[1] The scope of damage claim that the National Health Insurance Corporation obtains by subrogation of a victim of a tort under Article 58 (1) of the National Health Insurance Act, and the meaning of "damage claim for the same reason as the health insurance benefit" here

[2] In a case where the National Health Insurance Corporation provided health insurance benefits to the victim of a tort, whether the damage claim equivalent to the medical expenses eligible for non-payment can be obtained in subrogation of the victim (negative)

[1] Article 58(1) of the National Health Insurance Act / [2] Article 58(1) of the National Health Insurance Act, Article 41 of the former National Health Insurance Act (Amended by Act No. 13985, Feb. 3, 2016); Article 9(1) [Attachment 2] of the former Regulations on the Standards for Medical Care Benefits in National Health Insurance (Amended by Ordinance of the Ministry of Health and Welfare No. 431, Aug. 4, 2016)

[1] Supreme Court Decision 2014Da206853 Decided September 10, 2015 (Gong2015Ha, 1488)

National Health Insurance Corporation

Samsung Fire & Marine Insurance Co., Ltd. and two others (Law Firm Gyeongpyeong, Attorneys Kim Young-soo et al., Counsel for the plaintiff-appellant)

Busan District Court Decision 2017Na61843 Decided June 14, 2018

All appeals are dismissed. The costs of appeal are assessed against the Plaintiff.

The grounds of appeal are examined.

1. A. If the National Health Insurance Corporation provides health insurance benefits under the National Health Insurance Act (hereinafter “health insurance”) to a victim of a tort, it shall obtain the victim’s damage liability for the perpetrator to the extent of the expenses incurred in providing such insurance benefits (Article 58(1) of the National Health Insurance Act). This is to prevent the victim who received the health insurance benefits from receiving double benefit by receiving damages again from the perpetrator. As such, the damage liability that the National Health Insurance Corporation gains by subrogation of the victim is limited to the damage liability for the same reason as the health insurance benefits out of the total damage liability of the victim (see Supreme Court Decision 2014Da206853, Sept. 10, 2015).

Here, the damage claim for the same reason as the health insurance benefit refers to the case where the damage claim against the perpetrator can be extinguished due to the provision of the insurance benefits because the insurance benefits and the damages are mutually complementary.

B. Meanwhile, Article 41(1) of the former National Health Insurance Act (amended by Act No. 13985, Feb. 3, 2016; hereinafter “former Health Insurance Act”) provides that “The following medical care benefits shall be provided for the injury, childbirth, etc. of a policyholder or his/her dependent.” Under each subparagraph, “the methods, procedures, scope, and scope of medical care benefits under paragraph (1) shall be prescribed by Ordinance of the Ministry of Health and Welfare” under Article 41(2) of the former Health Insurance Act. On the other hand, Article 41(3) of the former Health Insurance Act provides that “The Minister of Health and Welfare may exclude the scope of duties or daily life when determining the criteria for medical care benefits under paragraph (2), and other matters prescribed by Ordinance of the Ministry of Health and Welfare may be excluded from medical care benefits.” Article 41(1) of the former Rules on Medical Care Benefits (amended by Ordinance of the Ministry of Health and Welfare No. 1394, Apr. 1, 2016);

According to this, the subjects of health insurance benefits provided by the National Health Insurance Corporation and those of non-health insurance benefits are distinguished from each other, and thus, the claim for damages equivalent to the treatment costs of non-payment is not extinguished due to the provision of insurance benefits for those of health insurance benefits. Therefore, the two cannot be deemed as complementary relationship. Therefore, the damage claim equivalent to the treatment costs of non-payment out of the total damage claim of the victim cannot be deemed as the damage claim equivalent to the health insurance benefits due to the same reasons as the health insurance benefits. Therefore, the National Health Insurance Corporation that provided the health insurance insurance benefits cannot obtain the damage claim equivalent to the treatment costs of non

2. Based on its stated reasoning, the lower court determined that the Plaintiff, who provided the health insurance benefits, could not subrogate the liability for damages equivalent to the medical expenses eligible for non-payment. Such determination by the lower court is justifiable in accordance with the aforementioned legal doctrine, and it did not err by misapprehending the legal doctrine on the scope of subrogation by the National Health Insurance Corporation that provided the insurance benefits under the National Health Insurance

3. Therefore, all appeals are dismissed, and the costs of appeal are assessed against the losing party. It is so decided as per Disposition by the assent of all participating Justices on the bench.

Justices Noh Jeong-hee (Presiding Justice)