In a case where the victim of a traffic accident claims direct damages to an insurance company, etc. through a lawsuit, whether the motor vehicle insurance medical fee serves as an absolute basis for calculating the amount of damages for medical expenses (negative), and whether the court can calculate the amount of damages for medical expenses to a reasonable extent

According to Article 2 subparag. 7, Article 15, and Article 12(2) of the Guarantee of Automobile Accident Compensation Act, the term “standards for motor vehicle insurance medical fees” refers to the guarantee of appropriate medical treatment for motor vehicle accident patients, and the dispute between an insurance company, etc. and a medical institution on the medical expenses for motor vehicle accident patients, or the relevant medical expenses incurred from the relevant traffic accident are paid to a medical institution after compensation for the motor vehicle accident patients, as a standard for preventing disputes between the motor vehicle accident patients

Meanwhile, in a case where the victim of a traffic accident claims direct damages to an insurance company, etc. through a lawsuit, medical expenses incurred in the traffic accident can be compensated for the actual damages within the scope of proximate causal relation with the tort. Therefore, the scope of medical expenses incurred in the pertinent treatment act should be reasonably determined in consideration of all the circumstances, such as the degree of injury, treatment details, frequency, and medical insurance amount.

In full view of all these facts, in a case where the victim of a traffic accident claims direct damage to an insurance company, etc. through a lawsuit, the motor vehicle insurance medical fees may serve as the basis for calculating the amount of damage for medical expenses, but it cannot be considered an absolute standard. Even if the court did not calculate the amount of damage for medical expenses according to the motor vehicle insurance medical fees, it cannot be said that there is a proximate causal relation in the event of calculating the amount of damage for medical expenses within reasonable scope, by taking into account the degree of injury and disability of the victim of the traffic accident, the treatment content, the frequency and the general level of medical expenses in the medical society, the possibility or

Article 2 Subparag. 7 of the Guarantee of Automobile Accident Compensation Act, Articles 12(2) and 15 of the same Act, Articles 393 and 763 of the Civil Act, Article 202 of the Civil Procedure Act

Supreme Court Decision 2002Da63411 Decided February 14, 2003 (Gong2008Da41574, 41581 Decided October 23, 2008)

Plaintiff (Attorney Han-chul et al., Counsel for the plaintiff-appellant)

Mez Fire Insurance Co., Ltd. (Law Firm Dowon, Attorneys Hong-ho et al., Counsel for the plaintiff-appellant)

Seoul Central District Court Decision 2015Na72834 decided October 6, 2016

The appeal is dismissed. The costs of appeal are assessed against the defendant.

The grounds of appeal are examined.

1. As to the grounds of appeal Nos. 1 through 3

In full view of the facts and circumstances as indicated in its reasoning, the lower court determined that ① (a) as a soldier, the Plaintiff was negligent in boarding the partitions behind the 5/4t military vehicle without a safety belt according to an order, or that there is no circumstance to limit the Defendant’s liability, and ② (b) the Plaintiff suffered permanent disability of 100% in the labor capacity loss rate due to the safying expenses, taking into account all the circumstances, such as the parts and degree of the Plaintiff’s injury, treatment process, the degree and degree of the injury, the part and degree of the aftermath disability, the contents and necessity of the name, and anticipated leisure, one adult female 8 hours per day by the end of the remaining life, and calculated the damages

In light of the relevant legal principles and records, the lower court did not exhaust all necessary deliberations, contrary to what is alleged in the grounds of appeal, and did not err by exceeding the bounds of the principle of free evaluation of evidence against logical and empirical rules, or by misapprehending the legal doctrine

2. Regarding ground of appeal No. 4

Article 2 Subparag. 7 of the Guarantee of Automobile Accident Compensation Act (hereinafter referred to as the “Act on the Guarantee of Automobile Accident Compensation”) provides that “The expenses incurred by a traffic accident patient in receiving medical treatment at a medical institution under the Medical Service Act (hereinafter referred to as “self-compensation”) shall be the amount applied to cases where the relevant expenses are paid with the insurance proceeds (including mutual aid money) of an insurance company (including a mutual aid business operator; hereinafter referred to as “insurance company, etc.”) (including a mutual aid business operator; hereinafter referred to as “insurance company, etc.”), (b) where the relevant expenses are paid with the compensation for the business of guaranteeing automobile accident compensation under Article 30 (including (b) and (3) where the relevant expenses incurred from the relevant traffic accident are paid to the medical institution by the traffic accident patient (including the compensation under Article 30).”

Accordingly, Article 15 of the Automobile Loss Compensation Act provides that “The Minister of Land, Infrastructure and Transport may publicly announce the standards for motor vehicle insurance medical fees (hereinafter “self-compensation standards”) including the scope of self-compensation approval, procedures for filing procedures, procedures for payment, and other matters determined by Ordinance of the Ministry of Land, Infrastructure and Transport.” Article 12(2) of the Automobile Loss Compensation Act provides that “a medical institution that treats a motor vehicle accident patient may file a claim for self-compensation with an insurance company, etc. in accordance

According to the above provisions, the self-repair standard is meaningful in order to guarantee appropriate medical treatment for traffic accident patients, and to prevent disputes between the insurance company, etc. and the medical institution on medical expenses for traffic accident patients, or to prevent disputes on medical expenses between traffic accident patients and the medical institution in cases where the relevant traffic accident patient pays medical expenses to the medical institution after compensation for traffic accident patients is completed

Meanwhile, in a case where the victim of a traffic accident claims direct damages to an insurance company, etc. through a lawsuit, medical expenses incurred in the traffic accident can be compensated for the actual amount of damages within the scope of proximate causal relation with the tort. Therefore, the scope of medical expenses incurred in the pertinent treatment act should be reasonably determined in consideration of all the circumstances, such as the degree of injury, treatment details, frequency of treatment, and medical insurance fees, etc. (see Supreme Court Decision 2002Da63411, Feb. 14, 2003, etc.).

In full view of all these facts, in a case where the victim of a traffic accident claims direct damages to an insurance company, etc. through a lawsuit, his/her remuneration may serve as the basis for calculating the amount of damages for medical expenses, but it cannot be considered an absolute standard. Even if the court did not calculate the amount of damages for medical expenses according to his/her own remuneration, it cannot be said that there is a proximate causal relation in calculating the amount of damages for medical expenses within reasonable scope after taking into account the degree of injury or disability of the victim of the relevant traffic accident, the content of treatment, the number of times of treatment, the general level of medical expenses in the medical society, the possibility of the application

Examining the reasoning of the lower judgment in light of the aforementioned legal doctrine and the record, the lower court did not err by misapprehending the legal doctrine on the self-sufficiency fee under the Automobile Loss Compensation Act, thereby failing to exhaust all necessary deliberations, in determining that the lower court calculated the Plaintiff’s future medical care costs based on

3. Conclusion

Therefore, the appeal is 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 Park Poe-young (Presiding Justice)