In cases where a disability compensation annuity is paid to an affected worker who has received temporary layoff benefits during the same period of care, if the sum of the daily disability compensation annuity and the daily amount of temporary layoff benefits exceeds 70/100 of the average wage applied in calculating the disability compensation annuity pursuant to Article 56(3) of the former Industrial Accident Compensation Insurance Act, whether the disability compensation annuity to be paid should be deducted from the disability compensation annuity to be paid (affirmative)

In full view of the contents and structure of Articles 36, 40, 51(1), 52, 56(3), 57, and 60(1) of the former Industrial Accident Compensation Insurance Act (amended by Act No. 17326 of May 26, 2020), where a disability compensation annuity is paid to a disaster worker who received temporary disability compensation benefits during the same period of medical care, the sum of the daily disability compensation annuity and the daily amount of temporary disability compensation benefits exceeds 70/100 of the average wage applied in calculating the disability compensation annuity (Grade 1 through 3 of the disability grade corresponding thereto), the disability compensation annuity to be paid shall be paid “the amount equivalent to the temporary disability compensation benefits already paid” from the disability compensation annuity to be paid (the disability grade 1 to 3 of the disability grade corresponding thereto).

Articles 36, 40, 51(1), 52, 56(3), 57, and 60(1) of the former Industrial Accident Compensation Insurance Act (amended by Act No. 17326 of May 26, 2020)

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

Korea Labor Welfare Corporation (Attorneys Kim Won-won et al., Counsel for the plaintiff-appellant)

Seoul High Court Decision 2019Nu57642 decided May 7, 2020

The judgment below is reversed and the case is remanded to Seoul High Court.

The grounds of appeal are examined.

1. Case summary and key issue

A. Review of the reasoning of the lower judgment and the record reveals the following circumstances.

1) On August 26, 1985, the deceased Nonparty (hereinafter “the deceased Nonparty”) was determined under class 9 of disability grade 11 (type 2 of pneumoconiosis type 2 and cardiopulmonary function (F0) due to pneumoconiosis symptoms, and was paid a lump sum of disability benefits.

2) On July 17, 2009, the Deceased died due to aggravation of cardiopulmonary function on December 30, 2016, while receiving the approval of the medical care as a pulmonary tuberculosis with respect to the pulmonary pulmonary tuberculosis by the pneumoconiosis monitoring witness.

3) The Deceased was paid temporary layoff benefits of KRW 101,187,220 in total from October 2, 2009 to December 30, 2016 during the period of medical care.

4) On February 23, 2018, the Plaintiff, a spouse of the Deceased, requested the Defendant to pay disability benefits on the ground that the cardiopulmonary function of the Deceased at the time of the medical care approval falls under class 1 of the disability grade (F3) as a condition of advanced disability (F3).

5) On July 11, 2019, the Defendant rendered a decision to pay the Plaintiff KRW 136,102,290 of temporary layoff benefits, excluding KRW 101,187,220 of the existing pension benefits (excluding KRW 244 of the number of pension days of Grade 11) based on Articles 56 and 60 of the former Industrial Accident Compensation Insurance Act (amended by Act No. 17326, May 26, 2020; hereinafter “Industrial Accident Insurance Act”) (hereinafter “instant disposition”).

B. The key issue of the instant case is whether it is possible to make a double payment of temporary layoff benefits and disability benefits, that is, whether a disability compensation annuity should be paid after deducting the already paid temporary layoff benefits, or whether the full amount of disability compensation benefits should be paid in the case of the disaster workers who received temporary layoff benefits during the same period.

2. Whether temporary layoff benefits and disability benefits can be paid in duplicate;

A. Under the Industrial Accident Insurance Act, when a worker suffers from an injury or disease due to an occupational accident, he/she shall be paid medical care benefits to cure the injury or disease, and the amount equivalent to 70/100 of the average wage per day for the period in which he/she is unable to be employed as a result of the medical care is paid, and, if there is a physical disability after recovery, etc., he/she shall be paid disability benefits in accordance with the disability grade standards prescribed by the Industrial Accident Insurance Act (Articles 36, 40, 52, and 57). Furthermore, if an employee needs active treatment to cure the occupational injury or disease which was the subject of the medical care after recovery from the medical care benefits, due to the recurrence of the occupational injury or disease or the aggravation of the state above the time of recovery, he/she may receive additional medical care, and even during the period of additional medical care, the amount equivalent to 70/100 of the average wage calculated based on the wage at the time of the medical care shall be paid as temporary disability benefits per day (Articles 51 and 56

Article 60 (1) of the Industrial Accident Insurance Act provides that even if a beneficiary of a disability compensation annuity receives additional medical care, the payment of the disability compensation annuity shall not be suspended, and Article 56 (3) of the Industrial Accident Compensation Insurance Act provides that if the beneficiary of the disability compensation annuity re-medical care, the sum of the disability compensation annuity per day (the amount calculated by dividing the disability compensation annuity amount calculated in accordance with attached Table 2 by 365) and the daily amount of temporary disability compensation benefits exceeds 70/100 of the average wage applied in calculating the disability compensation annuity, the amount in excess shall not

B. Disability benefits under the Industrial Accident Insurance Act, in principle, can be paid when a worker completely recovers from occupational injury or disease, i.e., “if a worker completely recovers from occupational injury or disease and has a physical disability,” i.e., the effect of treating the injury or disease is no longer expected, and the symptoms thereof is fixed. However, in the case of pneumoconiosis symptoms, even if it is impossible to completely recover from modern medical science, and even left the workplace where dust occurs, its progress is continuing, and it is difficult to predict the degree of progress. Considering the above characteristics of pneumoconiosis, the Industrial Accident Insurance Act provides that, unlike other ordinary diseases, it is difficult to expect that the pneumoconiosis is completely cured from the treatment of pneumoconiosis or any effect of treating the pneumoconiosis is no longer expected if the pneumoconiosis falls under the disability grade criteria as prescribed by the Industrial Accident Insurance Act, and without requiring a fixed state of symptoms, it may be subject to disability benefits during medical treatment without requiring the payment of disability benefits under the relevant disability grade (see Supreme Court Decision 9Du2589, Apr. 19, 199).

