2020du3928 Demanding revocation of the disposition of revocation of disability pension payment

Plaintiff:

Attorney Kim Young-young, Counsel for the defendant-appellant

Korea Labor Welfare Corporation

Attorney Kim Won-young et al., Counsel for the defendant-appellant

Seoul High Court Decision 2019Nu57642 Decided May 7, 2020

December 10, 2020

The judgment below is reversed and the case is remanded to Seoul High Court.

The grounds of appeal are examined.

1. Case summary and key issue

A. Review of the reasoning of the lower judgment and the record reveals the following circumstances.

1) On August 26, 1985, the deceased Nonparty (hereinafter referred to as “the deceased Nonparty”) was judged as having caused pneumoconiosis Nos. 11 subparag. 9 [the second-class pneumoconiosis type and the cardiopulmonary function (FO)] of the disability grade No. 11, and was paid a lump-sum disability payment. 2) The deceased died on July 17, 2009 due to pulmonary tuberculosis with the approval of the medical care due to pulmonary tuberculosis for pneumoconiosis witnesses.

3) The Deceased was paid temporary layoff benefits of KRW 101,187,220 in total from October 2, 2009 to December 30, 2016 during the period of medical care.

4) On February 23, 2018, the Plaintiff, a spouse of the Deceased, requested the Defendant to pay disability benefits on the ground that the cardiopulmonary function of the Deceased at the time of the medical care approval falls under class 1 of the disability grade (F3) as a condition of advanced disability (F3).

5) On July 11, 2019, the Defendant rendered a decision to pay the remaining 136,102,290 won of temporary disability compensation benefits, excluding 101,187,220 won of temporary disability compensation benefits, which had been already paid to the Plaintiff at KRW 237,289,510 (excluding 244 days of existing 11th degree pension), in accordance with the Act and subordinate statutes, Articles 56 and 60 of the former Industrial Accident Compensation Insurance Act (amended by Act No. 17326, May 26, 2020; hereinafter referred to as the “Industrial Accident Compensation Insurance Act”) (hereinafter referred to as the “instant disposition”). The issue of the instant case is whether it is possible to duplicate the payment of temporary disability compensation benefits and disability benefits, that is, whether the payment of disability compensation benefits should be deducted from the amount of temporary disability compensation benefits, or whether the payment of disability compensation benefits should be made “the full amount of disability compensation benefits”.

2. Whether temporary layoff benefits and disability benefits can be paid in duplicate;

(a) The Industrial Accident Insurance Act provides that, when a worker suffers from an injury or disease due to an occupational accident, medical care benefits shall be paid in an amount equivalent to 70/100 of the average wage per day for the period in which the worker is unable to be employed as the result of the medical care, and, if there is a physical disability after the cure, etc., disability benefits shall be paid in accordance with the disability grade standards set forth in the Industrial Accident Insurance Act (Articles 36, 40, 52, and 57). In addition, Article 60 (1) of the Industrial Accident Insurance Act provides that, after the cure of the medical care benefits, the amount of temporary disability compensation benefits shall not be paid in excess of the daily amount of disability compensation annuity calculated by dividing the amount of the temporary disability compensation annuity by 10 percent (Articles 51 (1) and 56) of the average wage as at the time of the medical care, the amount of temporary disability benefits shall not be paid in excess of the daily amount of disability compensation annuity calculated by dividing the amount of the temporary disability compensation annuity by 360 percent.

B. Disability benefits under the Industrial Accident Insurance Act, in principle, can be paid when a worker completely recovers from a occupational injury or disease, i.e., “if a physical disability occurs after the worker completely recovers from a occupational injury or disease,” i.e., “if the worker completely recovers from the injury or disease, or if the treatment for the injury or disease was no longer expected, and the symptoms become fixed. However, in the case of pneumoconiosis symptoms, even if the worker is unable to completely recover from a modern medical science, and leaves a workplace where dust is generated, its progress is continuing, and it is difficult to predict the degree of progress. Considering the above characteristics of pneumoconiosis symptoms, the Industrial Accident Insurance Act, unlike other general medical diseases, does not necessarily require that the pneumoconiosis be completely cured from the treatment for the pneumoconiosis symptoms or that the treatment for the pneumoconiosis should no longer be expected, and it is subject to disability benefits while receiving the treatment without requiring the payment of disability benefits under the relevant disability grade (see, e.g., Supreme Court Decision 9Du2548, Apr. 19, 199).

