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(영문) 수원지방법원 2015.09.25 2015구단1711
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 21, 2014, the Plaintiff was working as a caregiver belonging to the Kucheon-gu, Seoul Special Metropolitan City, 124 Dong 1106, and was living in Gangnam-gu D and was on duty to care for patients.

B. On September 15, 2015, the Plaintiff filed an application for medical care benefits with the Defendant on April 15, 2015, alleging that he/she had caused an accident in transit with the patient, and that he/she had caused the injury (hereinafter referred to as “the injury and disease in this case”).

C. However, in consideration of the Plaintiff’s business contents, period of service, etc., the Defendant issued the instant disposition to not approve medical care on the ground that there is no proximate causal relation with the instant branch’s business.

[Grounds for recognition] The descriptions of Gap evidence Nos. 12 and 15, and the purport of the whole pleadings

2. Whether the disposition is lawful;

A. The Plaintiff’s assertion is that the instant injury was caused or the Plaintiff’s existing pain was aggravated, where the patient was faced with the back part of the Plaintiff’s head, and the patient was faced with his/her shoulder at the time of around March 2015, after the Plaintiff’s home service had a paind with his/her own shoulder, around September 2014, and around March 2015.

Nevertheless, the instant disposition that did not approve the medical care is unlawful.

B. The "occupational accident" under the Industrial Accident Compensation Insurance Act refers to the worker's injury, disease, disability or death caused by the occupational reason, and in order to be recognized as a disaster due to the occupational reason, the accident is caused by the occupational reason, and there is a proximate causal relation between the occupational accident and the accident. In this case, the causal relation between the worker's accident and the work should be proved by the claimant.

In full view of the respective descriptions of Gap evidence Nos. 3, 4, Eul evidence Nos. 2, 4, and 5 and the purport of the whole pleadings, the plaintiff begins with the service from June 21, 2014.

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