cases

Supreme Court Decision 96Nu18755 Decided March 28, 1997 (Gong1997Sang, 1263), Supreme Court Decision 2002Du1762 Decided April 26, 2002 (Gong2002Sang, 1270), Supreme Court Decision 2002Du8091 Decided December 10, 2002, Supreme Court Decision 201Du14532 Decided March 12, 2015

Plaintiff-Appellee

Plaintiff (Attorney Kim Young-young, Counsel for the plaintiff-appellant)

Applicant for Takeover of Plaintiff Lawsuit

Applicant for Takeover of Plaintiff’s Lawsuit (Attorney Kim Young-young, Counsel for plaintiff-appellant)

Defendant-Appellant

Korea Labor Welfare Corporation

Judgment of the lower court

Busan High Court Decision 2014Nu175 decided October 22, 2014

Text

The judgment of the court below is reversed, and the case is remanded to Busan High Court. The plaintiff's request for taking over the lawsuit is dismissed. The cost for taking over the lawsuit is borne by the plaintiff's requester.

Reasons

The grounds of appeal are examined.

1. According to the reasoning of the judgment below, the court below acknowledged facts and circumstances as stated in its judgment and found them in light of the legal principles at the time of original adjudication, and found that there was a proximate causal relation between the first injury and disease in this case as a result of the Plaintiff’s first injury and disease in this case’s first injury and disease in this case’s first injury and disease in this case’s first injury and disease in this case’s first injury and treatment is necessary. Thus, the court below determined that the Defendant’s disposition of this case, which approved the Plaintiff’s application for additional medical care, was unlawful on the ground that it is reasonable to deem that the Plaintiff satisfied the requirements for additional medical care as stipulated in Article 51 of the Industrial Accident Compensation Insurance Act.

2. However, the lower court’s determination is difficult to accept for the following reasons.

A. Further medical care under the Industrial Accident Compensation Insurance Act is identical to the first medical care and its nature, except that the relevant injury or disease occurs after the completion of the medical care or that the relevant injury or disease occurred due to the merger. Therefore, the requirements for additional medical care do not meet the requirements for the first medical care, except that the first medical care is provided after the completion of the first medical care. Therefore, in order to be subject to additional medical care, there is a medical opinion that the medical proximate causal relation between the first injury or the branch of the injury or disease applying for additional medical care is recognized in addition to the requirements for the medical care, and that the symptoms are expected to become more worse than the injury or disease condition at the time of the completion of the medical care or the payment of disability benefits (see Supreme Court Decisions 202Du1762, Apr. 26, 2002; 2014Du14532, Mar. 12, 2015, etc.).

In addition, the medical proximate causal relationship here refers to not only the relationship of condition against the first injury or disease for which the medical care was applied, but also the relationship of relatively significant cause in light of the empirical rule. The method and degree of proof does not necessarily necessarily require direct evidence to be proved by the medical and natural science, and it is sufficient if it is proved to the extent that it can be inferred by indirect facts based on the health and physical condition of the relevant worker. It is not sufficient to establish a proximate causal relationship merely because the first injury or disease is likely to cause a recurrence, aggravation, or other mergers, as well as that the first injury or disease which applied for the medical care is not clearly denied from the medical perspective (see Supreme Court Decisions 96Nu18755, Mar. 28, 1997; 2002Du8091, Dec. 10, 2002, etc.).

B. According to the facts and records acknowledged by the lower court, the following facts or circumstances are revealed.

1) Although there was a medical opinion that there is a possibility of recurrence of brain color, “re-exploit” means that the brain color may result in a re-explosion on another part, and cannot be viewed as “re-explosion of the first wound, which is the subject of medical care.” However, the first wound of this case is a light color that occurs in the left-hand brain color, and the wound name of this case is the same as that of the first wound, and each side of the wound is different from that of the first wound in the brain structure, and it is difficult to view the first wound of this case, which was the cause of the first wound of this case, as a re-exploitation of the brain that was the cause of the second wound of this case. Accordingly, it is difficult to view the second wound of this case, which was the cause of the second wound of this case as a re-exploitation of the injury.

