2014Da226291 Undue gains

National Health Insurance Corporation

Korea Labor Welfare Corporation

Chuncheon District Court Decision 2014Na5149 Decided September 16, 2014

January 15, 2015

The judgment of the court below is reversed, and the case is remanded to the Gangnam Branch Branch Court Panel Division.

We examine the grounds of appeal.

1. Supreme Court Decision 2014Da44376 Decided November 27, 2014 rendered a decision on the following points: (a) Article 42(1) of the Industrial Accident Compensation Insurance Act (hereinafter referred to as the "Industrial Accident Insurance Act") provides that a person who files an application for medical care benefits under the Industrial Accident Compensation Insurance Act (hereinafter referred to as "industrial accident insurance benefits") may receive medical care benefits under the National Health Insurance Act (hereinafter referred to as "health insurance benefits") before the Korea Workers' Compensation and Welfare Service makes a decision on approval of medical care benefits for industrial accident insurance (hereinafter referred to as "decision on approval of additional medical care"), and Article 90(1) provides that the Korea Workers' Compensation and Welfare Service shall receive medical care benefits under the Industrial Accident Insurance Act (hereinafter referred to as "Health Insurance Benefits") prior to the payment of health care benefits to the beneficiaries of industrial accident insurance benefits in preference to other medical care benefits under Article 42(1) of the Industrial Accident Insurance Act, if the health insurance benefits are recognized as equivalent to medical care benefits that can be paid under the Industrial Accident Insurance Act, and the rights of the National Health Insurance Corporation shall be extinguished.

Article 53(1)4 of the National Health Insurance Act provides that no health insurance benefits shall be provided to a person eligible for industrial accident insurance benefits, and even if an employee who is injured or affected by a disease (hereinafter referred to as "repaid employee") applies for industrial accident insurance benefits due to occupational reasons, health insurance benefits may not be paid for industrial accident insurance benefits until approval for additional medical care is rendered. In order to eliminate the gap in social insurance, Article 42(1) and Article 90(1) of the Industrial Accident Insurance Act, the National Health Insurance Corporation may request the Korea Workers' Compensation and Welfare Service to pay settlement of the costs of health insurance benefits if the Korea Workers' Compensation and Welfare Service has decided to grant approval for additional medical care after receiving health insurance benefits from the time the occupational injury or disease occurred to the employee, until the Korea Workers' Compensation and Welfare Service has decided to grant approval for additional medical care.

B. In light of the above provisions and purport of the Industrial Accident Insurance Act, where the Health Insurance Corporation provides health insurance for the employees affected by occupational injury or disease before approval for additional medical care after the occurrence of occupational injury or disease, it may claim settlement of the amount to the Korea Workers' Compensation and Welfare Service pursuant to Article 90(1) of the Industrial Accident Insurance Act. Such right to claim settlement can only be exercised when the Korea Workers' Compensation and Welfare Service decides to approve additional medical care. Thus, if it is not exercised for three years from the time of the decision

2. According to the reasoning of the lower judgment and the record, the following can be acknowledged: ① (a) Nonparty A received medical care benefits from health insurance by receiving medical treatment from the branch of Seoul National University Hospital from April 12, 2010 to the 20th of the same month from April 12, 2010; (b) Defendant applied for the approval of industrial accidents on May 4, 2010; and (c) Defendant received the approval of additional medical care from the Defendant on June 17, 2010; and (d) Plaintiff filed the instant lawsuit on June 4, 2013. Accordingly, in accordance with the foregoing legal doctrine, the instant lawsuit was unlawful since three years have passed since the date the approval of additional medical care was determined, which was the date of the foregoing decision on May 17, 2010.

Nevertheless, the lower court determined that the instant lawsuit was lawful on the ground that the statute of limitations has not yet expired at the time of the instant lawsuit, since the Plaintiff’s claim against the Defendant (i.e., the Defendant), based on its legal doctrine and fact-finding based on its reasoning, was ten years since A received treatment, and thus, the statute of limitations has not expired. In so doing, the lower court erred by misapprehending the legal doctrine of Article 3(2) of the Trial of Small Claims

3. Therefore, the lower judgment is reversed, and the case is remanded to the lower court for further proceedings consistent with this Opinion. It is so decided as per Disposition by the assent of all participating Justices on the bench.

Justices Kim In-bok

Justices Min Il-young

Justices Park Young-young

Justices Kim Jong-il