In a case where a worker suffering from an occupational accident received benefits equivalent to the medical care compensation under Article 81(1) of the Labor Standards Act from a third party, not the employer, whether the employer is exempted from the duty to compensate for the worker’s injury (affirmative), and whether the employer should return the benefits accrued therefrom to the said third party (affirmative)

Article 81(1) of the Labor Standards Act provides that an employer shall provide necessary medical care at his/her expense or bear necessary medical care expenses in cases where an employee suffers from an occupational injury or disease. If an employee receives benefits equivalent to medical care compensation as provided for in Article 81(1) of the Labor Standards Act from a third party, other than an employer, a worker may not exercise the employer’s right to claim medical care compensation due to an occupational accident. Therefore, the employer is obligated to return benefits that he/she has discharged the employee from the duty to claim medical care for a third party who has provided the benefits equivalent to medical care compensation.

Article 741 of the Civil Act, Articles 81(1) and 90 of the Labor Standards Act

National Health Insurance Corporation (Law Firm Rate, Attorneys Park Jong-bong et al., Counsel for the plaintiff-appellant)

Daegu Central City (Attorney Kim-ju, Counsel for the plaintiff-appellant)

Daegu District Court Decision 2003Na12258 delivered on January 28, 2004

The judgment below is reversed, and the case is remanded to the Daegu District Court Panel Division.

1. Summary of the judgment below

According to the reasoning of the judgment below, since the non-party 1 operated the non-party 2's car on April 16, 200 and passed the pre-fluence path in Daegu-dong, Daegu-gu, and he scalved the non-party 3, a street cleaners belonging to the defendant, who performed cleaning work at the place, suffered bodily injury, such as the fluoral frighting off frighting, etc., and the non-party 3 was provided with medical treatment at the North Korean University Hospital and the Daegu Red Cross Hospital during the period from April 24, 200 to October 31, 201, the plaintiff was not obliged to receive the insurance benefits of this case from the non-party 3, the plaintiff was still subject to the duty to receive medical care benefits of this case from the non-party 38,320,480, and the plaintiff was still subject to the duty to receive the insurance benefits of this case from the non-party 1's occupational injury compensation institution under the Labor Standards Act.

2. The judgment of this Court

The above judgment of the court below is hard to accept.

Article 81(1) of the Labor Standards Act provides that an employer shall provide necessary medical care at his/her expense or bear necessary medical care expenses in cases where an employee suffers from an occupational injury or disease. If an employee receives benefits equivalent to medical care compensation under Article 81(1) of the Labor Standards Act from a third party, other than an employee who suffers from an occupational accident, he/she may not exercise the employer’s right to claim medical care due to an occupational accident. Therefore, the employer is obligated to return the benefits accrued from the employee’s exemption from the duty to claim medical care for the employee.

According to the records, the plaintiff's disposition of medical care benefits against the non-party 3 suffered from occupational accident on condition of recovering the plaintiff's charges by filing a claim for return of unjust enrichment against the defendant. Even if the plaintiff's insurance benefits against the non-party 3 fall under the grounds for restrictions on insurance benefits under Article 48 (1) 4 of the National Health Insurance Act and do not fall under the above law, the non-party 3 was unable to exercise the right to claim medical care benefits against the defendant as long as he received medical care benefits from the plaintiff within the scope of receiving the insurance benefits. Accordingly, the defendant who was exempted from the duty to claim medical care benefits against the non-party 3 is obligated to return unjust enrichment equivalent to the insurance benefits that the plaintiff provided against the plaintiff.

Nevertheless, the judgment of the court below, which held that the defendant cannot be deemed to have obtained any benefit as the insurance benefit of the plaintiff in this case on the premise that the non-party 3 still can still exercise the right to claim medical care compensation against the plaintiff under the Labor Standards Act, is erroneous in the misapprehension of legal principles as to unjust enrichment, which affected the conclusion of the judgment. Therefore, the ground of

However, the court below determined that the grounds for restrictions on insurance benefits by applying the National Health Insurance Act to the whole insurance benefits of this case that the Plaintiff and the Plaintiff comprehensively succeeded to the rights and obligations before and after the enforcement of the National Health Insurance Act constitutes grounds for restrictions on insurance benefits by applying the National Health Insurance Act. However, since Article 48(1)4 of the National Health Insurance Act cannot be applied to the insurance benefits that were provided before the enforcement of the National Health Insurance Act, the court below should have deliberated whether the above unjust enrichment relation can be established after examining whether the non-party 3's health insurance relationship remains before the enforcement

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.

Justices Shin Shin-chul (Presiding Justice)