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1. The Defendant’s disposition of restitution of unjust enrichment of KRW 3,089,780 against the Plaintiff on March 16, 2018 is revoked.
2...
Reasons
1. Details of the disposition;
A. The Plaintiff is a policyholder of the National Health Insurance operated by the Defendant. Around 08:30 on April 27, 2017, the Plaintiff’s father B (hereinafter “the deceased”), who is the Plaintiff’s dependent, died on December 13, 2017, after driving a three-lane road on the Gyeongbuk-gun, Chungcheongnam-gun, Gyeongwon-gun, without a motorcycle’s driver’s license, on the front side of the Dolle-do Office, in the front side of the Dolle-do Office (hereinafter “the instant Obaba”), and driving a three-lane road on the Dolle-gun, Dolle-gun, Gyeongwon-gun, the front side of the Plaintiff’s dependent, along with the front side of the Dolle-do office, the traffic accident (hereinafter “the instant Obababa”).
B. On March 16, 2018, the Defendant notified the Plaintiff that the instant traffic accident was caused by the deceased’s unlicensed operation, and that KRW 16,995,550 of the medical expenses paid to the deceased pursuant to Articles 53(1) and 57(1) of the National Health Insurance Act was restitution of unjust enrichment according to the heir’s inheritance ratio, and that the Plaintiff would recover KRW 3,089,780 according to the heir’s share of inheritance (hereinafter “instant disposition”).
C. Accordingly, the Plaintiff claimed revocation of the instant disposition to the Health Insurance Dispute Mediation Committee, but the said Committee dismissed it on October 31, 2019.
【Ground of recognition】 The fact that there is no dispute, Gap evidence 1, Eul evidence 1, Eul evidence 1, 4, 5, 9, the purport of the whole pleadings
2. Whether the instant disposition is lawful
A. The Plaintiff’s instant disposition is unlawful on the following grounds.
1. In light of the legislative intent of the National Health Insurance Act, Article 53 (1) of the National Health Insurance Act should be strictly interpreted to make "serious negligence" as a ground for the restriction on benefits.
Therefore, only one of the reasons for insurance benefits restriction is caused by the death's death or gross negligence, or caused the accident intentionally.