If a person who received a disability compensation annuity receives a disability compensation annuity even though the disability grade changes after additional medical care, the subject of collection of unjust enrichment pursuant to Article 84(1) of the former Industrial Accident Compensation Insurance Act

Articles 57(2), 58 subparag. 4, 60(2), and 84(1) of the former Industrial Accident Compensation Insurance Act (Amended by Act No. 10305, May 20, 2010); Article 58(1) and (2) of the Enforcement Decree of the Industrial Accident Compensation Insurance Act

Plaintiff

Korea Labor Welfare Corporation

Daegu High Court Decision 2010Nu2853 decided May 13, 2011

The appeal is dismissed. The costs of appeal are assessed against the defendant.

The grounds of appeal are examined.

1. Article 57(2) of the former Industrial Accident Compensation Insurance Act (amended by Act No. 10305, May 20, 2010; hereinafter “Industrial Accident Compensation Insurance Act”) provides that “Disability benefits shall be disability compensation annuities or lump-sum disability compensation benefits prescribed in attached Table 2 according to the disability grade, and the disability grade standards shall be prescribed by Presidential Decree.” Article 58 provides that “If a beneficiary of disability compensation annuities falls under any of the following subparagraphs, the right to receive the disability compensation annuity terminates,” and subparagraph 4 provides that “where a beneficiary of the disability compensation annuity is excluded from the beneficiary subject to disability grade change, the disability grade changes.” Meanwhile, Article 84(1) of the Industrial Accident Compensation Insurance Act provides that “Where a person who received insurance benefits falls under any of the following subparagraphs, the Service shall collect the amount corresponding to the amount of the disability benefits,” and subparagraph 3 provides for “other cases where there is any insurance benefits mistakenly

Meanwhile, Article 60(2) of the Industrial Accident Compensation Insurance Act provides that “If the state of disability becomes worse or worse after receiving additional medical care, disability benefits shall be paid according to the disability grade corresponding to such improved or aggravated state of disability. In such cases, the method of calculating and paying disability benefits after additional medical care shall be prescribed by Presidential Decree.” Accordingly, Article 58(1) of the Enforcement Decree of the Industrial Accident Compensation Insurance Act provides that “if a person who received a disability compensation annuity claims a disability compensation annuity due to a change in the disability grade after additional medical care, the disability compensation annuity corresponding to the changed disability grade shall be paid beginning with the month following the month in which the date of recovery after additional medical care falls.” Article 60(2) provides that “If a person who received a disability compensation annuity claims a lump-sum disability compensation annuity due to a change in the disability grade after additional medical care, the disability benefits shall be paid according to the following classification, and subparagraph 2 provides that “if the changed disability grade falls under any of grades 8 through 14, the amount of average wages paid only after additional medical care shall be determined as the number of days paid.”

Therefore, if a person who received a disability compensation annuity receives a disability compensation annuity even though the disability grade was changed after the additional medical care and excluded from the beneficiary of the disability compensation annuity, barring any special circumstance, it shall be deemed that the insurance benefits were mistakenly paid, but in order to change the disability grade, there should be a decision to change the disability grade. Thus, if the disability grade was changed, it shall be subject to collection of unjust enrichment pursuant to Article 84(1) of the Industrial Accident Compensation Insurance Act only for the disability compensation annuity paid after the determination of change of the disability grade. However, if a person who received the disability compensation annuity was unable to receive it due to the change of the disability grade due to the improvement of the state of disability after the additional medical care pursuant to Article 51(2)2 of the Industrial Accident Compensation Insurance Act, but it is still in a position to receive it as lump sum disability compensation, and it shall not be subject to collection of unjust enrichment within the scope

2. The lower court determined that the Plaintiff received lump-sum disability compensation benefits equivalent to the amount of 220 days of disability compensation benefits on or around July 5, 1995 after undergoing a precise diagnosis of pneumoconiosis around May 195; the Plaintiff applied for the receipt of disability compensation annuities from the Defendant after undergoing a precise diagnosis of pneumoconiosis grade 7 around May 2006; the Defendant suspended the payment of pensions for the period corresponding to the number of months calculated by dividing the 220 days of preexisting disability compensation benefits by the annual salary class 7 (138 days); the Defendant notified the Plaintiff of the result of the medical examination of the Plaintiff on or around November 24, 2008; the Defendant notified the Plaintiff of the result of the medical examination of the total amount of disability benefits from January 14, 2008 to June 14, 2009; and the Plaintiff notified the Plaintiff of the result of the medical examination of the Plaintiff on May 16, 2009 to June 23, 2009.

As above, the court below held that since the Plaintiff’s disability grade changed into class 11 and the right to receive a disability compensation annuity becomes extinct, the payment of disability compensation annuity of class 7 of the disability grade to the Plaintiff constitutes unjust enrichment, and further, as to the scope of unjust enrichment, the time when the Plaintiff’s entitlement to the disability compensation annuity terminates shall be May 6, 2009, which is the date when the Plaintiff’s disability grade changed, the Defendant paid to the Plaintiff the sum of KRW 1,479,056 of the disability compensation annuity amount of May 2009, and KRW 3,313,086 of the disability compensation annuity amount of KRW 1,834,03,00 for KRW 25 days among the disability compensation annuity amount of KRW 1,834,03,00 for June 209, the part exceeding the above amount shall be revoked as unlawful.

3. Examining the above legal principles and records in light of the above legal principles, the above judgment of the court below is just, and it is not erroneous in the misapprehension of legal principles as to the time of extinguishment of entitlement to disability compensation annuities, as otherwise alleged in the grounds of appeal.

In this case, pursuant to Article 58(1) of the Enforcement Decree of the Industrial Accident Compensation Insurance Act, the Defendant asserts that the time of extinguishment of the Plaintiff’s entitlement to disability compensation annuity ought to be considered as November 24, 2008, which is the first health examination date, which is the first health examination date confirmed to have been cured by the Plaintiff’s injury. However, as seen earlier, Article 58(1) of the Enforcement Decree of the same Act, which is cited by the Defendant, is applicable to the case where “the person who received the disability compensation annuity claims a disability compensation annuity due to a change in the disability grade after additional medical care,” and is still applicable to the case where the disability grade is subject to disability compensation annuity due to a change in the disability grade as seen in the instant case, and is not applicable to the case where the Plaintiff excluded the beneficiary from the beneficiary of disability compensation annuity due to a change in the disability grade as seen in

4. The appeal is dismissed, and the costs of appeal are assessed against the losing party. It is so decided as per Disposition by the assent of all participating Justices on the bench.

Justices Kim Chang-suk (Presiding Justice)