[1] In accordance with Article 26 (1) of the former Guarantee of Automobile Accident Compensation Act, the right to claim compensation against a third party under Article 53 (1) of the former National Health Insurance Act shall be deemed to be the right to claim compensation for damage against a motor vehicle owner or a non-insurance motor vehicle (negative)

[2] In a case where the National Health Insurance Corporation provided insurance benefits under the former National Health Insurance Act to the victim of a traffic accident caused by a motor vehicle or an non-insurance motor vehicle, whether it obtained unjust enrichment that the government or the assistance business operator entrusted with the business of guaranteeing motor vehicle accident compensation under Article 37 (1) of the former Guarantee of Automobile Accident Compensation Act exempted from liability for compensation due to the assistance business (negative

[1] Article 26 (1) of the former Guarantee of Automobile Accident Compensation Act (wholly amended by Act No. 9065 of March 28, 2008) (see current Article 30 (1)), Article 53 (1) (see current Article 58 (1)) of the former National Health Insurance Act (wholly amended by Act No. 9022 of March 28, 2008) / [2] Article 48 (2) (see current Article 53 (2)) of the former National Health Insurance Act (wholly amended by Act No. 9022 of March 28, 2008), Article 26 (1) of the former Guarantee of Automobile Accident Compensation Act (wholly amended by Act No. 9065 of March 28, 2008), Article 28 (1) (see current Article 30 (1)), Article 28 (1) and Article 53 (1) (see current Article 58 (1)) (see current Article 58 (2) (30 (1) and (2) (2) (2) (2) (7) (see current Enforcement Decree of the Guarantee of Automobile Compensation Act)

[1] [2] Supreme Court Decision 2012Da200394 Decided December 13, 2012 (Gong2013Sang, 152) / [1] Supreme Court Decision 2003Da62477 Decided April 15, 2005 (Gong2009Ha, 1538) Decided August 20, 2009 / [2] Supreme Court Decision 2004Da35113 Decided April 15, 2005 (Gong2005Sang, 736)

National Health Insurance Corporation

Dongbu Fire Marine Insurance Co., Ltd. (Law Firm Squa, Attorneys Kim Dong-ho et al., Counsel for the plaintiff-appellant)

Daegu District Court Decision 201Na10684 Decided October 21, 2011

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

The grounds of appeal are examined.

1. A. Article 53(1) of the former National Health Insurance Act (amended by Act No. 9022, Mar. 28, 2008; hereinafter “former National Health Insurance Act”) provides that when a ground for insurance benefits occurred due to a third party’s act and the insured has paid the insurance benefits to the insured, the National Health Insurance Corporation (hereinafter “former National Health Insurance Corporation”) shall obtain the right to claim compensation against the third party within the limit of the expenses required for the payment of the benefits. Thus, the right to receive the insurance benefits from a third party’s act and the insured under Article 53(1) of the former National Health Insurance Act is the right to claim compensation against the third party of the insured who received the insurance benefits within the limit of the expenses required for the benefits.

However, Article 26 of the former Guarantee of Automobile Accident Compensation Act (wholly amended by Act No. 9065, Mar. 28, 2008; hereinafter “former Guarantee of Automobile Accident Compensation Act”) (hereinafter “Guarantee Business”) provides that the government shall collect a specified amount of the liability insurance premium to be paid by the owner of a motor vehicle as the contribution and shall compensate the damage suffered by the victim who died or was injured due to an accident caused by the operation of a motor vehicle which is not known to the owner of the motor vehicle, or is a type of social security system, the main purpose of which is to supplement the Motor Vehicle Liability Insurance System, which is legally enforced for the purpose of protecting the victim of a traffic accident caused by a motor vehicle accident caused by a motor vehicle or an non-insurance vehicle (see, e.g., Supreme Court Decisions 2003Da62477, Apr. 15, 2005; 2009Da27452, Aug. 20, 209).