C. In full view of the contents and structure of the aforementioned relevant provisions and the purpose of the payment of temporary layoff benefits and disability benefits, if the sum of the daily disability compensation annuity and daily amount of temporary layoff benefits exceeds 70/100 of the average wage applied in calculating the disability compensation annuity (the disability grade 1 or 3 corresponding thereto), it shall be deemed that the amount equivalent to the already paid temporary layoff benefits should be deducted from the disability compensation annuity to be paid, and the payment should be made, in the event that the worker affected by the disaster who received the temporary layoff benefits during the medical care receives the disability compensation

1) Article 56(3) of the Industrial Accident Insurance Act provides for the purpose of adjustment inasmuch as a person who received a disability compensation annuity receives the full amount of the additional medical care, if he/she receives the additional medical care, the same kind of insurance benefits. Since both temporary disability compensation benefits and disability benefits are insurance benefits paid to compensate for lost income resulting from the loss of labor ability resulting from occupational accidents, so if both temporary disability compensation benefits and disability benefits are paid in duplicate during the same period, the same economic compensation for the same purpose would result in double payment. For example, for instance, in cases where disability grade such as the Deceased is in Grade 1, the amount equivalent to 90% of the average wage (=329 minutes ± 365 x 100%) is paid as disability compensation annuity for the worker whose average wage is 70%, the amount equivalent to 160% of the average wage would be transferred to the actual income, and thus, it goes against the legislative purpose of the Industrial Accident Compensation Insurance Act for the purpose of compensating more than the average wage of the worker.

2) Article 56(3) of the Industrial Accident Insurance Act does not stipulate that “the amount of temporary disability compensation benefits shall not be paid” and “the amount corresponding to the temporary disability compensation benefits” shall not be considered to be limited to “temporary disability compensation benefits.” As such, Article 56(3) of the Industrial Accident Insurance Act provides that “where a beneficiary of disability compensation benefits has received additional medical care and has received temporary disability compensation benefits,” the subject of adjustment shall not be deemed to be limited to “temporary disability compensation benefits”. Article 56(3) of the Industrial Accident Compensation Insurance Act provides that “where a beneficiary of disability compensation benefits has received temporary disability compensation benefits after receiving additional medical care, the beneficiary of temporary disability compensation benefits shall be considered to be the most typical situation in which disability benefits and temporary disability compensation benefits may be paid in duplicate, so it shall be deemed that it is possible to adjust the amount of “ disability benefits” in accordance with Article 56(3) of the Industrial Accident Insurance Act. Even if considering the legislative purport of Article 56(3) of the Industrial Accident Insurance Act, there is no reason to apply Article 56(3) of the Industrial Accident Insurance Act.

3) Article 56(3) of the Industrial Accident Insurance Act applies to cases where a beneficiary of disability compensation annuity receives “additional medical care” as well as “additional medical care.” Inasmuch as “additional medical care” is not different from “the first medical care” except that the beneficiary of the disability compensation annuity re-treatments after the completion of the medical care or that the relevant injury or disease provides a merger certificate due to the pertinent injury or disease (see, e.g., Supreme Court Decision 2002Du1762, Apr. 26, 2002) and its nature (see, e.g., Supreme Court Decision 2002Du1762, Apr. 26, 2002). Since a disability compensation annuity has to be paid after the completion of the medical care, it is difficult to present the case where the beneficiary of the disability compensation annuity is paid at the same time, and therefore, Article 56(3) of the Industrial Accident Insurance Act provides for “additional medical care” when the beneficiary of the disability benefits is paid at the same time after the first medical care benefit becomes more different from the patient’s.

3. Determination as to the instant case

A. We examine the above facts in light of the above legal principles.

1) The Deceased was paid KRW 101,187,220 of temporary layoff benefits from October 2, 2009 to December 30, 2016.

2) The Deceased’s disability compensation annuity to be paid to the Plaintiff from August 2009 to December 2, 2016 is KRW 237,289,510 (excluding the existing 11th degree pension days).

3) During the period from August 2009 to December 2, 2016, the sum of the daily disability compensation annuity per day and the daily amount of temporary disability compensation benefits to be paid to the Plaintiff exceeds 70/100 of the average wage applied to the calculation of disability compensation annuity. As such, the Defendant shall pay disability benefits of KRW 136,102,290, which deducts KRW 101,187,220 of the temporary disability compensation benefits already paid to the Plaintiff from KRW 237,289,510.

B. Nevertheless, the lower court determined that the instant disposition was unlawful, deeming that only the “temporary disability compensation benefit” among disability compensation annuity and temporary disability compensation benefit under Article 56(3) of the Industrial Accident Insurance Act is not applicable to the Plaintiff claiming disability benefits. In so doing, the lower court erred by misapprehending the legal doctrine on the interpretation and application of Article 56(3) of the Industrial Accident Insurance Act, thereby adversely affecting the conclusion of the judgment. The allegation contained in the grounds of appeal on

4. Conclusion

Therefore, the lower judgment is reversed, and the case is remanded to the lower court for further proceedings consistent with this Opinion. It is so decided as per Disposition by the assent of all participating Justices on the bench.

Justices Lee Dong-gu (Presiding Justice)