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(영문) 서울행정법원 2016.06.23 2016구단50511
요양급여부지급처분취소
Text

1. The plaintiff's claim is dismissed.

2. The costs of lawsuit shall be borne by the Plaintiff.

Reasons

1. Details of the disposition;

A. From September 15, 1962 to March 15, 1979, the Plaintiff: (a) applied for pneumoconiosis medical care benefits to the Defendant on December 15, 2014; and (b) received the precise diagnosis of pneumoconiosis at the Cartol Seoul University Hospital.

B. Upon examination by the Pneumoconiosis Review Board on April 21, 2015, the Defendant rendered a disposition not to pay medical care benefits on the ground that the Plaintiff’s pneumoconiosis type (0/1) and cardiopulmonary function were determined as requiring re-examination (the instant disposition is conducted below).

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

2. Determination on the legitimacy of the instant disposition

A. The Plaintiff asserted that the Plaintiff was engaged in dusty work for about 12 years at the Korea Coal Corporation B Mining Center, and that the Plaintiff’s disease type of pneumoconiosis was diagnosed as falling under the type 1 as a result of the diagnosis of pneumoconiosis in the KatoTol University Seoul Facoup Hospital, which is the Plaintiff’s doctor, the Defendant issued the instant disposition on the erroneous premise that the Plaintiff’s condition constitutes the proof (0/1) even though it is required to pay pneumoconiosis benefits to the Plaintiff.

Therefore, the instant disposition should be revoked.

B. (1) According to Article 83-2(1) [Attachment 11-2] of the Enforcement Decree of the Industrial Accident Compensation Insurance Act, in order to be eligible for pneumoconiosis insurance benefits, the pneumoconiosis type should be more than Type 1; whether the pneumoconiosis was affected and the progress of pneumoconiosis was determined by reading chest simple radiation images; and the classification of pneumoconiosis type should comply with the complete classification as prescribed by the International Labour Organization (ILO) Act on Cinematographic Video for Pneumoconiosis (2000).

(2) According to the result of the examination of the medical records by the Chief of the Seoul National University Hospital, as to the instant case, it is determined that pneumoconiosis type C is a medical certificate (0/1) as the result of the examination of the medical records by the Seoul National University Hospital.

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