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(영문) 대법원 2019.04.25 2018다248138
구상금
Text

All appeals are dismissed.

The costs of appeal are assessed against the Plaintiff.

Reasons

The grounds of appeal are examined.

1.(a)

If a victim of a tort provides health insurance benefit under the National Health Insurance Act (hereinafter “health insurance”), the National Health Insurance Corporation shall obtain the victim’s damage claim against the perpetrator within the limit of the expenses incurred in providing such benefit (Article 58(1) of the National Health Insurance Act). This is to prevent the victim who received the health insurance benefit from receiving double benefit by receiving the injury compensation again from the perpetrator. As such, the damage claim that the National Health Insurance Corporation obtains by subrogation of the victim is limited to the damage claim arising from the same cause as the health insurance benefit out of the total damage claim of the victim (see Supreme Court Decision 2014Da206853, Sept. 10, 2015). Here, the damage claim arising from the same cause as the health insurance benefit refers to the case where the insurance benefit and the damage claim arising from the same cause are mutually complementary, and thus, can be extinguished due

B. Meanwhile, Article 41(1) of the former National Health Insurance Act (amended by Act No. 13985, Feb. 3, 2016; hereinafter “former Health Insurance Act”) provides that “The provision of the following medical care benefits with respect to illness, injury, childbirth, etc. of a policyholder and his/her dependent” (hereinafter “former Health Insurance Act) provides that “the provision of medical care benefits: (a) medical examination; (b) the provision of medicines and materials for medical treatment; and (c) other treatment, rehabilitation, prevention, rehabilitation, hospitalization, nursing, and transfer; and (d) the provision of paragraph (2) provides that “the criteria for the method, procedure, and scope of medical care benefits

On the other hand, Article 41(3) of the former Health Insurance Act provides that "the Minister of Health and Welfare may exclude a disease that does not interfere with business or daily life and other matters prescribed by Ordinance of the Ministry of Health and Welfare from the beneficiary of health care benefit when determining the criteria for health care benefit pursuant to paragraph (2)."

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