In a case where a person who suffers from a physical disability due to an occupational accident is not entitled to compensation for the existing disability because he/she did not claim disability benefits, and where a person claims a disability compensation annuity after the change of the disability grade due to aggravation of the existing disability condition, whether the disability compensation annuity equivalent to the number of days paid for lump-sum disability compensation according to the existing disability grade can be paid as a site for disability compensation benefits (negative), and whether the same applies to the case where the claim for disability benefits was extinguished (affirmative)

[Majority Opinion] The purpose of Article 58(3)1 of the Enforcement Decree of the Industrial Accident Compensation Insurance Act is to prevent the occurrence of unreasonable consequences, given that if a person who received medical care benefits and lump-sum disability compensation benefits due to occupational accidents receives the full disability compensation annuity corresponding to the changed disability grade due to aggravation of the state of disability after receiving additional medical care, the disability benefits already paid shall also be paid in duplicate.

Therefore, if a person who suffers from a physical disability due to an occupational accident claims for disability benefits due to his/her failure to claim disability benefits determined at the time of the occurrence of the existing disability, which led to the aggravation of the existing disability condition and the change of the disability grade, there is no unreasonable result in the duplicate payment. Therefore, the Korea Labor Welfare Corporation shall pay disability compensation annuities according to the number of days of payment of disability compensation benefits corresponding to the changed disability grade starting from the month following the month when the recovery was completed after the re-treatment, and the Korea Labor Welfare Corporation shall not pay disability compensation annuities according to the changed disability grade, based on the above provision, and shall not pay disability compensation annuities corresponding to the number of days of payment of disability compensation benefits corresponding to the changed disability grade. This applies likewise to the case where a claim for disability benefits due to the existing disability grade is extinguished. This is because there is no possibility of double payment, and this is consistent with the language and text of the above provision expressed as the "number of days of payment of lump-sum disability compensation benefits

[Dissenting Opinion by Justice Min Il-young, Justice Lee Sang-hoon, and Justice Kim Yong-deok] The system of additional medical care and the system of extinctive prescription for various claims for insurance benefits under the Industrial Accident Compensation Insurance Act are separate systems with independent legislative purposes, and the purport of the additional medical care system is to pay insurance benefits such as medical care through additional medical care for subsequent disabilities for which proximate causal relation with the existing disability is recognized, and it does not aim to restore the right to claim disability benefits which

Therefore, the right to claim disability benefits for existing disabilities cannot be asserted again as long as the period of extinctive prescription expires due to the completion of the extinctive prescription. If the state of disability after additional medical care worsens compared with the previous one, the worker has only the right to claim disability benefits due to additional medical care.

Articles 36, 40, 51(1), and 60(2) of the Industrial Accident Compensation Insurance Act; Article 58(3)1 of the Enforcement Decree of the Industrial Accident Compensation Insurance Act

Plaintiff

Korea Labor Welfare Corporation

Busan High Court Decision 2012Nu1792 decided October 24, 2012

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

The grounds of appeal are examined (to the extent of supplement in case of supplemental appellate briefs not timely filed).

1. Where a worker is injured or affected by an occupational accident, as prescribed by the Industrial Accident Compensation Insurance Act (hereinafter referred to as the “Act”), with respect to a period during which he/she was paid medical care benefits and was unable to be employed as a result of medical care as well as for the cure, temporary disability benefits, such as disability benefits, shall be entitled to receive such benefits if he/she has physical disability, etc. even after recovery (Article 36 of the Act). If an employee needs to receive medical care benefits and provide active medical care in order to cure the occupational injury or disease which was the subject of the medical care aggravated or aggravated after recovery (Article 51(1) of the Act), and if his/her condition becomes worse after recovery from additional medical care, disability benefits may be paid according to the grade of disability corresponding to the aggravated condition, and the method of calculating and paying disability benefits after additional medical care shall be prescribed by Presidential Decree (Article 60(2) of the Act).

Accordingly, the Enforcement Decree of the Industrial Accident Compensation Insurance Act (hereinafter “Enforcement Decree”) separates recipients of disability benefits from those who received disability compensation annuities and those who received lump-sum disability compensation benefits, and stipulates methods for calculating and paying disability benefits by dividing them into cases where the recipient claims disability benefits after receiving additional medical care as disability compensation annuities and cases where the recipient claims them as lump-sum disability compensation annuities. If a person who received lump-sum disability compensation benefits claims a disability compensation annuity due to aggravation of the state of disability after receiving additional medical care, the disability compensation annuity corresponding to the modified disability grade shall be paid from the month following the month in which the date the medical care is cured after receiving the additional medical care, and the disability compensation annuity corresponding to the number of days paid for the lump-sum disability compensation benefits (hereinafter “instant provision”).

The purport of the instant provision is to prevent such unreasonable consequences, given that if a person who received medical care benefits and lump-sum disability compensation benefits due to occupational accidents receives the full amount of disability compensation annuities corresponding to the changed disability grade due to aggravation of the state of disability after receiving additional medical care, the disability benefits already received shall also be paid in duplicate.

Therefore, in a case where a person who suffered a physical disability due to an occupational accident is not entitled to compensation for the existing disability because he/she did not claim disability benefits according to the grade of disability determined at that time, which led to the aggravation of the existing disability and the change of the disability grade, there is no unreasonable result in the duplicate payment. Thus, the defendant is obliged to pay disability compensation annuity according to the number of days of payment for disability compensation benefits corresponding to the changed disability grade starting from the month following the month when the medical care was cured after the medical care was received, and the defendant shall not pay disability compensation annuity in proportion to the number of days of payment for disability compensation benefits corresponding to the changed disability grade, which is equivalent to the number of days of payment for lump sum disability compensation benefits according to the previous disability grade, which is not timely paid to the worker, based on the provision of this case. This is also applicable to the case where the claim for disability benefits was not filed for the existing disability grade, but its prescription expires. This is because there is no possibility of duplicate payment is in accord with the provision of this case.

