[1] Validity of the review of and objection to the Motor Vehicle Insurance Medical Fee Review Council

[2] Whether the standards for motor vehicle insurance medical fees are an absolute basis for calculating the amount of damages for medical fees (negative)

[1] Article 17(2) of the former Guarantee of Automobile Accident Compensation Act (amended by Act No. 9065 of Mar. 28, 2008) provides that the examination and decision of the Motor Vehicle Insurance Dispute Council shall be deemed to have been constituted if the party who received the notification of the examination and decision accepts the decision of the Council or does not bring a lawsuit within 30 days from the date of receipt of the notification, and the parties shall be deemed to have agreed with the same contents as the decision of the Council. However, the procedure and method of filing a lawsuit shall not be deemed to be an administrative disposition in full view of the relevant provisions regarding the composition of the Council, examination procedure, effect of the examination and decision. Thus, the party who received the notification of the examination and decision of the Council shall not be deemed to be an administrative disposition. Thus, the party who received the notification of the examination and decision of the Council may object to the examination and decision by filing a lawsuit that cannot be compatible with the contents of the examination and decision, such as seeking directly payment of medical expenses or seeking return of unjust enrichment from the already paid medical expenses.

[2] The Motor Vehicle Insurance Medical Fee Review Council has examined and decided on the basis of the criteria for motor vehicle insurance medical fees under Article 13 of the former Guarantee of Automobile Accident Compensation Act (amended by Act No. 8852 of Feb. 29, 2008) (Article 16(1) of the same Act). Since the victim of a traffic accident is entitled to compensation for actual damages within the scope of proximate causal relation with the tort due to medical expenses incurred from the traffic accident, the amount of medical expenses incurred in the pertinent treatment act shall be reasonably determined in consideration of all the circumstances, such as the degree of injury, content of treatment, frequency of treatment, and the amount of medical insurance fees, etc. The standard for medical fees covered by the motor vehicle accident medical fees is meaningful in order to guarantee appropriate medical treatment for the motor vehicle accident patients and to prevent disputes over the medical expenses incurred by the victim of a traffic accident between the insurer, etc. and the medical institution, and it

[1] Article 17 (2) (see current Article 21 (2)) of the former Guarantee of Automobile Accident Compensation Act (amended by Act No. 9065 of March 28, 2008) / [2] Article 741 of the Civil Act, Article 13 (see current Article 15) and Article 16 (1) (see current Article 20 (1)) of the former Guarantee of Automobile Accident Compensation Act (amended by Act No. 8852 of February 29, 2008)

[2] Supreme Court Decision 2002Da63411 Delivered on February 14, 2003, Supreme Court Decision 2004Da47895 Delivered on November 25, 2004

Plaintiff (Law Firm Seo-gu, Attorneys Lee Young-gu et al., Counsel for the plaintiff-appellant)

Heung-gu Fire Insurance Co., Ltd. (Attorney Kang Sung-sung, Counsel for the plaintiff-appellant)

Seoul Central District Court Decision 2007Na21794, 32954 (Counterclaim) decided May 9, 2008

The judgment below is reversed, and the case is remanded to Seoul Central District Court Panel Division.

We examine the grounds of appeal.

1. The lower court confirmed that the Plaintiff (Counterclaim Defendant; hereinafter “Plaintiff”) had no liability to return medical expenses according to the review and decision of the Motor Vehicle Insurance Medical Fee Review Council (hereinafter “Council”) stating that “The Plaintiff (Counterclaim Plaintiff; hereinafter “Defendant”) received medical expenses from the Nonparty (Counterclaim Plaintiff; hereinafter “Defendant”) and refund of KRW 7,550,000 (hereinafter “instant medical expenses”) out of KRW 8,180,000 (hereinafter “the examination fees”) and its delay damages, and that the examination fees shall be paid in advance, and the Plaintiff’s medical expenses and examination fees received from the Nonparty are unjust enrichment and sought the return thereof, regardless of whether the medical expenses were those paid by the Nonparty, the Plaintiff appears to have rejected the Plaintiff’s claim for the medical expenses for motor vehicle insurance medical fees (hereinafter “the medical expenses”) under Article 3(1)2 of the Standards for Motor Vehicle Medical Fees, regardless of whether the medical expenses were those paid by the Nonparty, and thus, the Nonparty’s claim for the medical expenses for emergency medical fees are necessary and reasonable within the scope of the Plaintiff’s appeal.

