[1] Where the National Health Insurance Corporation provided the insured with medical care benefits under the National Health Insurance Act, the time and scope of the acquisition of the right to indemnity against the third party

[2] Where a victim who received insurance benefits under the National Health Insurance Act claims for damages to a third party, the method of offsetting negligence, and where the insurer subrogates the victim's damage claim against the perpetrator after receiving the insurance benefits from the illegal victim, the extent of subrogation

[3] The case holding that since the amount of damage compensation for medical expenses borne by the victim who suffered medical care benefits from the National Health Insurance Corporation due to a traffic accident is the remainder after offsetting the amount from the total medical expenses paid by the Corporation and the total medical expenses borne by the victim himself/herself, and the amount exceeds the above amount, the Corporation can ultimately claim for the whole amount

[1] Articles 39, 40, 43, and 53(1) of the National Health Insurance Act / [2] Article 53 of the National Health Insurance Act, Articles 396, and 763 of the Civil Act / [3] Article 53 of the National Health Insurance Act, Articles 396, and 763 of the Civil Act

[1] Supreme Court Decision 94Da46046 Decided December 9, 1994 (Gong1995Sang, 462) Supreme Court Decision 2004Da59249 Decided January 14, 2005 / [2] Supreme Court Decision 2002Da50149 Decided December 26, 2002 (Gong2003Sang, 481) Supreme Court Decision 2008Da641 Decided May 8, 2008

National Health Insurance Corporation

State Fire and Marine Insurance Co., Ltd. (Law Members of Law Firm, Attorneys Jeong Mao et al., Counsel for the plaintiff-appellant)

Incheon District Court Decision 2009Na9461 Decided December 17, 2009

1. The judgment of the court of first instance is reversed and the judgment is modified as follows.

A. The defendant shall pay to the plaintiff 14,104,539 won with 5% interest per annum from April 1, 2009 to December 17, 2009 and 20% interest per annum from the next day to the day of full payment.

B. The plaintiff's remaining claims are dismissed.

2. The total costs of the lawsuit shall be ten minutes, which shall be borne by the Plaintiff, and the remainder by the Defendant, respectively.

Examination of the Grounds of Appeal

Medical care benefits under the National Health Insurance Act are, in principle, provided in kind benefits for medical care until a disease or injury is cured by a medical care institution. Thus, when the insured under medical care institution receives medical care, it is practically provided with insurance benefits and the National Health Insurance Corporation obtains the right to indemnity from a third party within the scope of such insurance benefits (see, e.g., Supreme Court Decisions 94Da46046, Dec. 9, 1994; 2004Da59249, Jan. 14, 2005). In addition, when the victim who received insurance benefits under the National Health Insurance Act claims for damages against a third party, the amount of damages calculated first should be deducted from the amount of damages calculated if the victim's negligence conflicts with each other, and the insurer cannot offset the amount of the insurance benefits to be deducted again, and where the insurer subrogates the victim's damage to the perpetrator after receiving the insurance benefits due to a tort, the scope of subrogation liability is the total amount of insurance benefits within the scope of the damages claim (see, e.g., Supreme Court Decision 2008Da268Da268, Dec. 268, 2008.

According to the reasoning of the judgment of the court below, the defendant is the insurer who entered into the comprehensive automobile insurance contract with the co-defendant 3 of the first instance court. The non-party suffered injury requiring treatment for about 3 months since he was faced with the above vehicle operated by Co-defendant 2 of the first instance court on August 21, 2004. The non-party due to the above accident was treated by the medical care institution until March 1, 2008. The plaintiff paid 17,696,140 won in total as the medical care benefit cost and the non-party paid 17,565,208 won in total to the defendant at 35,261,348 won in total. The non-party is liable for damages damages claim of the non-party 17,69,140 won in total to the defendant's medical care benefit cost + 17,565,208 won in total to the non-party's compensation claim for damages within 300 million won in light of the legal principles as to seek damages claim against the defendant.

On the other hand, the court below determined that since the non-party used the damage claim for the defendant with respect to the amount of 7,026,083 won (i.e., KRW 17,565,208 x 40%) equivalent to the ratio of the defendant's liability among the medical expenses borne by the non-party himself, the scope of the plaintiff's claim for damages can be claimed to the defendant is limited to KRW 7,078,456 (i.e., KRW 14,026,083 won after deducting the above KRW 7,026,083 won from the remaining amount after offsetting the above negligence, the scope of the plaintiff's claim for damages can be claimed to the defendant is limited to KRW 14,104,539 (= KRW 14,104,539 - KRW 7,026,083 won).

Therefore, the judgment of the court below shall be reversed and the decision of the court below shall be made. The defendant is obligated to pay damages for delay at the rate of 5% per annum under the Civil Act from April 1, 2009 to December 17, 2009, and 20% per annum under the Act on Special Cases concerning the Promotion, etc. of Legal Proceedings from the next day to the day of full payment, as the plaintiff's insurance benefits payment for the above KRW 14,104,539 as well as the above KRW 14,539 as the plaintiff's insurance benefits after the date of the plaintiff's insurance benefits, and as the defendant is deemed reasonable to dispute about the existence or scope of the obligation, as requested by the plaintiff. Thus, the plaintiff shall accept the plaintiff's claim of this case within the extent of the above recognition, and the remaining claims shall be dismissed for the reasons. It is so decided as per Disposition by the assent of all participating Justices on the bench.

Justices Shin Young-chul (Presiding Justice)