In medical insurance which is part insurance, in case the third party's claim against the insured does not reach the amount of damages due to negligence, the scope of the amount acquired by the medical insurance association which is the insurer by subrogation of the insurer

In a case where a claim against a third party in a medical insurance does not reach the amount of loss due to negligence offsetting, the purport of recognizing subrogation by insurers, and in light of the purpose of establishing the medical insurance association and the fact that the medical insurance is part of the insurance for which the insured himself/herself is forced to bear part of the expenses of the medical care under the Medical Insurance Act and the Enforcement Decree thereof, even if the medical insurance association paid part of the expenses, its rights can be acquired only to the extent that it does not infringe on the insured’s rights, by analogy of the proviso of Article 682 of the Commercial Act, which is the provision that applies

That is (the position of the theory of the principle of difference).

Articles 34 and 46 of the Medical Insurance Act, Article 682 of the Commercial Act

Gangwon Medical Insurance Association in the Class I of the Gangwon Medical Insurance Association

Defendant

Chuncheon District Court Decision 90Na3213 delivered on May 25, 1994

1. Of the lower judgment, the part of the lower judgment against the Defendant ordering payment exceeding the amount of KRW 1,183,688 and the annual rate of KRW 5% from March 19, 1994 to September 30, 1994; and the part of the lower judgment against the Defendant ordering payment exceeding the amount of KRW 25% per annum from the next day to the date of full payment; and the Plaintiff’s claim corresponding to the revoked portion is dismissed.

2. The defendant's remaining appeal is dismissed.

3. The costs of lawsuit shall be four minutes for both the first and second instances, and one of them shall be borne by the plaintiff and the other by the defendant respectively.

The defendant shall pay to the plaintiff 1,594,720 won with 25% interest per annum from the day following the service of the original copy of the payment order of this case to the day of full payment.

The judgment of the court below shall be revoked.

The plaintiff's claim is dismissed.

1. Basic facts

The following facts may be acknowledged in full view of the whole purport of the pleadings in the evidence No. 1 (the benefit statement due to the third party harmful act), evidence No. 2 (the notification of the disease, etc.), evidence No. 3 (the notification of the disease, etc.), evidence No. 4 (the notification of the disease, etc.), evidence No. 5 (the details of the receipt of medical expenses), evidence No. 10-3 (the indictment), evidence No. 10-4 (the statement of witness examination), evidence No. 11-2 (the statement of witness examination), 3, 4 (each statement of witness examination), 5, and 6 (each protocol of suspect examination).

A. On December 13, 1991, at around 20:45, the Defendant, at the main place of head collection in Switzerland-si, Macheon-si, Macheon-si, Mancheon-si, Mancheon-si, was drinking again while drinking a compromise on the immediately preceding day with the Nonparty, and went beyond the Nonparty’s face on the ground floor when drinking once, and caused the Nonparty’s injury to the Nonparty, on the two occasions, such as the right-hand pelke, the pelke, and the cerebral stroke.

B. From December 14, 1991 to April 14, 1992, the Nonparty received hospitalization for 49 days at the Insane Hospital and received medical treatment for the said 49-day period, and paid KRW 2,05,160. The Nonparty paid KRW 1,594,720 (2,05,160-460,440) from the Defendant’s personal charges under the Medical Insurance Act among the above medical treatment expenses paid by the Nonparty, the insured at the Insane Hospital, the medical care institution designated by the Plaintiff for four times from March 7, 1992 to June 12 of the same year, and the Nonparty was a member of the Plaintiff’s association organized under the Medical Insurance Act.

2. Judgment on the plaintiff's claim

The plaintiff asserts to the purport that he subrogatedly acquired the right to claim damages against the defendant due to the above accident of the non-party pursuant to Article 46 (1) of the Medical Insurance Act within the limit of the above amount of benefits, since he paid the non-party a premium of KRW 1,594,720 as insurance benefits due to the non-party's injury caused by the above harmful act.

The defendant is liable for damages suffered by the non-party as a tortfeasor who was injured by the non-party, and the plaintiff also can claim the amount of insurance benefits to the defendant who is the victim within the scope of the right to claim damages against the defendant under the above provision.

Furthermore, in full view of the whole purport of the pleadings, the above evidence Nos. 10-3, 10-4, 11-2 through 6, and 3 (judgment) as to the scope of the Plaintiff’s subrogation among the money paid to the Nonparty, the Nonparty may recognize the fact that the Defendant was punished by Si expenses and suffered bodily injury, and there is no counter-proof evidence, and the Nonparty is also erroneous in causing the Defendant’s bodily injury. Therefore, such negligence is the cause of the above injury, and thus, it should be considered in calculating the amount of damages that the Defendant shall compensate, but it should be considered that the negligence ratio is 20 percent.

Therefore, the non-party's right to claim damages against the defendant is limited to the remaining parts except the ratio of the non-party's fault, and it is limited to the amount of KRW 1,64,128 (2,05,160 x 0.8) out of the above treatment costs.

However, since the plaintiff paid only 1,594,720 won after deducting 460,440 won from the defendant's insurance premium under the Medical Insurance Act among the above medical expenses, only 1,59,720 won after deducting 460,000 won from the defendant's insurance premium, the plaintiff and the non-party transferred the non-party's claim for damages within the scope of the above amount to the plaintiff in installments. However, as seen above, since the amount entitled to compensation from the defendant is limited to 1,64,128 won, the specific scope of the amount acquired by the insurer's subrogation right is at issue. The insurer's subrogation right is recognized as policy to prevent double profit of the insured, and the insurer's right to indemnity under the Medical Insurance Act without considering a certain degree of the insurer's acquisition of the right to indemnity, the plaintiff's association, which is the insurer under the Medical Insurance Act, guarantees damages caused by the plaintiff's minor negligence and the non-party's claim for compensation from the non-party's insurer (the non-party's claim for indemnity 681).

3. Conclusion

Therefore, the defendant is obligated to pay to the plaintiff 1,183,68 won and damages for delay at the rate of 5% per annum under the Civil Act from March 19, 1993 to September 30, 1994, which is the date following the delivery date of the original copy of the payment order of this case, as requested by the plaintiff, and after the date of payment on behalf of the plaintiff, the defendant is obligated to pay to the plaintiff the damages for delay at the rate of 1,183,68 won and 2,5% per annum under the Act on Special Cases concerning the Promotion, etc. of Legal Proceedings from the next day to the date of full payment. Thus, the plaintiff's claim of this case of this case is accepted within the above scope of recognition, and the remaining claims are dismissed because it is unfair to accept part of the defendant's appeal and dismiss the plaintiff's appeal corresponding to the revoked portion because the defendant's remaining appeal of the defendant is without merit. It is so decided as per Disposition by the application of Articles 96, 89, and 92 of the Civil Procedure Act.

Judges 18: 1. 1. 1. 1. 1.