C. In full view of the contents and structure of the aforementioned relevant provisions and the purpose of the payment of temporary layoff benefits and disability benefits, if a disaster worker who received temporary layoff benefits during the medical care pays disability compensation benefits for the same period, the sum of the daily disability compensation annuity and the daily amount of temporary layoff benefits exceeds 70/100 of the average wage applied in calculating the disability compensation annuity (the disability grade 1 through 3 corresponding thereto) and the amount equivalent to the temporary layoff benefits already paid should be deducted from the disability compensation annuity to be paid. The detailed reasons are as follows.

1) Article 56(3) of the Industrial Accident Insurance Act provides for the purpose of adjustment inasmuch as a person who received a disability compensation annuity receives the full amount of the additional medical care benefits, if the person receives the additional medical care, the same kind of insurance benefits. Since both temporary disability compensation benefits and disability benefits are insurance benefits paid to compensate for lost income resulting from the loss of labor ability caused by an occupational accident, if the benefits are paid in duplicate for the same period, the economic compensation for the same purpose would be made double. For example, in the case of a worker with a disability grade 1, such as the Deceased, the amount equivalent to 90% of average wage (=329%:365 x100%) would be paid as disability compensation annuity for the worker with a disability grade 70% higher than the amount obtained in the status of 160% higher than the amount obtained in the status of actual income prior to the occurrence of an occupational accident. Furthermore, the purpose of the Industrial Accident Compensation Insurance Act’s legislative purpose is not only to compensate for the amount exceeding 10% of average wage in the occupational accident insurance system.

2) Article 56(3) of the Industrial Accident Insurance Act does not stipulate that “the amount of temporary disability compensation benefits out of the excess amount shall not be paid” and it does not necessarily mean that “the amount corresponding to the temporary disability compensation benefits out of such excess amount” is limited to “temporary disability compensation benefits”. Article 56(3) of the Industrial Accident Insurance Act provides that “where a beneficiary of disability compensation benefits receives additional medical care and receives temporary disability compensation benefits due to such additional medical care,” it is only a typical example of ‘the case where a beneficiary of temporary disability compensation benefits has received temporary disability compensation benefits in which disability benefits and temporary disability compensation benefits can be paid in duplicate, so it is possible to adjust the amount of ‘temporary disability benefits' in accordance with Article 56(3) of the Industrial Accident Insurance Act even if a person who has received temporary disability compensation benefits has received it later. Even if considering the legislative intent of Article 56(3) of the Industrial Accident Insurance Act, there is no reason to apply Article 56(3) of the Industrial Accident Insurance Act differently.

3) Article 56(3) of the Industrial Accident Insurance Act applies to cases where a beneficiary of disability compensation annuity receives not only the case where the beneficiary of the medical care but also the case where the beneficiary of the medical care receives the first medical care after the completion of the medical care. Since Article 56(3) of the Industrial Accident Insurance Act does not differ from the first medical care (see, e.g., Supreme Court Decision 2002Du1762, Apr. 26, 2002) except that the medical care was provided for the case where the beneficiary of the medical care re-treatment after the medical care was completed, or that the beneficiary of the medical care was provided with a merger certificate due to the disease, the first medical care and its nature are not different (see, e.g., Supreme Court Decision 2002Du1762, Apr. 26, 2002).

3. Determination as to the instant case

A. We examine the above facts in light of the above legal principles.

1) The Deceased was paid KRW 101,187,220 of temporary layoff benefits from October 2, 2009 to December 30, 2016.

2) The Deceased’s disability pension to be paid to the Plaintiff from August 2009 to December 2, 2016 is KRW 237,289,510 (excluding KRW 244-day pension of Grade 11).

3) During the period from August 2009 to December 2, 2016, the sum of the daily disability compensation annuity per day and the daily amount of temporary disability compensation benefits to be paid to the Plaintiff exceeds 70/100 of the average wage applied in calculating the disability compensation annuity. As such, the Defendant shall pay 136,102,290 won, subtracting KRW 101,187,220 of the temporary disability compensation benefits paid to the Plaintiff from KRW 237,289,510.

B. Nevertheless, the lower court determined that the instant disposition was unlawful on the ground that Article 56(3) of the Industrial Accident Insurance Act limited only to the scope of adjustment of the disability compensation annuity and temporary disability compensation benefits, deeming that it cannot be applied to the Plaintiff claiming disability benefits. In so determining, the lower court erred by misapprehending the legal doctrine on the interpretation and application of Article 56(3) of the Industrial Accident Insurance Act, thereby adversely affecting the conclusion of the judgment. The allegation contained in

Conclusion

Therefore, the judgment of the court 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 Lee Young-gu

Justices Lee Dong-won

Justices Park Jong-young