In light of the purpose, purpose, character, etc. of the guaranteed business, in the case of traffic accidents caused by a motor vehicle or a non-insurance motor vehicle without the owner of the motor vehicle, for which the owner of the motor vehicle is unknown, the right to claim compensation for the guaranteed business owned by the victim under Article 26(1) of the former Act is a claim specifically recognized by the law for the relief of the victim, and it cannot be deemed as a right to claim compensation for a third party under Article 53(1

B. Meanwhile, Article 28(1) of the former Act provides that “If a victim is compensated or compensated for damage under the provisions of Article 26(1) by the State Compensation Act, the Industrial Accident Compensation Insurance Act, or other Acts prescribed by the Presidential Decree (hereinafter “other Acts”), the Government shall be exempted from liability for compensation under the provisions of Article 26(1) within the scope of the amount of compensation that the victim is compensated or compensated.” This provision provides for adjustment relations between the payment of compensation under the guaranteed project and the compensation under other Acts in the sense that the relief by the Government is final and conclusive, and that it is for the minimum relief of social security system (see Supreme Court Decision 2004Da35113, Apr. 15, 2005). Since the former Enforcement Decree of the Child Compensation Act (wholly amended by Presidential Decree No. 21036, Sep. 25, 2008; hereinafter “former Enforcement Decree”) provides that the victim of a traffic accident under the National Health Insurance Act shall not be considered as one of the grounds for restriction on compensation under the National Health Insurance Act.

Therefore, even if the Corporation provided insurance benefits under the former National Health Insurance Act to the victim of a traffic accident caused by a motor vehicle or a non-insurance accident, it cannot be deemed that the Corporation has performed its duty to provide insurance benefits, and thus, the guaranteed business operator entrusted by the Minister of Construction and Transportation with the duty to provide insurance benefits under Article 37 (1) of the former Act has gained the benefit from the victim's liability for compensation for the guaranteed business within the scope of the amount of compensation received through the insurance benefits under the former National Health Insurance Act.

2. According to the reasoning of the lower judgment and the evidence duly admitted by the lower court, the instant accident occurred when Nonparty 1 driven a Daegu (vehicle No. 1 omitted) car that was not covered by the liability insurance on January 12, 2008 and driven the road on January 12, 2008. The back part of the Daegu (Motor Vehicle No. 2 omitted) freight vehicle parked on the front section of the said franchise was shocked by the front section of the said franchise. The fact that Nonparty 2 was receiving medical treatment from the hospital on January 25, 2008 by the victim Nonparty 2, who was a passenger of the said franchise due to the instant accident, died on January 25, 2008. Upon the victim’s request, the Plaintiff provided medical care benefits under the former National Health Insurance Act on April 7, 2008, and paid KRW 20,361,560 to the said hospital, excluding the Defendant’s share in the total medical expenses.

In light of these facts in light of the legal principles as seen earlier, the victim non-party 2's right to claim compensation under Article 26 (1) of the former Act cannot be deemed as the right to claim compensation against the third party under Article 53 (1) of the former National Health Insurance Act. Thus, the plaintiff cannot claim compensation against the defendant entrusted with the business of guarantee under Article 37 (1) of the former Act against the defendant, who is entrusted with the business of guarantee under Article 53 (1) of the former National Health Insurance Act. Further, the insurance benefits provided by the plaintiff to the non-party 2 cannot be deemed as a benefit that the defendant exempted the defendant from liability for compensation for the guarantee business without any legal cause within the scope of the insurance benefits. Thus, the plaintiff cannot claim restitution of unjust enrichment against the defendant.

Nevertheless, on the premise that the guaranteed business is a system of the same kind on the extension line of the automobile liability insurance system, the lower court deemed the Defendant to be a third party under Article 53(1) of the former National Health Insurance Act and accepted the Plaintiff’s claim for reimbursement against the Defendant. In so doing, the lower court erred by misapprehending the legal nature of the right to claim compensation under Article 26(1) of the former Act, and the legal doctrine on the requirements for exercise under Article 53(1) of the former National Health Insurance Act, thereby affecting the conclusion of the judgment. The allegation in the grounds of appeal on this point is with merit

3. Therefore, the lower judgment is reversed, and the case is remanded to the lower court for further proceedings consistent with this Opinion. It is so decided as per Disposition by the assent of all participating Justices on the bench.

Justices Lee Sang-hoon (Presiding Justice)