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(영문) 서울행정법원 2018.12.21 2017구단18514
요양급여불승인처분 취소
Text

1. On March 17, 2017, the Defendant’s disposition of non-approval for medical care rendered to the Plaintiff is revoked.

2. The costs of the lawsuit are assessed against the defendant.

Reasons

1. Details of the disposition;

A. On November 21, 2016, the Plaintiff, who was employed as a taxi driver of the Company B, was diagnosed as “brain color” as a result of the Plaintiff’s medical examination and treatment at the instant company’s parking lot due to abnormal symptoms, such as learning, walking, and visual disability, etc. at around November 21, 2016.

B. On March 17, 2017, the Plaintiff filed an application for medical care benefits with the Defendant on the ground that it is difficult to recognize the occurrence of brain color and the existence of proximate causal relation between the Plaintiff’s duties. As such, on March 17, 2017, the Defendant issued a disposition not to grant medical care (hereinafter “instant disposition”).

【Fact-finding without a dispute over the basis of recognition, Gap evidence 1, 2, Eul evidence 1, 2, and 8, the purport of the whole pleadings

2. The "occupational accident" under the Industrial Accident Compensation Insurance Act refers to an accident caused by an employee's occupational accident while performing his/her duties. As such, there is a proximate causal relation between the employee's occupational accident and the accident. In this case, the causal relation between the employee's occupational accident should be proved by the assertion. However, the existence of proximate causal relation between the occupational accident and the accident should be determined on the basis of the worker's health and physical condition, not by the average person, but by the average person. In addition, the degree of proof of causal relation should not be clearly proved by medical and natural science, and it should be proved even in the case where there is a proximate causal relation between the occupational accident and the accident

In light of the above legal principles, in light of the following facts and circumstances, it can be known that the health unit, Gap evidence Nos. 9 through 14 were included in the evidence Nos. 1, 2, Eul evidence Nos. 3, 5, 6, and 8, and the result of the request for the examination of medical records to the director of the hospital of this court and the result of the inquiry of the fact to the director of the hospital of this court.

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