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(영문) 서울고등법원 2020.07.15 2019누67267
진료계획 불승인 처분취소
Text

1. Revocation of the first instance judgment.

2. On April 10, 2018, the Defendant issued a medical treatment plan modification disposition against the Plaintiff.

Reasons

1. The reasons why the court should explain this part of the disposition are as stated in Paragraph 1 of the reasoning of the judgment of the first instance, except where the "this court" in Section 5 of the judgment of the first instance is deemed to be the "Seoul Administrative Court".

It shall be quoted in accordance with Article 8 (2) of the Administrative Litigation Act and the main sentence of Article 420 of the Civil Procedure Act.

2. Whether the instant disposition is lawful

A. The summary of the Plaintiff’s assertion 1) Although the injury and disease of this case at the time of the instant disposition could have expected to be supported by continuous treatment, the symptoms of this case cannot be deemed to have been fixed, the instant disposition based on the premise that the Plaintiff’s symptoms have been fixed is unlawful. (2) According to the result of the Defendant’s medical record appraisal entrustment conducted by the court of first instance, the Plaintiff appears to have been caused by the reduction or removal of stress in daily life rather than by active treatment; (3) the Plaintiff received disability benefits upon the determination of class 14 subparag. 10 of the disability grade No. 14 on July 5, 2018; and (4) the Plaintiff continued to receive necessary treatment at the medical institution after the completion of the medical treatment on April 30, 2018 through the Defendant’s merger certificate, etc., the instant disposition based on the premise that the Plaintiff’s symptoms have been fixed is lawful.

B. 1) Article 5 Subparag. 4 of the Industrial Accident Compensation Insurance Act provides that “The term “the treatment of an injury or disease is completely cured or the treatment is no longer expected, and the symptoms thereof are fixed.” In full view of the contents and legislative purport of each provision of the Industrial Accident Compensation Insurance Act (Medical Care Benefits), Articles 40, 51, 57, and 77 (Additional Medical Care Benefits), and the Industrial Accident Compensation Insurance Act (hereinafter “Industrial Accident Compensation Insurance Act”), the meaning of the cure is to prevent the aggravation of a fixed symptoms rather than the treatment to defend the injury or disease of an employee receiving medical care.

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