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(영문) 서울행정법원 2018.11.02 2018구단56285
요양급여신청 불승인처분 취소 청구의 소
Text

1. The Defendant’s disposition of refusal to grant medical care to the Plaintiff on January 25, 2018 is revoked.

2. The costs of the lawsuit are assessed against the defendant.

Reasons

1. Details of the disposition;

A. The Plaintiff worked in a female-stock company B, and was active as C, a member of the camping club of the said company.

B. C participated in the 'E Games' hosted by an incorporated association D (hereinafter “instant Games”) as the representative of Jeonnam-do, and on August 27, 2016, the first competition of the instant Games was planned.

C. On August 25, 2016, the Plaintiff, along with C members, was engaged in the last practice competition to participate in the instant competition, and was diagnosed as “cerebral ties and traumaal spawnosis” due to an accident fit for her head (hereinafter “instant accident”). On December 27, 2017, the Plaintiff filed an application for medical care benefits with the Defendant on December 27, 2017.

However, on January 25, 2018, the Defendant rendered a disposition not to grant medical care (hereinafter “instant disposition”) to the Plaintiff on the ground that “the instant accident cannot be recognized as an occupational accident.”

[Ground of recognition] Facts without dispute, Gap evidence 1, 7 evidence, Eul evidence 2, the purport of the whole pleadings

2. Whether the instant disposition is lawful

A. The summary of the Plaintiff’s assertion is that the instant accident that occurred during the practice competition to participate in the instant competition is an occupational accident, in view of the fact that the Plaintiff Company B actively supported the employees’ self-esteem in the company and the need for labor management to promote labor-management harmony, including C, according to the need for labor management. However, the instant disposition made on a different premise is unlawful.

(b) Entry in the attached Form of relevant Acts and subordinate statutes;

C. According to Article 30 subparag. 4 of the Enforcement Decree of the Industrial Accident Compensation Insurance Act, which provides for the detailed criteria for recognition of “accident during events” with the delegation of Article 37(5) of the Industrial Accident Compensation Insurance Act, where the employee’s participation in sports games is recognized as necessary for labor management or business operation by social norms, and the employer is the employee.

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