U.S. Co., Ltd. (Law Firm Ratel, Attorney Bag-young, Counsel for the defendant-appellant)

National Health Insurance Corporation

January 22, 2013

Seoul Western District Court Decision 2010Kadan81301 Decided December 28, 2011

1. The defendant's appeal is dismissed.

2. The costs of appeal shall be borne by the Defendant.

1. Purport of claim

It is confirmed that there is no obligation to return unjust enrichment of KRW 25,673,510 against the defendant.

2. Purport of appeal

The judgment of the first instance is revoked. The plaintiff's claim is dismissed.

1. Basic facts

A. The Plaintiff subscribed to industrial accident compensation insurance for the Plaintiff’s employees, who are engaged in electromagnetic waves, shielding, and supply business.

B. On November 23, 2007, the Nonparty, who had been a worker of the Plaintiff, suffered injury, such as brain dystrophism, cerebral dystrophism, brain damage, fall in intelligence, etc. (hereinafter “instant injury”), and was treated by a medical care institution.

C. Based on the above industrial accident compensation insurance purchased by the Plaintiff, the Nonparty applied for the approval of the medical care from November 24, 2007 to November 15, 2009 to Korea Labor Welfare Corporation.

D. The Korea Labor Welfare Corporation approved the Nonparty’s above application, and decided to pay the Nonparty KRW 24,225,840 of temporary layoff benefits and KRW 87,216,930 of the medical care benefits and KRW 9,832,410 of the disability benefits as pension.

E. The Nonparty received medical treatment from the medical care institution from November 16, 2009 to January 18, 201, the following day of the application period for the approval of medical care as above (hereinafter “instant application period”). The Nonparty applied for the re-treatment of medical care such as the above treatment to the Korea Workers’ Compensation and Welfare Service, but the Korea Workers’ Compensation and Welfare Service rejected the said application on the ground that it does not meet the requirements for the approval of medical care on March 3, 201.

F. Meanwhile, during the pertinent period, the Defendant paid KRW 25,673,510 to the medical care institution due to the medical expenses that the Nonparty received from the medical care institution during the pertinent period, and paid to the Plaintiff on November 3, 2010, the above amount that the Defendant paid to the Plaintiff on behalf of the Defendant, in accordance with the Labor Standards Act, was paid to the Plaintiff, who is the Nonparty’s employer, under the Labor Standards Act, so

[Ground of recognition] Facts without dispute, Gap evidence 1-3, evidence 1-2, Eul evidence 1-3, the purport of the whole pleadings

2. Summary of the parties' arguments

A. The plaintiff's assertion

The Plaintiff joined the industrial accident compensation insurance and received medical benefits, etc. from the Korea Workers' Compensation and Welfare Service after obtaining the approval of medical care for the injury of the instant case. In addition, the Nonparty retired from the Plaintiff company on June 18, 2010, the Plaintiff is not liable for medical expenses, etc. during the subject period. Therefore, the Plaintiff did not have a duty to respond to the Defendant's claim for reimbursement.

B. Defendant’s assertion

The Plaintiff, an employer, shall be liable for accident compensation pursuant to Article 78 of the Labor Standards Act, due to the non-approval of the medical treatment of the Nonparty during the instant period subject to medical care by the Korea Labor Welfare Corporation. However, since the Defendant was exempted from its liability for compensation due to the payment of the above medical treatment expenses, the Plaintiff is obligated to return the amount equivalent to the above medical treatment expenses to

3. Determination

A. Whether medical expenses, etc. during the pertinent coverage period constitute compensation for medical treatment

First of all, we examine whether the medical expenses, etc. of the non-party during the subject period of this case are eligible for medical care compensation under the Labor Standards Act.

1) Article 78 of the Labor Standards Act provides that an employer shall provide necessary medical care or bear necessary medical care costs when a worker suffers from an occupational injury or disease. Article 80 of the same Act provides that an employer shall provide compensation for disability in accordance with the degree of disability if a worker suffers from a physical disability after the worker completely recovers from occupational injury or disease. In addition, Article 40 of the Industrial Accident Compensation Insurance Act provides that medical care benefits shall be paid in cases where the worker suffers from an injury or disease due to an occupational reason, and Article 57 of the same Act provides that the worker shall be paid disability benefits in cases where the worker suffers from an injury or disease after treating the injury or disease due to an occupational reason.

