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(영문) 서울행정법원 2018.05.30 2017구단53074
요양급여불승인처분취소
Text

1. The plaintiff's claim is dismissed.

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

Reasons

1. Details of the disposition;

A. From June 15, 1987 to May 31, 201, the Plaintiff served as an auxiliary coal support unit at the Korea Coal Corporation's Korea Coal Corporation (hereinafter "Do Mining Corporation").

B. On September 1, 2016, the Plaintiff filed an application for medical care benefits with the Defendant, asserting that “the Plaintiff was diagnosed as “damage to the opening of the opening of the opening of the opening of the opening of the opening of the opening of the opening of the opening of the opening of the Do mining center” (hereinafter “the instant injury”). At that time, the Plaintiff claimed that “the Plaintiff caused the instant injury and disease by performing the duties owed to the body while serving in the Do mining center.”

C. On November 17, 2016, the Defendant rendered a disposition of refusal of medical care (hereinafter “instant disposition”) against the Plaintiff on the ground that “The instant injury and disease is confirmed, but there is no proximate causal relation between the occurrence and the Plaintiff’s work.”

[Ground of recognition] Unsatisfy, Gap evidence Nos. 1, 2, and 5, the purport of the whole pleadings

2. Whether the instant disposition is lawful

A. The plaintiff's assertion is clear that the plaintiff carried out the duty of physical burden while working in the Do mining center, and that the injury or disease in this case occurred.

Therefore, the instant disposition issued on a different premise should be revoked as it is unlawful.

B. Determination 1) Since an occupational accident under the Industrial Accident Compensation Insurance Act refers to a disease caused by an employee’s occupational accident during his/her work, there must be a causal relationship between the occupational and the disease. The causal relationship must be proved by the party asserting it, and even if it is not necessarily necessary to prove clearly in medical and natural science, a proximate causal relationship between the occupational and the disease should be determined by considering all circumstances (see, e.g., Supreme Court Decision 2001Du7725, Feb. 5, 2002). 2) Nos. 2 through 5, No. 1, 2, and 3, and this Court.

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