2. Comprehensively taking account of the evidence adopted, the lower court determined that the Plaintiff’s treatment on July 15, 1982 was necessary to undergo a bridge for other workers during the period of 10th 7th 6th 2nd 6th 6th 0th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 6th 1984 1th 1st 3th 1984.

Such determination by the lower court is justifiable in light of the aforementioned legal doctrine, and there was no error by misapprehending the legal doctrine on the calculation and payment method of disability benefits after additional medical care.

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, except for a dissenting opinion by Justice Min Il-young, Justice Lee Sang-hoon, and Justice Kim Yong-deok.

4. Dissenting Opinion by Justice Min Il-young, Justice Lee Sang-hoon, and Justice Kim Yong-deok

A. Various insurance benefits under the Act, including disability benefits, are not paid by the defendant ex officio, but paid at the request of a beneficiary entitled to such insurance benefits (Article 36(2) of the Act). The Act does not distinguish whether disability benefits claimed by the parties were first given medical care, and due to additional medical care, and the period of extinctive prescription of such claims is uniformly set at three years (Article 112(1)1 of the Act). The system of additional medical care under the Act and the system of extinctive prescription of various claims for insurance benefits is separate systems with independent legislative purposes, and the purpose of the additional medical care system is to provide insurance benefits such as medical care through additional medical care for subsequent disabilities for which proximate causal relation with the existing disability is recognized, and it does not aim to restore the right to claim disability benefits whose extinctive prescription has already expired.

In other words, disability benefits are paid to an employee according to his/her disability grade if he/she suffers from an injury or disease due to an occupational reason (Article 57(1) and (2) of the Act). In contrast, additional medical care is provided to an employee who receives medical care benefits under Article 40 of the Act (hereinafter “existing medical care benefits”), so that the occupational injury or disease, which became the object of medical care, becomes worse or worse after recovery, is entitled to medical care benefits under Article 40 of the Act (Article 51(1) of the Act) and is distinguishable from the existing medical care benefits. Furthermore, if the worker’s state of disability after receiving additional medical care, becomes better or worse than the previous medical care benefits, additional medical care benefits are provided in accordance with the disability grade corresponding to such improved or aggravated condition, and thus, subsequent additional medical care benefits are not paid in excess of the previous disability benefits after reflecting the outcome of cure, and thus, additional medical care benefits are paid in excess of the number of disability benefits paid after additional medical care.

However, according to the majority opinion, where the state of disability becomes worse after receiving additional medical care even after the completion of the extinctive prescription period, disability benefits due to additional medical care should be paid, including the part of disability benefits which has been extinguished by the prescription period. This is not only an unreasonable interpretation of the extinctive prescription period system without any legal basis, but also an interpretation of the Enforcement Decree of the Act, which excludes the extinctive prescription system from the interpretation of the Enforcement Decree.

Ultimately, the Majority Opinion states that “a person against whom a right to claim disability benefits arising from additional medical care has been created without the completion of the extinctive prescription of a right to claim disability benefits from an existing disability” and “a person against whom a right to claim disability benefits arising from additional medical care has been created after the expiration of the extinctive prescription of a right to claim disability benefits from an existing disability” are equally treated. As long as a system recognized by law has its own meaning, both cannot be the same, and rather than treating “the same” as “the same,” it is difficult to accept it against the concept of justice.

Furthermore, the right to claim disability benefits, which has been extinguished by the statute of limitations, is not restored if the state of disability where the state of disability had not been receiving additional medical care from the beginning or even after additional medical care has been received, rather than where the state of disability where the state of disability has deteriorated after receiving additional medical care, not only contravenes equity but also leads to the outcome of following the foundation of the extinctive prescription system that seeks to ensure legal stability by determining the effect of the completion of the statute of limitations due to the unexpected circumstances such as the aggravation of state of disability.

B. Article 58(5) of the Enforcement Decree provides that where disability compensation annuities are paid after additional medical care, Article 57(4) of the Act on the Payment of Disability Compensation Benefits does not apply to the case where “the person who was not subject to the previous disability benefits” receives the disability compensation annuity after additional medical care. Accordingly, even if the former disability benefits have not been actually paid due to the completion of the extinctive prescription period, it is not included in the subject of the pre-paid disability benefits. Ultimately, even if the parties could exercise the right to claim disability benefits, it can be deemed that the payment of disability benefits after additional medical care and the pre-paid of disability compensation annuity differs from the payment of disability benefits. However, there is no reason to treat the legal effect of the extinctive prescription of the right to claim disability benefits differently.

C. Meanwhile, according to the records, the plaintiff filed an application for disability benefits with the defendant on October 10, 203 for the first disability that occurred on the right bridge, but the defendant, on the ground that the three-year extinctive prescription has expired from the end of March 1984, which was the date of treatment, was terminated, and the plaintiff filed a lawsuit seeking its revocation, but the judgment against the plaintiff was finalized on April 13, 2006 by the Supreme Court (Supreme Court Decision 2006Du1876). Accordingly, the claim for disability benefits was extinguished by the judgment as to the existing disability before the plaintiff received additional medical care. Accordingly, according to the majority opinion that became final and conclusive by the judgment, the plaintiff has no right to the plaintiff, and therefore, I cannot agree with the majority opinion in this respect.

As above, we express our dissent with the Majority Opinion.

Justices Yang Sung-tae (Presiding Justice)