[1] In a case where a medical institution prescribed a medical care benefit standard in excess of the medical care benefit standard and issued an out-of-the-counter prescription as the subject of the medical care benefit, whether liability for damages can be limited by taking into account the circumstances, motive, etc. of the act (affirmative

[2] The limitation of finding facts or calculating the ratio of comparative negligence or limitation of liability in a damage compensation case

[3] The case holding that the court below's judgment which limits the liability ratio of Gap corporation to 50% on the ground that Gap corporation's medical corporation's medical corporation's medical corporation's medical care costs had been repeatedly issued for a long period of time and similar cases had already become final and conclusive, in a case where Gap medical corporation's medical doctor prescribed the medical care benefits ratio to the medical care benefits amount

[1] Articles 393, 750, and 763 of the Civil Act; Article 41 of the National Health Insurance Act; Articles 5, 9(1) [Attachment 2] [Attachment 2] of the Regulations on the Standards for Medical Care Benefits in National Health Insurance / [3] Articles 393, 396, 750, and 763 of the Civil Act / [3] Articles 393, 750, and 763 of the Civil Act; Articles 41 of the National Health Insurance Act; Articles 5, 9(1) [Attachment 2] of the Regulations on the Standards for Medical Care Benefits in National Health Insurance

[1] Supreme Court Decision 2009Da78214 Decided March 28, 2013 (Gong2013Sang, 717) Supreme Court Decision 2009Da104526 Decided March 28, 2013 / [2] Supreme Court Decision 2010Da52126 Decided October 28, 2010

Medical Corporations, White Hospital (Law Firm Sejong, Attorneys Shin Tae-op et al., Counsel for the defendant-appellant)

National Health Insurance Corporation (Attorney Ansan-young, Counsel for defendant-appellee)

Seoul High Court Decision 2011Na58673 decided September 6, 2013

The part of the lower judgment against the Defendant is reversed, and that part of the case is remanded to the Seoul High Court.

The grounds of appeal are examined.

1. Where a medical institution is liable for compensating the National Health Insurance Corporation for damages by prescribing the medical institution's medical care benefits outside of the medical care benefits standards and issuing the medical prescription outside of the medical care benefits, the scope of compensation for such damages may be limited in light of the principle of fair compensation system, taking into account various circumstances, such as the background and motive leading up to such act, objective circumstances involved in the occurrence of damages by the National Health Insurance Corporation, and existence of profits from such act by the medical institution (see Supreme Court Decision 2009Da78214, Mar. 28, 2013). However, the fact-finding on the limitation of liability for comparative negligence or the fair apportionment of damages in a damage compensation case shall not be considerably unreasonable in light of the principle of equity, even if it falls under the exclusive jurisdiction of the fact-finding court (see Supreme Court Decision 2010Da52126, Oct. 28, 2010).

2. According to the reasoning of the lower judgment, the lower court determined that the Plaintiff is liable for damages sustained by the Defendant due to an illegal act that prescribed the medical care benefit standard in excess of the medical care benefit standard and issued the non-medical care benefit standard, and determined the scope of compensation for the damages. Of prescribing the scope of compensation for the non-pharmaceutical prescription outside the medical care benefit standard, it appears that the Plaintiff provided medical treatment in accordance with the clinical grounds at the time to fulfill the best medical care obligation required under the Medical Service Act or the medical care contract, as well as that there is a need to prescribe beyond the medical care benefit standard. ② Non-pharmaceutical prescription outside the medical care benefit standard of the Plaintiff goes beyond the medical care benefit standard in the process of performing the best medical care obligation for patients outside the medical care area, the lower court determined that the Plaintiff was not liable for damages due to the Plaintiff’s medical care institution’s handling of non-medical care benefit at the expense of the Plaintiff’s non-medical care institution, and that the Plaintiff’s subsequent medical care benefit rate can not be imposed directly on the patient’s side.

3. The court below acknowledged the liability for damages against the defendant with respect to the issuance of an out-of-the-counter prescription that deviates from the Plaintiff’s medical care benefit standard, and it is acceptable to limit the liability as above, but it is difficult to accept the Plaintiff’s liability limitation ratio

If a medical institution issues a prescription outside of the medical care benefits standard as the medical care benefits target, even though the prescription is intended to fulfill the best medical care obligation for patients, and cannot be deemed illegal acts in relation to the relationship with the National Health Insurance Policyholders, etc., it is recognized as unlawful in relation to the insurer as an act causing losses to the insurer to pay the medical care benefits for medical treatment not subject to the medical care benefits. However, according to the facts acknowledged by the court below and the evidence adopted by the court below, the Health Insurance Review and Assessment Service notifies each medical institution of the adjustment of the medical care benefits cost regarding the issuance of the medical care benefits standard through the Korean Association of Medical Doctors and the Korean Hospital Association, etc. on several occasions, and the issuance of the medical care benefits policy outside of the medical care benefits standard by the Plaintiff was 1,700 times or more from December 203 to December 206. Meanwhile, in relation to the issuance of the medical care benefits standard by a medical institution outside of the medical care benefits standard, since there are special circumstances such as the liability for damages to the National Health Insurance Corporation and the limitation of liability ratio, etc.

However, the court below limited the plaintiff's liability ratio solely for the above reasons, without sufficiently examining the details and details of the issuance of an out-of-the-counter prescription that could reasonably change the ratio of the plaintiff's liability even though the issuance of the out-of-the-counter prescription beyond the medical care benefit standard was made repeatedly for a long time, and the similar cases became final and conclusive. In so doing, the court below erred by misapprehending the legal principles on the limitation of liability in damages compensation cases, thereby failing to exhaust all necessary deliberations, which affected the conclusion of the judgment. The defendant's ground

4. Therefore, the part of the judgment below against the defendant is reversed, and that part of the case is remanded to the court below for a new trial and determination. It is so decided as per Disposition by the assent of all participating Justices on the bench.

Justices Kim Yong-deok (Presiding Justice)