In a case where a person qualified and licensed as a medical person established a medical institution pursuant to the Medical Service Act and provided medical care prescribed in the Industrial Accident Compensation Insurance Act to an employee suffering from occupational accidents, but a medical person who already established and operated another medical institution was in violation of the Medical Service Act by practically establishing and operating the said medical institution under the name of another medical person, or by establishing and operating the said medical institution under the name of another medical person, whether the circumstance alone constitutes “medical institution under Article 3 of the Medical Service Act” where the said medical institution does not constitute “medical institution under Article 3 of the Industrial Accident Compensation Insurance Act” or “an act of receiving medical expenses by fraud or other improper

Articles 1, 40(1), 43(1)3, 45(1), and 84(3)1 of the Industrial Accident Compensation Insurance Act; Articles 1, 4(2), 33(2)1 and 33(8) of the Medical Service Act

Plaintiff (Law Firm Ba, Attorneys Lee In-hwa et al., Counsel for the plaintiff-appellant)

Korea Labor Welfare Corporation

Seoul High Court Decision 2017Nu62879 decided October 19, 2017

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

The grounds of appeal are examined.

1. A. The Industrial Accident Compensation Insurance Act provides that the Industrial Accident Compensation Insurance Act is an Act enacted to compensate workers for occupational accidents promptly and fairly, establish and operate insurance facilities necessary for facilitating the rehabilitation of workers suffering from occupational accidents and their return to society, and to contribute to the protection of workers by carrying out projects for preventing accidents and promoting workers’ welfare (Article 1); the payment of medical care benefits to the relevant workers if an injury or disease occurs due to occupational reasons (Article 40(1)); the medical institution designated by the Service as “medical institution under Article 3 of the Medical Service Act”; the medical institution for industrial accident insurance, including the medical institution designated by the Service, shall be in charge of medical care for workers suffering from occupational accidents (Article 43(1)3); the Defendant’s payment of the medical expenses (Article 45(1)); and the Defendant’s payment of the medical expenses to the medical institution that received the medical expenses by “any false or other unjust means” (Article 84(3)1).

In addition, the Medical Service Act was enacted for the purpose of protecting and improving the health of the people by providing for matters necessary for the public’s medical treatment so that all citizens can benefit from high-quality medical treatment (Article 1); and, on the other hand, prescribing that only a doctor, dentist, oriental medical doctor, or midwife (hereinafter “medical person”), etc. may establish a medical institution (Article 33(2)1); and on the other hand, restricting medical personnel to prevent from establishing and operating two or more medical institutions (the main sentence of Article 33(8)); and restricting medical personnel from establishing or operating a medical institution under the name of another medical person (Article 4(2) and the main sentence of Article 33(8) (hereinafter “each of the instant provisions of the Medical Service Act”).

B. As can be seen, the Industrial Accident Compensation Insurance Act provides for the operation of insurance for workers’ compensation for occupational accidents, and the Medical Service Act provides for medical persons, medical institutions, and medical practices to ensure that all citizens enjoy high-quality medical benefits, and it is difficult to view the legislative purpose and subject matter thereof. Therefore, the scope of “medical institutions under Article 3 of the Medical Service Act,” which may be recognized as industrial accident insurance-related medical institutions under the Industrial Accident Compensation Insurance Act, shall be determined by taking into account the difference between the Industrial Accident Compensation Insurance Act and the Medical Service Act, in mind, whether the scope of “medical institutions under Article 3 of the Medical Service Act” is appropriate as institutions in charge of medical care under the Industrial Accident Compensation Insurance Act. Even if a medical person establishes and operates more than one medical institution or establishes and operates a medical institution under the name of another medical institution, that medical institution is established and operated by a medical person that is allowed to establish and operate a medical institution under the Medical Service Act

In full view of these circumstances, if a person qualified and licensed as a medical person established a medical institution under the Medical Service Act and provided workers suffering from occupational accidents with medical care prescribed in the Industrial Accident Compensation Insurance Act, even if a medical person who already established and operated another medical institution actually established and operated the above medical institution, or a medical person who established and operated the above medical institution under the name of another medical person violates the Medical Service Act, such circumstance alone does not constitute “medical institution under Article 3 of the Medical Service Act” where the above medical institution is not deemed to be “medical institution under Article 3 of the Industrial Accident Compensation Insurance Act,” or where the above medical institution received medical expenses by fraud or other improper means.

2. Based on its stated reasoning, the lower court determined that the instant hospital constitutes “medical institution under Article 3 of the Medical Service Act” under Article 43(1)3 of the Industrial Accident Compensation Insurance Act, even if the Nonparty, a medical doctor who already operates another medical institution, established and operated the instant hospital in the name of the Plaintiff, who is a doctor, constitutes “medical institution under Article 3 of the Industrial Accident Compensation Insurance Act” and thus, the instant hospital’s claim for medical expenses to the Defendant after receiving medical treatment for affected workers does not constitute “the case where the medical expenses were received by false or other unjust means” under Article 84(3)1 of

In light of the aforementioned legal principles, the lower court did not err by misapprehending the legal doctrine on Article 84(3)1 of the Industrial Accident Compensation Insurance Act, contrary to what is alleged in the grounds of appeal.

3. 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 Lee Ki-taik (Presiding Justice)