In full view of the above provisions, the employer’s disability compensation under the Labor Standards Act and disability benefits under the Industrial Accident Compensation Insurance Act shall be liable on the premise of the worker’s full recovery or cure of occupational injury, etc. Meanwhile, Article 5 subparag. 4 of the Industrial Accident Compensation Insurance Act provides that the injury or disease with respect to the above “cure” shall be completely cured, or the effect of treatment cannot be expected any longer, and the symptoms thereof shall be fixed, and Article 80(1) of the Industrial Accident Compensation Insurance Act provides that the insured shall be exempted from the liability for accident compensation under the Labor Standards Act for the same reason if the beneficiary received or is able to receive the insurance benefits under this Act. In light of the above, it is reasonable to deem that the employer as the employer provided necessary medical care or bears all necessary medical care expenses as provided under the Labor Standards Act, barring any special circumstance.

2) Meanwhile, Article 51 of the Industrial Accident Compensation Insurance Act provides that, if there is a medical opinion that an employee who received medical care benefits suffers from a recurrence of occupational injury or disease, which was the object of the medical care after the medical care or becomes worse than the time of the medical care, active medical care may again be received, namely, medical care benefits under Article 40. The above provision does not change the first medical care and its nature, except that the medical care was conducted after the medical care was terminated, or that the medical care was conducted after the medical care was terminated, or that the Nonparty’s medical care was conducted after the completion of the medical care, and thus, the requirement for additional medical care was not different (see Supreme Court Decision 200Du5050, Apr. 26, 200; Supreme Court Decision 94Nu12326, Sept. 15, 1995; etc.). The Nonparty’s application for the approval of the medical care was not recognized as having been paid to the Nonparty after the medical care was finalized after the medical treatment period.

3) Sub-decisions

Therefore, it is not recognized that the Plaintiff is not liable for accident compensation for medical expenses of the non-party spent during the pertinent period. Therefore, the Plaintiff is not liable for the payment of indemnity related thereto to the Defendant, and as long as the Defendant seeks the payment of indemnity against the Plaintiff, there is a benefit to seek confirmation that there is no liability for indemnity against the Plaintiff.

B. Family judgment

Even if the medical expenses, etc. of the Nonparty spent during the pertinent period are subject to medical care compensation, we examine whether the Plaintiff is liable to compensate for such expenses.

Article 80(1) of the Industrial Accident Compensation Insurance Act provides that where a beneficiary received or is able to receive insurance benefits pursuant to this Act, the insured is exempt from the liability for accident compensation pursuant to the Labor Standards Act for the same reason. In light of the above provision and the purport of the Industrial Accident Compensation Insurance Act, in cases where the employer purchased the industrial accident compensation insurance and the insurance benefits should be paid for the relevant accident, the employer is exempted from the liability for accident compensation pursuant to the Labor Standards Act (see Supreme Court Decision 2001Da7834, Sept. 18, 2001).

Meanwhile, even if an administrative disposition becomes final and conclusive and conclusive, the facts or legal judgment that form the basis of the disposition becomes final and conclusive, and the parties or the court is bound to do so, it does not make any assertion or judgment inconsistent therewith (see Supreme Court Decision 93Nu5437, Aug. 7, 1993, etc.). Even if a beneficiary of an industrial accident compensation insurance claims insurance benefits, if the beneficiary of the industrial accident compensation insurance claims for workers, the employer who pays the accident compensation can claim for the State if the requirements for the industrial accident compensation benefits are met (see Supreme Court Decision 93Da3826, May 24, 1994, etc.). The Industrial Accident Compensation Insurance Act has the nature of compensating the workers for the damages arising from the occupational accident that the employer is obliged to compensate under the Labor Standards Act from the standpoint of the insurer, and thus, it is reasonable for the State to interpret that the industrial accident compensation insurance should be based on the nature of the industrial accident compensation insurance system, such as the industrial accident compensation insurance system to which the employer is obliged to compensate for damages.

4. Conclusion

Therefore, the plaintiff's claim of this case is justified, and the judgment of the court of first instance is just, and the defendant's appeal is dismissed. It is so decided as per Disposition.

[Attachment Form 5]

The delay of judge's grievance settlement (Presiding Judge)