[1] Where a ground for the payment of insurance benefits occurred due to the competition between a third party's illegal act and a person who received the insurance benefits, the scope of subrogated acquisition by the National Health Insurance Corporation among the claims for damages by the person who received

[2] In a case where the king certificate of the victim of an automobile accident aggravated in competition with the automobile accident, part of the medical expenses for the king certificate, which constitutes the medical expenses under the proviso of Article 3(1)2 of the Enforcement Decree of the Guarantee of Automobile Accident Compensation Act (=the medical expenses for the portion aggravated due to the automobile accident

[1] Article 58 (1) of the National Health Insurance Act / [2] Article 15 of the Guarantee of Automobile Accident Compensation Act; Article 3 (1) 2 of the Enforcement Decree of the Guarantee of Automobile Accident Compensation Act; Article 5 and Article 6 (1) 2 of the Standards for Medical Fees Covered by the former Automobile Insurance (Amended by Act No. 2014-513, Aug. 28, 2014)

[1] Supreme Court Decision 2009Da100920 Decided May 13, 201 (Gong2011Sang, 1142) Supreme Court Decision 2011Da39038 Decided December 13, 2012 / [2] Supreme Court Decision 2012Da107167 Decided April 26, 2013

National Health Insurance Corporation

Federation of National Bus Transport Business Cooperatives (Attorney Choi In-bok, Counsel for defendant-appellant)

Suwon District Court Decision 2016Na51658 decided September 7, 2017

The judgment of the court below is reversed, and the case is remanded to Suwon District Court.

The grounds of appeal are examined.

1. If a third party’s act causes insurance benefits to be provided to the insured or his/her dependent, the National Health Insurance Corporation shall obtain a claim for damages against such third party within the limit of the expenses to be paid therefrom (Article 58(1) of the National Health Insurance Act). This is to prevent the third party’s act from being unjust that a person who received insurance benefits receives compensation from a third party again, and a third party liable for compensation, from being exempted from liability due to the payment of insurance benefits. Therefore, in cases where a cause for payment of insurance benefits arises due to a tort committed by a third party and a king increase of the person who received the insurance benefits, the scope of subrogation acquired by the National Health Insurance Corporation among the claims for damages by the person who received the insurance benefits is the total amount of insurance benefits within the scope of the remaining claim for damages after deducting the contribution ratio (see Supreme Court Decision 2011Da39038, Dec. 13, 201

The proviso of Article 3(1)2 of the Enforcement Decree of the Guarantee of Automobile Accident Compensation Act (hereinafter “Enforcement Decree of the Automobile Accident Compensation Act”) provides that where the amount of damage suffered by the victim falls short of the corresponding amount of medical expenses calculated according to the standards for medical fees covered by automobile accident insurance under Article 15(1) of the Guarantee of Automobile Accident Compensation Act (hereinafter “Automobile Accident Compensation Act”), the relevant amount of medical expenses shall be paid within the limit of the amount prescribed in attached Table 1 as a liability

Article 5 of the “Standards for Medical Fees Covered by Automobile Accident Insurance” (amended by the Ministry of Land, Transport and Maritime Affairs No. 2014-513, Aug. 28, 2014) provides that “The scope of recognition of medical fees for automobile accident patients shall be set up, and Article 6(1)2 of the Enforcement Decree of the Automobile Accident Compensation Act provides that “Notwithstanding the scope of recognition prescribed in Article 5, the medical expenses for symptoms (hereinafter referred to as “resperition”) already held before the relevant automobile accident shall be excluded within the extent of recognition: Provided, That this shall not apply to medical expenses which are aggravated due to the aggravation of the relevant automobile accident, where the sperition of the victim of the automobile accident becomes worse compared to the car accident.” Therefore, only the medical expenses aggravated due to the car accident among the medical expenses for the speriosis shall be deemed as falling under the medical expenses prescribed in the proviso to Article 3(1)2 of the Enforcement Decree of the Automobile Accident Compensation Act (see Supreme Court Decision 2013Da16276, Apr. 26, 2017, 2017).

2. According to the reasoning of the lower judgment and the evidence duly admitted, the following facts are revealed.

A. The Plaintiff is an insurer of the national health insurance under the National Health Insurance Act, and Nonparty 1 is a policyholder of the national health insurance. The Defendant is a mutual aid insurer who has taken over the liability for damages to a third party due to an accident that occurred while Nonparty 2 operated a bus (automobile registration number 1 omitted) by Nonparty 2 (hereinafter “Defendant bus”).

B. On December 28, 2013, Nonparty 2: (a) driven the Defendant bus and changed a sudden lane; and (b) accordingly, Nonparty 1, who was driving a motor vehicle (registration number 2 omitted) after Defendant bus, caused an accident where Nonparty 1, who was driving a motor vehicle (hereinafter “Plaintiff”) caused Nonparty 1, who caused the central line in order to avoid Defendant bus, shocked another motor vehicle on the opposite lane (hereinafter “instant accident”).

C. From December 28, 2013 to April 28, 2014, Nonparty 1 received medical treatment from a medical corporation ○○ Hospital, etc. from a medical corporation from February 5, 2014 to May 22, 2014, Nonparty 1 paid KRW 2,323,80,00, excluding KRW 820,880, out of the total medical expenses 3,14,680, to Nonparty 1 for Nonparty 1.

D. The lower court recognized Nonparty 2’s fault ratio of the instant accident as 80%, and found Nonparty 1’s injury as the result of the combination of the instant accident and king’s contribution to 70% on the grounds of the result of Nonparty 1’s entrustment of appraisal of medical records with respect to the head of the Seoul Hospital at Ycheon-do University.

3. Examining the above facts in light of the legal principles of the Supreme Court precedents as seen earlier, the amount of damages incurred to Nonparty 1 caused by the instant accident falls short of 754,723 won (i.e., total medical expenses 3,14,680 won x 30% of the contribution ratio of Nonparty 2 x 80% of the negligence ratio of Nonparty 2 x less than KRW 80% of the car loss x 304,404 of the relevant medical expenses under the proviso of Article 3(1)2 of the Enforcement Decree of the Automobile Loss Compensation Act (=total medical expenses 3,144,680 x 30% of the contribution ratio of the car loss x 30%). Therefore, the Defendant is liable to pay the pertinent amount of medical expenses 943,404 won with the liability insurance proceeds, and the scope of the Plaintiff’s reimbursement to the Defendant by subrogation of Nonparty 1 ought to be deemed to be the amount equivalent

Nevertheless, the lower court held that the Plaintiff can claim the total amount of KRW 2,323,800 insurance money paid by the Plaintiff without distinguishing or taking account of the distinction between the medical expenses for kings and the medical expenses incurred due to the aggravation of kings caused by car accidents, is contrary to the legal doctrine of Supreme Court Decision 2012Da107167 Decided April 26, 2013.

The judgment of the court below is erroneous in the judgment contrary to the Supreme Court's precedents under Article 3 subparagraph 2 of the Trial of Small Claims Act, and the ground of appeal pointing this out is justified.

4. The defendant's appeal is with merit, and the judgment 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 Chang-suk (Presiding Justice)