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(영문) 서울행정법원 2018.11.07 2018구단57134
요양불승인처분취소
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. The Plaintiff is an employee of the Dong Sea Co., Ltd. (hereinafter referred to as “B”) located in the Dong Sea, and is a heavy equipment that means the “Auger's truck loading equipment”. The Plaintiff is loaded with scrap dust, which is capable of drilling a hole on the ground and transporting heavy goods.

운전원으로 근무하다가 2015. 9. 19. 뇌내출혈 원고가 상병명을 “뇌실내출혈”로 기재하여 최초 요양급여 신청 및 재차 요양급여 신청을 함에 따라 피고가 상병명을 “뇌실내출혈”로 기재하여 각 요양불승인처분을 하였으나 원고에게 인정되는 상병은 뇌실내출혈(腦室出血, intraventricular hemorrhage)이 아닌 뇌내출혈([腦內出血, Intracerebral hemorrhage)이다. [자발성 뇌내출혈(spontaneous intracerebral hemorrhage), 이하 ‘이 사건 상병’이라고 한다

(2) On November 1, 2016, the Plaintiff filed an application for medical care benefits with the Defendant [Article 41(1) of the former Industrial Accident Compensation Insurance Act (amended by Act No. 14933, Oct. 24, 2017; hereinafter “Industrial Accident Insurance Act”).

C. On December 29, 2016, the Defendant issued a disposition of non-approval for medical care, which denied the above application on December 29, 2016, pursuant to the review by the Seoul Occupational Disease Determination Committee, that “the instant injury and disease appears to be the volume of high-tension brain transfusion, and thus, there is no proximate causal relation between the work of the instant injury and the instant injury and disease.”

In response to the above disposition, the Plaintiff filed a request for examination with the Defendant, but was dismissed again, and the Industrial Accident Compensation Insurance Reexamination Committee filed a request for reexamination on March 16, 2017.

E. On September 21, 2017, the Plaintiff filed a second application with the Defendant for medical care benefits for the instant injury on the ground that “the Plaintiff’s blood pressure prior to the instant injury was judged to have been normal.” However, on September 26, 2017, the Defendant filed a second application with the Defendant for the medical care benefits for the instant injury.

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