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(영문) 대법원 1998. 12. 22. 선고 98두8773 판결
[요양불승인처분취소][공1999.2.1.(75),250]
Main Issues

[1] Requirements for recognition of additional medical care

[2] In a case where only a certain injury or disease is recognized as a subject of medical care in a lawsuit seeking revocation of a disposition not to grant medical care for multiple injury or disease, whether the disposition not to grant medical care can be revoked (negative)

Summary of Judgment

[1] Further medical care under the Industrial Accident Compensation Insurance Act is not different from that of the first medical care except that of the first medical care due to the recurrence of the injury or the combination of the injury or disease in question after the completion of the medical care. Thus, the requirement of additional medical care does not meet all the requirements of the medical care, except that of the medical care after the completion of the medical care. Therefore, it is sufficient that there is a medical opinion that there is a proximate causal relation between the first injury or disease branch which applied for additional medical care in addition to the requirements of the medical care, and that the medical care can be expected by the aggravation of the symptoms compared to the injury or disease at the time of the completion of the medical care at the time of the first injury or the payment of disability benefits, and that there is no need for active medical care only if the symptoms have significantly aggravated compared to the disease or disease at the time of the first injury or disease at the time of the completion of the medical care of the injury or disease at the time of the payment of disability benefits.

[2] The application for the approval of the medical care under the Industrial Accident Compensation Insurance Act requires that the name of a wounded soldier and a wounded soldier be stated in the application for the approval of the medical care, and the application for the approval of the medical care is also made based on the name of a wounded soldier and a wounded soldier. Therefore, even if the part of the application is recognized as being subject to the medical care in a lawsuit to revoke the approval of the non-approval of the medical care for multiple wounded soldiers, if the remainder of the injury and a disease is not subject to the medical care, the part of the injury and a disease subject to the medical care during the non-approval of the medical care should be revoked

[Reference Provisions]

[1] Article 40 of the Industrial Accident Compensation Insurance Act, Article 15 of the Enforcement Rule of the Industrial Accident Compensation Insurance Act / [2] Articles 2, 4 and 19 of the Administrative Litigation Act, Article 40 of the Industrial Accident Compensation Insurance Act, Article 15 of the Enforcement Rule of the Industrial Accident Compensation

Reference Cases

[1] Supreme Court Decision 94Nu12326 delivered on September 15, 1995 (Gong1995Ha, 3418), Supreme Court Decision 96Nu18755 delivered on March 28, 1997 (Gong1997Sang, 1263), Supreme Court Decision 97Nu13573 delivered on November 14, 1997 (Gong1997Ha, 387)

Plaintiff, Appellee

Plaintiff (Attorney Lee J-ho et al., Counsel for plaintiff-appellant)

Defendant, Appellant

Korea Labor Welfare Corporation

Judgment of the lower court

Seoul High Court Decision 96Gu36823 delivered on April 7, 1998

Text

The part of the judgment of the court below that revoked the disposition not to approve the additional medical care for injury and disease other than the 1-2 conical signboard escape certificate is reversed, and the plaintiff's claim corresponding to that part is dismissed. The defendant's remaining appeal is dismissed. One-half of the total litigation costs are assessed against the defendant and the remainder.

Reasons

We examine the grounds of appeal.

1. Whether the applicant is subject to additional medical care;

Since additional medical care under the Industrial Accident Compensation Insurance Act is not different from that of the first medical care except that of the injury or disease in question after the medical care has been terminated or that of the injury or disease in question is the medical care provided for a merger after the medical care has been terminated, the requirements for additional medical care do not meet the requirements for additional medical care. Therefore, the requirements for additional medical care are recognized that there is a medical proximate causal relationship between the first injury or disease in addition to the requirements for additional medical care, and there is a medical opinion that the medical care can be expected by the aggravation of the symptoms compared to the injury or disease in question at the time of the completion of medical care or the payment of disability benefits, and it does not recognize additional medical care only where active medical care is deemed necessary because the symptoms significantly aggravated compared to the disease or disease at the time of the first injury or disease at the time of the payment of disability benefits (see, e.g., Supreme Court Decisions 94Nu12326, Sep. 15, 195; 197Nu375, Nov. 197, 1997).

In light of the above legal principles, the court below held that the plaintiff's 1-2 conical signboard escape certificate was subject to additional medical care due to the deterioration of the 1-2 conical signboard escape certificate caused by the accident in this case after the treatment of the plaintiff, and that this can be improved by an operation on the 1-2 conical test, and that the 1-2 conical test escape certificate is subject to additional medical care. In light of the records, the above recognition and judgment of the court below is just, and there is no error of law in the misapprehension of legal principles on the requirements for additional medical care. The argument is without merit.

2. Whether the revocation of non-approval for the part of the injury or disease not subject to additional medical care is illegal.

In the application for the approval of the medical care under the Industrial Accident Compensation Insurance Act, the name of the sick and wounded shall be stated in the application for the approval of the medical care, and the approval of the medical care shall be based on the name of the sick and wounded and the injury and the name of the injury and the injury and the name of the injury and the disease for which the application for the approval of the medical care is filed. Therefore, even if the remaining injury and disease are recognized as being the subject of the medical care, if the remaining injury and the subject of the medical care is not the subject of the medical care, the part of the non-approval of the injury and the subject of the medical care should be revoked

According to the reasoning of the judgment of the court below, the plaintiff sought the revocation of the non-approval of the re-treatment of the post-2 and 4-5 post-examination escape certificate, and the court below revoked the whole of the defendant's disposition of non-approval of the re-treatment because the post-5 post-examination escape certificate could not be subject to the re-treatment because the post-5 emergency escape certificate was sleep, but the post-2 emergency escape certificate could not be subject to the re-treatment, as seen above. In this case, the part of the defendant's disposition of non-approval of the re-treatment should be revoked only for the post-2 emergency escape certificate among the defendant's disposition of non-approval of the re-treatment, so the court below erred by misapprehending the legal principles on approval of the medical care under the Industrial Accident Compensation Insurance Act. This point is with merit.

3. Therefore, the part of the judgment of the court below that revoked the disposition not to approve the additional medical care for injury and disease other than the 1-2 protruding escape card is reversed, and as to the plaintiff's claim corresponding to this part, it is sufficient for the trial to judge the facts. Thus, this part of the plaintiff's claim cannot be subject to additional medical care, and it is dismissed, the defendant's remaining appeal is dismissed, and the total costs of the lawsuit in this case are assessed against each losing party. It is so decided as per Disposition by the assent of all participating Justices on the bench.

Justices Lee Jae-soo (Presiding Justice)

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심급 사건
-서울고등법원 1998.4.7.선고 96구36823
본문참조조문