The scope of damage liability that the National Health Insurance Corporation obtains by subrogation of a victim of a tort pursuant to Article 58 (1) of the National Health Insurance Act and the method of calculating the amount of damage liability where the victim's negligence competes with each other in the occurrence or expansion of damage.

If a victim of a tort provides health insurance benefit under the National Health Insurance Act (hereinafter “health insurance”), the National Health Insurance Corporation shall obtain the victim’s damage claim against the perpetrator within the limit of the expenses incurred in providing such benefit (Article 58(1) and Article 53(1) of the National Health Insurance Act before wholly amended by Act No. 11141, Dec. 31, 201). This is to prevent the victim who received health insurance benefits from receiving double benefit by receiving damages from the perpetrator. As such, the damage claim that the victim received through subrogation is limited to the damage claim arising from the same cause as the health insurance benefit out of the total damage claim of the victim. Therefore, where the victim’s negligence competes with each other due to occurrence or expansion of damage, the amount that the National Health Insurance Corporation may assert against the perpetrator shall be limited to the amount of damage claim that the National Health Insurance Corporation obtains by subrogation of the victim, not to the total damage claim, but to the extent of the expenses incurred in calculating the amount of health insurance benefits paid within the limit of

Article 58(1) of the National Health Insurance Act, Article 53(1) of the former National Health Insurance Act (wholly amended by Act No. 11141, Dec. 31, 201) (see current Article 58(1))

Supreme Court Decision 93Da34091 Decided December 21, 1993 (Gong1994Sang, 491) Supreme Court Decision 2009Da100920 Decided May 13, 201 (Gong2011Sang, 1142)

National Health Insurance Corporation (Attorney Kim Han-soo, Counsel for defendant-appellant)

Defendant 1 and two others (Dongwon General Law Firm, Attorneys Lee Ho-hoon et al., Counsel for the defendant-appellant)

Suwon District Court Decision 2013Na51194 decided February 6, 2014

The part of the judgment of the court below against the Defendants shall be reversed, and that part of the case shall be remanded to the Panel Division of the District Court.

The grounds of appeal are examined.

1. As to the Defendants’ grounds of appeal on the scope of subrogation of damage claim arising from health insurance benefits

A. If the victim of a tort provides health insurance benefit under the National Health Insurance Act (hereinafter “health insurance”), the National Health Insurance Corporation shall obtain the victim’s damage claim against the perpetrator to the extent of the expenses incurred in providing such benefit (Article 58(1) and Article 53(1) of the National Health Insurance Act before wholly amended by Act No. 11141, Dec. 31, 201). This is to prevent the victim who received the health insurance benefit from receiving double benefit by receiving the damages from the perpetrator. As such, the damage claim that the victim received through subrogation of the victim is limited to the damage claim for the same reason as the health insurance benefit out of the total damage claim of the victim (see Supreme Court Decisions 93Da34091, Dec. 21, 1993; 2009Da10920, May 13, 2011). Therefore, the amount of damage claim that the victim’s damage claim should be claimed within the scope of the total amount of the health insurance benefit calculated under the foregoing provision, not by negligence but by the National Health Insurance Corporation.

B. The lower court: (1) (1) Defendant 1 suffered the instant accident due to Defendant 2’s breach of his duty of care during driving of the instant vehicle owned by Defendant 2, the mother on January 2, 2008; (2) the Nonparty was injured by the Nonparty; (3) from January 2, 2010 to December 7, 2011; and (3) from January 7, 2011 to September 27, 2012, the Plaintiff was provided medical treatment at several medical care institutions; and (4) during the previous period, Defendant Heunggu Fire & Marine Insurance Co., Ltd. (hereinafter “Defendant Heunggu Fire”), the insurer of the instant automobile, 26,931,290 won; and (3) the Nonparty was provided to the medical care institutions, 207, 301, 307, 407, 307, 407, 307, 407, 297, 30631, 4636, 297.

C. However, in light of the above legal principles, the facts acknowledged by the court below are determined as follows.

(1) Medical treatment from January 2010 to December 2012, 2010 is provided by the guarantee of payment against Defendant interesting fire, and is not based on the Plaintiff’s insurance benefits.

(2) As the Plaintiff’s insurance benefits were provided for medical treatment from January 7, 2011 to September 27, 2012, the Plaintiff’s damage claim for the same reason as the Plaintiff’s above insurance benefits out of the total damage claim of the Nonparty is the part related to the treatment that occurred during the above period. Ultimately, the Plaintiff only acquired the damage claim for KRW 33,231,810, paid as the insurance benefits during the above period.

(3) From January 7, 201 to September 27, 2012, the amount of comparative negligence set off against the Nonparty’s amount of damages caused by the treatment between the Nonparty and the period between January 7, 2011 and September 27, 2012 is KRW 30,683,394 (i.e., KRW 43,83,420 x 0.7). The Plaintiff’s expenses paid for the insurance benefits exceed KRW 33,231,810, and thus, the Plaintiff’s damage claim that the Plaintiff may claim against the Defendants by subrogation is the said KRW 30,683

D. Nevertheless, the lower court set off the amount of comparative negligence from the total amount of damage, including the damage for the period irrelevant to the Plaintiff’s insurance benefits, as the upper limit of the damage claim that the Plaintiff gains. In so doing, the lower court erred by misapprehending the legal doctrine on the scope of the damage claim that the victim was subrogated according to the health insurance benefits, thereby affecting the conclusion of the judgment. The allegation contained in the grounds of appeal

2. As to the ground of appeal by Defendant 1 and Defendant 2 on subrogation of the damage claim arising from the health insurance insurance benefits after the decision to recommend reconciliation in this case became final and conclusive

Among health insurance benefits, health insurance benefits are provided in the form of spot benefit, so insurance benefits are practically provided when a victim receives treatment from a health care institution. Accordingly, the National Health Insurance Corporation obtains damage claim against the perpetrator at that time (see, e.g., Supreme Court Decisions 94Da46046, Dec. 9, 1994; 2012Da39103, Sept. 13, 2012).

The lower court, on the grounds the grounds indicated in its reasoning, determined that even if the non-party had already obtained damage claim on behalf of the non-party regarding the insurance benefits when the medical care institution received medical treatment, even if the non-party had already paid the amount in full according to the instant decision of recommending reconciliation after the decision of recommending reconciliation was finalized between the non-party and the non-party, it cannot be asserted against the plaintiff who had already subrogated

Such determination by the court below seems to be based on the above legal principles, and contrary to the allegations in the grounds of appeal, there were no errors in the misapprehension of legal principles as to the subrogation of damage claim arising from health insurance benefits or the validity of

3. Conclusion

Therefore, without further proceeding to decide on the remaining grounds of appeal, the part of the judgment below against the Defendants is reversed, and that part of the case is remanded to the court below for further proceedings consistent with this Opinion. It is so decided as per Disposition by the assent of all participating Justices.

Justices Kim So-young (Presiding Justice)