Plaintiff (Attorney Im Chang-soo, Counsel for the plaintiff-appellant)

National Health Insurance Corporation

April 29, 2020

Seoul Administrative Court Decision 2019Guhap65382 Decided November 14, 2019

1. The plaintiff's appeal is dismissed.

2. The costs of appeal shall be borne by the Plaintiff.

The judgment of the first instance is revoked. The defendant shall revoke the disposition of recovery notice of KRW 50,924,280, which was rendered to the plaintiff on May 2, 2017.

1. Quotation of the first instance judgment

The Plaintiff’s grounds for appeal are not significantly different from the allegations in the first instance court, and in light of the evidence adopted by the first instance court, the fact-finding and judgment in the first instance court are deemed legitimate. The reasoning of this court is as stated in the reasoning of the first instance judgment, except for supplementing the judgment, especially as to the DaNN, as the grounds for appeal, in addition to supplementing the judgment in accordance with paragraph (2). Therefore, this court cites it as it is in accordance with Article 8(2) of the

2. Supplementary determination on the Plaintiff’s assertion in this Court

A. Summary of the assertion

At the time of the instant traffic accident, the Plaintiff was negligent, such as neglect of duty at the time of the instant accident. However, there was a possibility that the victim was negligent by violating the duty to follow-up at the intersection. As such, the instant traffic accident does not constitute a case where the Plaintiff committed a criminal act entirely due to the Plaintiff’s intentional or gross negligence, or where the Plaintiff intentionally caused an accident. Therefore, in light of the legal principle that the requirement for payment restriction under the National Health Insurance Act ought to be strictly interpreted, the instant disposition is unlawful as it mislead

B. Determination

According to the following circumstances, the statements in the evidence No. 4-1, No. 2, and No. 5-1, No. 4-2 and No. 5 and the overall purport of the pleadings, it is reasonable to restrict the insurance benefits of the Plaintiff on the following grounds: “The instant traffic accident constitutes a crime caused by intention or gross negligence or intentionally resulting in an accident” under Article 53(1)1 of the National Health Insurance Act.

1) In general, “serious negligence” refers to the occurrence of an accident, which would have been able to prevent the occurrence of the accident by recognizing it in advance and neglecting due to a significant negligence, and thus, is close to the intent where the occurrence of the accident was not recognized or was not prevented. External factors, such as weather conditions and road conditions at the time of the instant traffic accident, such as weather conditions, etc. are deemed to have never existed, and the instant traffic accident occurred at the location where the second vehicle, which was the victim of the vehicle, who was the left left pursuant to the new subparagraph of the left left-hand turn, almost left-hand turn, and the vehicle in the same direction as the Plaintiff, before entering the intersection, was stopped by observing the signal, is recognized as gross negligence to the extent that the Plaintiff intentionally committed the accident.

2) The driver of a vehicle driving along an intersection where traffic is controlled by signal, etc., is sufficient to ensure that other vehicles are believed to observe traffic regulations and take appropriate measures to avoid collision, barring special circumstances. There is no duty of care to take special measures to prevent the occurrence of accidents in advance as well as to anticipate that other vehicles are in compliance with the signal, etc., even if they are in compliance with the signal, if there are other vehicles already entering the intersection, or other vehicles are found to have continued to enter the intersection immediately after the signal of the direction was changed to the stop signal, or if it is anticipated that the other vehicles will enter the intersection in violation of the signal, etc., they should drive with the attitude to prevent accidents by driving, etc. while examining the movement of such vehicles. However, if the other vehicles are expected to have been in compliance with the signal, and if they are expected to have been in compliance with the signal, they shall not enter the intersection by being changed to 200, before and after the rapid change of the vehicle (see, e.g., Supreme Court Decision 200, supra., 2000.).

According to each photograph attached to the traffic accident report (A No. 4-1), at the time of the Plaintiff’s entry into the instant intersection, the signal of the direction was already red, and the vehicles in the four, five, and six lanes were stopped in the signal atmosphere, and the victim’s vehicle began to turn left and was at the five-lane speed of the Plaintiff’s proceeding direction. Thus, it cannot be deemed that there was any negligence on the part of the victim who proceeded with the signal. Thus, the instant traffic accident is deemed to have occurred solely due to the Plaintiff’s intentional or gross negligence.

3. Conclusion

Therefore, the plaintiff's claim is dismissed as it is without merit, and the judgment of the court of first instance is just, and the plaintiff's appeal is dismissed. It is so decided as per Disposition.

Judges Lee Dong-sung (Presiding Judge)