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(영문) 서울행정법원 2016.11.07 2015구단62296
진료계획불승인처분취소
Text

1. All of the plaintiffs' claims are dismissed.

2. The costs of lawsuit are assessed against the plaintiffs.

Reasons

1. On June 11, 2015, the Plaintiffs submitted to the Defendant a medical treatment plan, the content of which is the outpatient treatment from July 1, 2015 to December 31, 2015, while receiving medical care approval from the Defendant by June 30, 2015 due to chronic closed diseases.

On September 25, 2015, the Defendant rendered a disposition not to approve each of the above medical treatment plans on the ground that the Plaintiffs do not fall under the subject of chronic closed-pulmonary disease (FE1) due to the result of the recent pulmonary function examination.

(hereinafter “each disposition of this case”). 【No dispute exists, Gap evidence Nos. 1 and 2, and the purport of the whole pleadings

2. Whether the disposition is lawful;

A. The Plaintiffs’ assertion 1) Since chronic closed-end diseases were not cured, each of the instant dispositions is unlawful, notwithstanding the Defendant’s guidelines for handling chronic closed-end diseases whose primary quantity (FEV1) is less than 30%, regardless of the Defendant’s guidelines for handling chronic closed-end diseases. 2) The Plaintiffs trusted that they may continue to receive medical care after obtaining approval of the Defendant’s medical care plan prior to the enforcement of May 1, 2014, and that such trust is worthy of protection. Accordingly, each of the instant dispositions violates the principle of trust protection.

B. As to the first argument, Article 47 of the Industrial Accident Compensation Insurance Act and Article 41 of the Enforcement Decree of the Act provide that the Defendant may take necessary measures, such as examining whether the treatment plan submitted by an industrial accident insurance-related medical institution is appropriate, such as closing the treatment or ordering the reduction of the scheduled treatment period. Article 5 Subparag. 4 of the Act provides that “the treatment” refers to completely recovering from the injury or disease, or that the treatment cannot be expected any longer, and that the symptoms thereof become fixed. In addition to the above provisions, Articles 40 (Medical Care Benefits), 51 (Additional Medical Care) and 57 (Details of Disability Benefits) of the Act and its legislative purport.

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