2) While the general cause of brain emerculation is likely to cause various hazards, such as old age, high blood pressure, urology, urology, batosis, heart disease, blood response disorder, chatosis, smoking, drinking, etc., medical opinions were presented that various risk factors act together to cause diseases. However, with regard to the cause of the instant injury, the Plaintiff seems to have a high blood pressure, and thus, the cause of the instant injury is related to the high blood pressure. ② The possibility that brain emerculation occurred on the parts other than the existing body where the blood emerculation was proceeding in 200, rather than whether there was a causal relationship with the brain emerculation in 200, and ③ there is a lack of medical opinion that the first cause of the instant injury can be seen as a medical pressure of the Plaintiff, which is an initial risk factor of the instant injury. In light of the foregoing, the Plaintiff’s medical opinion that the first cause of the instant injury can be seen as a lack of medical pressure of the instant injury.

3) Meanwhile, around October 19, 201, the time of hospitalization at ○○ Hospital due to the outbreak of the instant injury, there is no difference between the Plaintiff’s body weight 82 km, blood pressure 140/90m Hg and the degree of 81 mHg and blood pressure 140/90m Hg from the body at the time of being found only by high blood pressure and rain from △△ machinery to the extent of 140/90m Hg. Thus, it is difficult to view that the blood pressure, which is the Plaintiff’s existing disease, was properly managed at the time of the instant injury.

4) Since the completion of the first injury and disease in this case, the injury and disease in this case occurred more than nine years since the completion of the medical care, and the Plaintiff did not perform his duties. Thus, it is difficult to view that the first injury and disease in this case was not aggravated due to B or any other reasons other than duties.

C. Examining the above facts and circumstances in light of the legal principles as seen earlier, since it is insufficient to view that the instant injury and disease occurred due to the recurrence or aggravation of the first injury and disease in this case, it cannot be deemed that a proximate causal relation exists between the first injury and the instant injury and disease in this case. Ultimately, it is reasonable to deem that the instant injury and disease is not subject to additional medical care under Article 51 of the Industrial Accident Compensation Insurance Act, and the Defendant’s disposition that did not approve the Plaintiff’s application for additional medical care is lawful.

Nevertheless, the lower court determined that the Defendant’s disposition of this case was unlawful on the grounds indicated in its reasoning. In so determining, the lower court erred by misapprehending the legal doctrine on the requirements for additional medical care under the Industrial Accident Compensation Insurance Act, which affected the conclusion of the judgment, and the Defendant’

3. Meanwhile, after the instant final appeal was filed against the lower judgment, the Plaintiff filed a motion to resume the instant lawsuit on November 27, 2015, if the Plaintiff died.

However, according to the records, the Defendant’s appeal on November 5, 2014, submitted a written appeal stating the grounds of appeal, and the Plaintiff’s death on November 5, 2015, which was subsequent to the submission of the grounds of appeal to supplement the appeal on December 10, 2014. As long as the litigation procedure of the court of final appeal reaches the same phase, there is no need to take over the lawsuit by the bereaved family who succeeded to the entitlement to insurance benefits under the Industrial Accident Compensation Insurance Act (see, e.g., Supreme Court Decisions 2014Da21049, Apr. 29, 2016; 2014Da225519, Nov. 10, 2016). Thus, the request to resume the instant lawsuit is groundless.

4. Therefore, the judgment of the court below is reversed, and the case is remanded to the court below for a new trial and determination. The request for a motion for a motion for a motion to resume a lawsuit is dismissed, and the cost incurred by the request for a motion to resume a lawsuit is borne by the plaintiff. It is so decided as per Disposition by the assent of all

Justices Kim Shin (Presiding Justice)