Plaintiff 1 and one other (Attorney Kim Jae-hwan, Counsel for the plaintiff-appellant)

National Health Insurance Corporation (Attorney Kim Han-soo et al., Counsel for the plaintiff-appellant)

July 19, 2018

1. Of the instant lawsuit, the part of the Plaintiff 2’s claim is dismissed.

2. The plaintiff 1's claim is dismissed.

3. The costs of lawsuit are assessed against the plaintiffs.

The Defendant’s disposition of notifying the payment of other collected amount of KRW 3,677,90 on December 11, 2017 against the Plaintiffs (unlawful gains) shall be revoked.

1. Details of the disposition;

A. On November 22, 2016, the Nonparty, who is the Plaintiffs, was injured on the left-hand bridge by Nonparty 2, while crossinging the crosswalk prior to the office of Kimcheon-si, Kimcheon-si on November 16, 2016 (hereinafter “instant accident”).

B. On December 8, 2016, the Plaintiffs agreed with the interesting country Fire Insurance Co., Ltd. (hereinafter “interesting country Fire Insurance”) that Nonparty 2 purchased on behalf of Nonparty 2, who is a minor, and received medical expenses of KRW 14 million.

C. From December 23, 2016 to August 8, 2017, the Nonparty received 20 health insurance benefits from the Defendant, after receiving 3,677,90 won of the instant accident from ○ University Hospital, etc. to 20 injury and disease patients, such as “alleys of light bridges accompanied by a non-alley aggregate body,” in relation to the instant accident.

D. On December 11, 2017, pursuant to Articles 58(2) and 57 of the National Health Insurance Act, and Article 755 of the Civil Act, the Defendant issued a notice to notify the Plaintiff 1 to pay other collected money (illegal gains) (hereinafter “instant disposition”).

[Reasons for Recognition] Facts without dispute, Gap evidence 1, 2, 3, Eul evidence 1 (including branch numbers; hereinafter the same shall apply) and the purport of the whole pleadings

2. Whether the part concerning Plaintiff 2’s claim among the instant lawsuit is lawful

Plaintiff 2 is not the other party to the instant disposition, but cannot be deemed to have been infringed upon the interests legally protected by the instant disposition. Therefore, the part of Plaintiff 2’s claim in the instant lawsuit is unlawful.

3. Whether the instant disposition is lawful

A. The plaintiff 1's assertion

1) Since Plaintiff 1 determined the negligence ratio between Nonparty and Nonparty 2 at the time of the agreement with the interested country fire insurance, such negligence ratio shall also apply to the Defendant’s charge regarding insurance benefits after agreement.

2) Therefore, the Defendant may collect unjust enrichment within the limit of KRW 90,000,00,000, which is KRW 300,000,000,000, which Plaintiff 1 received as the “outstanding treatment expenses” from the fire insurance for interesting country. However, as Plaintiff 1 deposits KRW 1,403,085 for the Defendant, the Defendant should rather return the said deposit and KRW 503,085,00,000, which is the difference between the said deposit and the said KRW 90,00

3) Ultimately, the instant disposition that is based on a different premise is unlawful.

B. Determination

1) Relevant legal principles

Article 58(1) of the former National Health Insurance Act provides that "Where a ground for insurance benefits has been provided to a policyholder or his/her dependent due to an act of a third party, the National Health Insurance Corporation shall obtain the right to claim compensation for damage from such third party to the extent of the expenses incurred in relation to such benefits." Article 58(2) of the same Act provides that "Where a person who has received insurance benefits pursuant to paragraph (1) has already received compensation from a third party, the Corporation shall not provide insurance benefits to the extent of the amount of compensation." The above provision aims to prevent the beneficiary of insurance benefits from being transferred to the insured through the insurance benefits and compensation by a third party and to prevent a third party from evading liability and securing insurance financing.

