In the case of a traffic accident by a motor vehicle or a non-insurance motor vehicle, whether the victim's right to claim compensation under Article 30 (1) of the former Guarantee of Automobile Accident Compensation Act constitutes a right to claim compensation against a third party under Article 53 (1) of the former National Health Insurance Act (negative)

Article 30(1) of the former Guarantee of Automobile Accident Compensation Act (Amended by Act No. 11369, Feb. 22, 2012); Article 53(1) of the former National Health Insurance Act (Amended by Act No. 11141, Dec. 31, 201) (see current Article 58(1))

Supreme Court Decision 2003Da62477 Decided April 15, 2005 (Gong2009Ha, 1538) Decision 2009Da27452 Decided August 20, 2009

State Fire and Marine Insurance Co., Ltd. (Dongwon General Law LLC, Attorney Lee Ho-il, Counsel for defendant-appellant)

National Health Insurance Corporation

Seoul Eastern District Court Decision 2011Na12486 decided January 27, 2012

The judgment of the court below is reversed, and the case is remanded to the Seoul Eastern District Court Panel Division.

The grounds of appeal are examined.

1. Article 53(1) of the former National Health Insurance Act (wholly amended by Act No. 11141, Dec. 31, 201; hereinafter “former National Health Insurance Act”) provides that when a ground for insurance benefits arises due to a third party’s act and an insured party or his/her dependent has paid insurance benefits to the insured party or his/her dependent, the Service shall obtain the right to claim compensation for the relevant third party within the limit of the expenses incurred in relation to the payment of the benefits. Thus, the right to receive the insurance benefits from the third party’s act and the insurance benefits from the insured pursuant to Article 53(1) of the former National Health Insurance Act is the right to claim compensation for the third party who received the insurance benefits to the extent of the expenses incurred in relation to the benefits.

However, the guarantee business under Article 30 of the former Guarantee of Automobile Accident Compensation Act (amended by Act No. 11369, Feb. 22, 2012; hereinafter “former Act”) is a type of social security system, the main purpose of which is to collect a specified amount of the liability insurance premium to be paid by a motor vehicle owner as a contribution from the government and to compensate for the damage of a victim who died or was injured due to an accident involving the operation of an unregistered motor vehicle within the scope of the insurance proceeds for liability insurance. It is to supplement the motor vehicle liability insurance system, which is legally enforced for the purpose of protecting the victim of a traffic accident caused by a motor vehicle or an unrelated motor vehicle (see, e.g., Supreme Court Decisions 2003Da62477, Apr. 15, 2005; 2009Da27452, Aug. 20, 209).

In light of the purpose, purpose, character, etc. of the guaranteed business, in the case of traffic accidents caused by a motor vehicle or an unrelated motor vehicle without the owner of a motor vehicle, the right to claim compensation for the guaranteed business owned by the victim under Article 30(1) of the former Act is a claim specifically recognized by the Act for the relief of the victim, and cannot be deemed as a right to claim compensation for a third party under Article 53(1) of the former National Health Insurance Act. Therefore, the Corporation cannot obtain the above right to claim compensation under the former National Health Insurance Act, and cannot exercise the right to claim compensation against the guaranteed business operator entrusted with the affairs concerning the guaranteed business concerning the expenses incurred in the insurance benefits

2. According to the evidence duly admitted, Nonparty 1 caused the instant accident of collision between the cargo vehicles and the taxi in the front direction while driving Oral Ba, which did not subscribe to the liability insurance on March 22, 2008. Nonparty 2, who was on the rear seat of Oral Ba, caused the instant accident to undergo the treatment at the hospital, which was the medical care institution, by suffering the injury to the hands, etc., and the Defendant paid KRW 1,069,820 to Nonparty 2, who was receiving the health insurance due to the instant accident, to the hospital, which was the medical care institution.

Examining these facts in light of the legal principles as seen earlier, the Defendant cannot claim reimbursement against the Plaintiff for the above medical care benefit cost that the Defendant paid in relation to the instant accident pursuant to Article 45(1) of the former Act pursuant to Article 53(1) of the former National Health Insurance Act.

3. Nevertheless, the lower court determined otherwise, on the premise that the guaranteed business is a system of the same quality on the extension line of the automobile liability insurance system, that the Plaintiff constitutes a third party under Article 53(1) of the former National Health Insurance Act. As a result, determined that there was no ground for objection, such as failure to claim compensation or invalidation of the claim for the decision on performance recommendation of this case, which recommended the Plaintiff to pay indemnity for the expenses of the above medical care benefits that the Defendant paid to the Plaintiff. Therefore, the lower court erred by misapprehending the legal doctrine on the legal nature of the claim for compensation under Article 30(1) of the former Act, and the requirements for exercise under Article 53(1) of the former National Health Insurance Act

4. Therefore, the lower judgment is reversed, and the case is remanded to the lower court for further proceedings consistent with this Opinion. It is so decided as per Disposition by the assent of all participating Justices on the bench.

Justices Shin Young-chul (Presiding Justice)