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(영문) 서울행정법원 2016.09.01 2015구단19285
요양불승인처분취소
Text

1. The plaintiff's claim is dismissed.

2. The costs of lawsuit shall be borne by the Plaintiff.

Reasons

1. On September 17, 2014, the Plaintiff filed an initial medical care benefit application with the Defendant, on March 29, 2014, on the following grounds: (a) around 2014:05, the Plaintiff was faced with the absence of the parts, such as the left shoulder and the shoulder at the first construction site; and (b) caused the instant accident (hereinafter “instant accident”).

On October 27, 2014, the Defendant rendered a decision not to approve the said application on the ground that there is no proximate causal relation between the instant accident and the injury and disease of the instant case.

(hereinafter “Disposition in this case”). / [Grounds for recognition] without dispute, Gap’s evidence No. 4, the purport of the whole pleadings

2. Whether the disposition is lawful;

A. Since the instant injury and disease occurred due to the instant accident, the instant disposition was unlawful.

B. The term “occupational accident” under Article 5 subparag. 1 of the Industrial Accident Compensation Insurance Act refers to the injury, disease, physical disability, or death of an employee who was caused by his/her duties during the performance of his/her duties. As such, there should be causation between the duties and the occurrence of the accident, and the causal relationship must be attested by the party

Only evidence Nos. 1-3 and 7-13 is insufficient to recognize that the instant disease was caused by the instant accident or that the existing disease was aggravated beyond the natural progress, and there is no other evidence to acknowledge it.

Rather, according to the result of the court’s entrustment of the medical record appraisal of the Seoul Medical Center, it is difficult to view that the sofatitis occurred once due to the organizational change due to the normal aging and repeated injury, etc., and only can it be seen that the Plaintiff’s injury and disease in this case cannot be seen as having occurred due to the accident in this case.

It cannot be deemed that there is a proximate causal relationship between the instant accident and the instant injury and disease.

The instant disposition taken in the same purport.

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