In light of the legislative purport and content of Article 58(2) of the former National Health Insurance Act, if a beneficiary of insurance benefits has received a certain amount of money related to his/her property damage compensation from a third party and has decided to waive or exempt the remainder of the claim, or has exempted a third party from the entire obligation to compensate for property damage without being paid at all, the Service shall be exempted from the obligation to pay insurance benefits within the extent of the real property damage (limited to the scope related to the insurance item) that the beneficiary may receive from a third party due to the accident. Furthermore, in cases where a beneficiary of insurance benefits is determined by filing a lawsuit against a third party seeking compensation for damage including the part related to the insurance benefit item against the third party in relation to the act of the third party, which caused the payment of insurance benefits, and the judgment has become final and conclusive, the Service shall be exempted from the obligation to pay insurance benefits to the extent of such amount.

Therefore, in cases where a third party, such as an perpetrator, paid all property damages related to an insurance benefit item to a beneficiary of the insurance benefit, but the beneficiary received the insurance benefit and the Service paid the insurance benefit, despite being exempted from the Service from the obligation to pay, the portion of the charge that the Service paid may be collected by unjust enrichment pursuant to Article 57 of the National Health Insurance Act. In such cases, the scope of collection shall be deemed as the portion of the charge actually paid by the Service to the extent of the amount of damages paid by the third party to the beneficiary of the insurance benefit, and it shall not be deemed as limited to the portion equivalent to the ratio of negligence of the perpetrator (see Supreme Court Decision 2014Du40340, Dec. 29, 2016).

2) Specific determination

Examining the following facts and circumstances revealed by adding evidence Nos. 3 and 4, in light of the aforementioned legal principles, the Defendant may collect unjust enrichment from Plaintiff 1 within the limit of eight million won for future treatment expenses received by Plaintiff 1 from the interesting fire insurance on behalf of the Nonparty.

A) On December 8, 2016, Plaintiff 1 agreed on the rate of negligence between the State Fire Insurance and the Non-Party’s fire insurance and the Non-Party’s fault ratio of 30%, and Non-Party 2’s fault ratio of 70%. However, the Defendant’s scope of collecting unjust enrichment cannot be deemed to be limited to the portion corresponding to the fault ratio of Non-Party 2, the perpetrator, out of the amount of insurance benefits paid by the Defendant. Therefore, the Defendant’s assertion that the amount of insurance benefits ought to be applied,

B) According to the calculation statement of agreed amount (Evidence 3-1) and the written resolution for personal payment (Evidence 3-2 of the Evidence A), it is revealed that the Plaintiffs’ amount of KRW 14 million for the treatment relation expenses received from the interesting fire insurance, which the Plaintiffs spent by the agreement date, is comprised of KRW 2048,110,000,000 for treatment expenses incurred by the Plaintiffs, KRW 300,000,000 for the treatment expenses incurred by the interesting fire insurance, and KRW 3,951,890 for the expenses incurred by the interesting sex treatment, and KRW 3,951,00 for the expenses incurred by the future. Accordingly, the Defendant may collect the total amount of the insurance benefits paid by the Plaintiffs 1 within the limit of KRW 8,00,000 in total for the future treatment expenses incurred by the Plaintiff 1 as unjust enrichment.

C) On January 3, 2018, Plaintiff 1 deposited KRW 1,403,085 with the Defendant as the principal deposit in the Chuncheon District Court’s original branch in 2018-201. However, the said repayment deposit was made after the instant disposition, and cannot be deemed to affect the illegality of the instant disposition.

C. Sub-committee

The instant disposition is lawful.

4. Conclusion

Therefore, the part of the plaintiff 2's claim among the lawsuit of this case is unlawful, and thus, the plaintiff 1's claim is dismissed as it is without merit. It is so decided as per Disposition.

(attached Form omitted)

Judges Hong Pung-chul (Presiding Judge)

(1) Although Plaintiff 1 is confused between Nonparty 1 and Nonparty 2’s respective fault rates in this case, Plaintiff 1 clearly stated that the Nonparty’s fault ratio is “30%” in the large payment resolution (No. 3-2).