2. However, we cannot accept the above judgment of the court below as it is.

A. The part concerning the medical expenses of this case

(1) Article 17(2) of the former Guarantee of Automobile Accident Compensation Act (amended by Act No. 9065 of Mar. 28, 2008) provides that the review decision of the Council shall be deemed to have reached an agreement identical to the decision of the Council in cases where the party who received the notice of the review decision accepts the decision of the Council or does not institute a lawsuit within 30 days from the date of receipt of the notice, and does not separately provide for the procedure or method of filing a lawsuit. Thus, the above review decision shall not be deemed an administrative disposition in light of the relevant provisions on the composition of the Council, examination procedure, effect of the review decision, etc. under the above Act. Thus, the party who received the notice of the review decision of the Council may be dissatisfied with the review decision by filing a lawsuit to the effect that it cannot be compatible with the contents of the review decision, such as seeking direct payment of medical expenses to the other party or seeking return of unjust enrichment from the already paid medical expenses, and it shall be interpreted that the review decision does not become legally binding upon such filing

However, according to the records, the plaintiff can be found to have filed the lawsuit of this case within 30 days from the date of receiving the notice of review and decision of this case and the decision of this case cannot be legally binding. Accordingly, whether the medical expenses of this case constitute unjust enrichment or not should be deliberated and determined in accordance with the legal principles as to the assertion and burden of proof in civil litigation, and it should not be determined by the propriety of the above decision of review and decision. Nevertheless, the court below determined that the medical expenses of this case constitute unjust enrichment on the grounds that the medical expenses of this case are subject to review by the Council and that the decision of review is reasonable. Thus, this is attributable to the misunderstanding of legal principles as to the review and decision of the above Council.

(2) In the return of unjust enrichment, the burden of proof for the occurrence of loss lies on a person who claims the return of unjust enrichment (see, e.g., Supreme Court Decisions 94Da54283, May 14, 1996; 98Da61593, Apr. 27, 1999). In a lawsuit seeking confirmation of non-existence of monetary obligation, if the plaintiff who is the debtor first specified the claim in advance and makes a claim denying the fact of the occurrence of the obligation, the defendant, who is the creditor, is liable to prove the facts of the legal relationship (see, e.g., Supreme Court Decisions 97Da45259, Mar. 13, 1998; 2007Da6772, May 31, 2007; 207Da678365, Mar. 27, 2007; 2007Da386386, Mar. 36, 2003>

The cause of the principal claim and the cause of the counterclaim regarding the instant medical expenses are all the purport of disputing the Plaintiff’s obligation to return the instant medical expenses that the Nonparty received from the Nonparty to the Defendant with unjust enrichment. According to the reasoning of the lower judgment, the instant medical expenses were paid by the Nonparty, the victim of the traffic accident, to the Plaintiff with the said money, and repaid the Plaintiff with the said money. In light of the aforementioned legal principles, in order for the Plaintiff to receive unjust enrichment in relation to the Defendant, the said medical expenses received from the Nonparty cannot be claimed as the insurance money for the traffic accident, the Nonparty, despite being unable to claim the said medical expenses from the Defendant as the insurance money for the traffic accident, acquired them by deceiving the Defendant, and there are special circumstances such as the Plaintiff

The court below did not further examine whether the medical expenses of this case received by the plaintiff, such as whether the non-party acquired the medical expenses of this case by fraud and whether the plaintiff was malicious or gross negligence, etc., and whether the medical expenses of this case received by the plaintiff in relation to the defendant had special circumstances that make it an unjust enrichment, and dismissed the claim for counterclaim and accepted the counterclaim on the sole ground that there is insufficient evidence to prove that the medical expenses of this case are within the extent that it is essential and reasonable to treat the non-party's escape certificate by light of the fact that the medical expenses of this case are within the scope. In so determining, the court below erred

The court below cited that the decision of the Council of this case seems to be reasonable as one of the grounds for recognizing the Plaintiff’s duty to return the medical fees of this case. However, unless the decision of this case is legally binding, the propriety of the decision cannot be the basis for the duty to return the medical fees of this case. The above Council shall make a decision in accordance with the criteria for medical fees covered by Article 13 of the former Guarantee of Automobile Accident Compensation Act (amended by Act No. 8852 of Feb. 29, 2008) (Article 16(1) of the above Act). Since the victim of traffic accident can be compensated for the actual damages within a proximate causal relation with the tort as medical fees, the medical expenses of this case can be reasonably determined in consideration of all the circumstances such as degree of injury, content and frequency of treatment, and the level of general medical expenses of medical society, while the above medical fees should not be reasonably determined in consideration of the standard for medical fees of this case to guarantee the appropriate traffic accident for patients and to prevent disputes between medical institutions, etc., and thus, it cannot be viewed as the standard for determination of damages 2014.

(3) The above errors of the court below have influenced the conclusion of the judgment.

B. Part concerning examination fees

Although the Council made a review and decision that “the Plaintiff paid the review fees to the Defendant,” such circumstance alone cannot be deemed to have made unjust enrichment against the Defendant. Moreover, the review and decision in this case has no legal binding force, as seen earlier, so the lower court recognized the Plaintiff’s obligation to return unjust enrichment on the Plaintiff’s review fees solely on the ground that the review and decision was made and the decision was reasonable, and thereby, erred by misapprehending the legal doctrine on the validity of the review and decision in this case or on the establishment of unjust enrichment, thereby adversely affecting the conclusion of the judgment.

3. Conclusion

Therefore, without examining the remaining grounds of appeal, the judgment of the court below is all reversed, and the case is remanded to the court below for a new trial and determination. It is so decided as per Disposition by the assent of all participating Justices on the bench.

Justices Park Ill-sook (Presiding Justice)