The starting point of counting extinctive prescription of a claim for pneumoconiosis compensation annuities under Article 91-3 of the former Industrial Accident Compensation Insurance Act

Article 112(1)1 of the former Industrial Accident Compensation Insurance Act (amended by Act No. 15665, Jun. 12, 2018; hereinafter “Industrial Accident Insurance Act”) provides that the extinctive prescription shall expire if the right to receive insurance benefits under the Industrial Accident Insurance Act is not exercised for three years. The extinctive prescription shall run from the time it is possible to exercise the right (Article 112(2) of the Industrial Accident Insurance Act; Article 166(1) of the Civil Act). The extinctive prescription of the right to receive insurance benefits under the Industrial Accident Insurance Act shall run from the time when the accident-related worker satisfies the requirements for the payment of insurance benefits under the Industrial Accident Insurance Act, barring special circumstances.

In cases of pneumoconiosis compensation annuities under Articles 91-3 and 91-8 of the Industrial Accident Compensation Insurance Act, when the state of pneumoconiosis disability, such as the type of pneumoconiosis, degree of cardiopulmonary function, etc. of pneumoconiosis workers falls under the criteria for pneumoconiosis disability grades prescribed in attached Table 11-2 [Attachment 1-2] and attached Table 11-3 of the Enforcement Decree of the Industrial Accident Compensation Insurance Act (hereinafter “Enforcement Decree of the Industrial Accident Compensation Insurance Act”), a pneumoconiosis compensation annuity shall be paid according to pneumoconiosis disability grade. Therefore, extinctive prescription of a right to claim pneumoconiosis compensation annuity shall commence from the time when the state of pneumoconiosis disability of pneumoconiosis workers falls under the criteria for pneumoconiosis disability grades prescribed by the Enforcement Decree of the Industrial Accident Compensation Insurance

Articles 91-3, 91-8, and 112(1)1 and (2) of the former Industrial Accident Compensation Insurance Act (Amended by Act No. 15665, Jun. 12, 2018); Article 83-2(1) [Attachment Table 11-2] and (2) [Attachment Table 11-3] of the Enforcement Decree of the Industrial Accident Compensation Insurance Act; Article 166(1) of the Civil Act

Plaintiff 1 and five others (Law Firm Woo, Attorneys Park Ho-ho et al., Counsel for the plaintiff-appellant)

Korea Labor Welfare Corporation

Seoul High Court Decision 2017Nu82514 decided April 5, 2018

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

The grounds of appeal are examined.

1. As to the ground for disposition that the application for medical care for pneumoconiosis and the procedure for determination was not implemented

The lower court determined that the Defendant’s refusal of Nonparty 1’s claim was unlawful solely on the ground that Nonparty 1, the wife of the deceased Nonparty 2 (hereinafter “the deceased”), fell under the criteria prescribed by the pneumoconiosis disability grade (Grade 7) other than the pneumoconiosis disability grade (Grade 1), on the ground that the deceased’s claim for a pneumoconiosis compensation annuity equivalent to the difference was made based on the preceding judgment finalized by the deceased Nonparty 2 (hereinafter “the deceased”), the Defendant should review whether the deceased already fell under the criteria prescribed by the pneumoconiosis disability grade (Grade 7) and the pneumoconiosis disability grade (Grade 1).

In light of the relevant legal principles and records, such determination by the court below is just, and contrary to the allegations in the grounds of appeal, the court below did not err by misapprehending the legal principles on the requirements of claim

2. As to the grounds for disposition for which the extinctive prescription expires

A. Article 112(1)1 of the former Industrial Accident Compensation Insurance Act (amended by Act No. 15665, Jun. 12, 2018; hereinafter “Industrial Accident Insurance Act”) provides that the extinctive prescription shall expire unless the right to receive insurance benefits under the Industrial Accident Insurance Act is exercised for three years. The extinctive prescription shall run from the time when the right to receive insurance benefits is exercised (Article 112(2) of the Industrial Accident Insurance Act; Article 166(1) of the Civil Act). Barring special circumstances, the extinctive prescription of the right to receive insurance benefits under the Industrial Accident Insurance Act shall run from the time when the occupational accident of the affected worker satisfies the requirements for the payment of insurance benefits under the Industrial Accident Insurance Act and is able to claim insurance benefits to the Defendant.

