[1] In a case where an insurance benefit under the Industrial Accident Compensation Insurance Act is not paid for the reason that the beneficiary is not dissatisfied with the decision on the insurance benefits paid by the Korea Workers' Compensation and Welfare Service, whether the employer is exempted from the liability for accident compensation under the Labor Standards Act (affirmative)

[2] In a case where Eul, a worker of Gap corporation, suffered injury while on duty, and applied for approval of medical care by the Korea Workers' Compensation and Welfare Service based on the industrial accident compensation insurance, but the Korea Workers' Compensation and Welfare Service did not approve the application, and the National Health Insurance Corporation paid medical expenses, etc. received by Eul during the above additional medical care to the medical care institution, and then claimed reimbursement of the amount equivalent to the above amount against Eul corporation, the case holding that the National Health Insurance Corporation cannot claim reimbursement of medical care expenses against Gap corporation who did not

[1] In light of the purport of Article 80(1) of the Industrial Accident Compensation Insurance Act (hereinafter “Industrial Accident Insurance Act”), Article 87 of the Labor Standards Act, and the Industrial Accident Insurance Act, where an employer has to take out an industrial accident compensation insurance and pay insurance benefits for the pertinent accident, the employer is exempted from liability for accident compensation under the Labor Standards Act, and even if the beneficiary is not dissatisfied with the decision of the Korea Workers’ Compensation and Welfare Service to pay insurance benefits under the Industrial Accident Compensation Insurance Act, it does not change even if the beneficiary did not receive insurance benefits as a result on the ground that

[2] In a case where Eul, a worker of Eul corporation, suffered an injury while on duty, received the approval of the Korea Workers' Compensation and Welfare Service on the basis of the industrial accident compensation insurance and received the approval of the Korea Workers' Compensation and Welfare Service, but the Korea Workers' Compensation and Welfare Service did not approve the re-treatment, and the National Health Insurance Corporation paid the medical expenses, etc. for which Eul was treated during the period of additional medical care to the medical care institution and claimed reimbursement of the amount equivalent to the above amount against Eul corporation, the case holding that if the medical treatment period subject to the application for the approval of the additional medical care for Eul is for the treatment of injury caused by occupational accident, the company Gap, an employer, is exempted from the liability for accident compensation under the Industrial Accident Compensation Insurance Act, and the re-medical care benefits under the Industrial Accident Compensation Insurance Act for the above medical treatment period should be paid, even if the Korea Workers' Compensation and Welfare Service did not object to the decision on non-approval of the additional medical care, and thus, the National Health Insurance Corporation cannot seek reimbursement of the above treatment period against Eul corporation not liable for accident compensation under the Labor Standards Act.

[1] Article 80(1) of the Industrial Accident Compensation Insurance Act, Article 87 of the Labor Standards Act / [2] Article 80(1) of the Industrial Accident Compensation Insurance Act, Article 87 of the Labor Standards Act

[1] Supreme Court Decision 2001Da7834 decided September 18, 2001 (Gong2001Ha, 2249)

Co., Ltd.

National Health Insurance Corporation (Attorney Song-young, Counsel for defendant-appellant)

Seoul Western District Court Decision 2012Na1331 decided February 15, 2013

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

The grounds of appeal are examined.

1. Article 80(1) of the Industrial Accident Compensation Insurance Act (hereinafter “Industrial Accident Compensation Insurance Act”) provides that “When a beneficiary has received or is entitled to receive insurance benefits pursuant to this Act, an insured shall be exempt from liability for accident compensation under the Labor Standards Act for the same reason.” Article 87 of the Labor Standards Act provides that “If a person entitled to receive compensation receives or is entitled to receive the same reason in accordance with the Civil Act or other statutes, the employer shall be exempted from liability for accident compensation to the extent of the value thereof.”

Insurance benefits under the Industrial Accident Insurance Act have the nature of directly compensating an employee for damages caused by occupational accidents from the standpoint of an insurer by the State, which is obliged to compensate under the Labor Standards Act. In that sense, the reason and type of insurance benefits and the criteria for calculating wages are identical or similar to accident compensation under the Labor Standards Act, and where the aforementioned mutual adjustment provisions are stipulated on the basis of the identity of the function of loss transfer, insurance benefits are also performing the function of liability insurance with regard to accident compensation under the Labor Standards Act (see Supreme Court Decision 93Da3826, May 24, 1994, etc.).

In light of these provisions and the purport of the Industrial Accident Insurance Act, if an employer has taken part in an industrial accident compensation insurance and has to pay insurance benefits for the accident, the employer shall be exempted from the liability for accident compensation under the Labor Standards Act. Although insurance benefits under the Industrial Accident Insurance Act have to be paid, it does not change even if the beneficiary did not receive insurance benefits for the reason that the beneficiary did not object to the decision of the Korea Workers' Compensation and Welfare Service on insurance benefits (see Supreme Court Decision 2001Da7834, Sept. 18, 2001).

2. According to the reasoning of the judgment below, the Plaintiff purchased industrial accident compensation insurance for the Plaintiff’s employees, ② the Nonparty, who was the Plaintiff’s employee, suffered injury such as cerebral hemopia, brain damage, recognition due to cerebral injury, and intelligence degradation during his service on November 23, 2007 (hereinafter “the instant injury”), and received treatment from a medical care institution; ③ the Nonparty applied for medical care from November 24, 2007 to November 15, 2009 to the Korea Workers’ Compensation and Welfare Service based on the industrial accident compensation insurance to which the Plaintiff joined; ④ the Nonparty’s application was approved as above by the Korea Workers’ Compensation and Welfare Service; ④ the Nonparty’s payment of KRW 24,225,840, medical care benefits; and KRW 87,216,930 shall be paid to the Nonparty for additional medical care; ⑤ The Nonparty’s payment of the medical care institution’s payment of the medical care expenses to the Plaintiff for the aforementioned period of medical care from 15th of the aforementioned period of medical care (hereinafter “the Nonparty’s payment”).

3. We examine the above facts in light of the legal principles as seen earlier.

If the treatment of the non-party during the pertinent period, as alleged by the Defendant, was conducted for the purpose of treating the injury caused by occupational accidents, the treatment costs are subject to medical care benefits under the Industrial Accident Insurance Act, and thus the Plaintiff, the employer, is exempted from liability for accident compensation under the Labor Standards Act, and the re-medical care benefits under the Industrial Accident Insurance Act should be paid to the non-party, even if the medical care benefits under the Industrial Accident Insurance Act should be paid to the treatment of the instant period against the non-party, the non-party, who is the beneficiary of the medical care benefits

Therefore, the defendant cannot seek reimbursement of medical expenses for the treatment period of this case against the plaintiff who is not liable for accident compensation under the Labor Standards Act.

In the same purport, the lower court is justifiable to have determined that the Plaintiff did not bear the liability for reimbursement against the Defendant for the medical expenses for the treatment period of this case. In so doing, contrary to what is alleged in the grounds of appeal, there were no errors by misapprehending the legal doctrine on the relation

4. 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 Yang Chang-soo (Presiding Justice)