In cases of pneumoconiosis compensation annuities under Articles 91-3 and 91-8 of the Industrial Accident Compensation Insurance Act, when the state of pneumoconiosis disability, such as the type of pneumoconiosis, degree of cardiopulmonary function, etc. of pneumoconiosis workers falls under the criteria for pneumoconiosis disability grades prescribed in attached Table 11-2 [Attachment 1-2] and attached Table 11-3 of the Enforcement Decree of the Industrial Accident Compensation Insurance Act (hereinafter “Enforcement Decree of the Industrial Accident Compensation Insurance Act”), a pneumoconiosis compensation annuity shall be paid according to pneumoconiosis disability grade. Therefore, extinctive prescription of a right to claim pneumoconiosis compensation annuity shall be deemed to run from the time when the state of pneumoconiosis disability of pneumoconiosis workers falls under the criteria for pneumoconiosis disability grades prescribed by Enforcement Decree of the Industrial Accident Compensation Insurance Act,

B. According to the reasoning of the lower judgment, the deceased’s diagnosis of pneumoconiosis was conducted from August 1986 to August 201, 198, and the deceased’s pneumoconiosis type constitutes 2/1 or 2/2 pneumoconiosis type, and cardiopulmonary function constitutes light disability (F1/2) or minor disability (F1/2) from January 2002 to the final diagnosis of pneumoconiosis, and ② the deceased obtained the determination of grade 7 of the pneumoconiosis grade from the Defendant on August 201 through the diagnosis of pneumoconiosis level and received the pneumoconiosis compensation annuity accordingly until his/her death (FVC) from the end of the examination of the pulmonary function performed on May 23, 201, the deceased’s Efforts level (FVH) 49%, daily 31%, EF 41%, and PEV/V41% after the diagnosis of pneumoconiosis level, and the deceased’s pulmonary function constituted pulmonary function (FVVH/44% after the diagnosis of pneumoconiosis level).

According to these factual relations, while the deceased’s pneumoconiosis type was maintained from the date of the first diagnosis of pneumoconiosis to April 2014, the cardiopulmonary function was aggravated to the high-level disability (F3) on May 23, 2012, and accordingly, as of May 23, 2012, the condition of the deceased’s pneumoconiosis disability falls under class 1 of the pneumoconiosis disability grade (see attached Table 11-2).

Furthermore, examining the above circumstances in light of the legal principles as seen earlier, since the Deceased was entitled to claim a pneumoconiosis compensation annuity under a higher pneumoconiosis grade from May 23, 2012, the period of extinctive prescription of the claim for the instant pneumoconiosis compensation annuity ought to be deemed to run from that time. This is no different in cases where Nonparty 1, a bereaved family member of the Deceased, claims the payment of the instant pneumoconiosis compensation annuity not paid to the Deceased pursuant to Article 81 of the Industrial Accident Compensation Insurance Act after the Deceased’s death.

C. Nevertheless, the lower court rejected the Defendant’s assertion that the three-year extinctive prescription has already expired on June 14, 2016 when Nonparty 1 claimed insurance benefits on May 23, 2012, on the grounds that the deceased’s pneumoconiosis continued to worsen until April 2014, on the ground that the symptoms were not deemed fixed on May 23, 2012. In so doing, the lower court erred by misapprehending the legal doctrine on the starting point of calculating the extinctive prescription period for the claim for pneumoconiosis compensation annuities, thereby adversely affecting the conclusion of the judgment. The allegation contained in the grounds of appeal on this point is with merit.

3. Conclusion

Therefore, the judgment of the court below is reversed, and the case is remanded to the court below for a new trial and determination. It is so decided as per Disposition by the assent of all participating Justices on the bench.

Justices Kim Jae-hyung (Presiding Justice)