Restriction on health insurance benefits on the grounds of gross negligence

[1] Article 1 and Article 48 (1) 1 of the National Health Insurance Act

Their incentives (Law Firm Dongwon General, Attorneys Lee Jung-il et al., Counsel for defendant-appellant)

National Health Insurance Corporation

Seoul High Court Decision 2002Nu5773 delivered on November 5, 2002

The appeal is dismissed. The costs of appeal are assessed against the defendant.

We examine the grounds of appeal.

Article 48(1)1 of the National Health Insurance Act provides that no insurance benefit shall be provided when a person entitled to insurance benefits has intentionally or by gross negligence caused a criminal act or intentionally caused an accident. In light of the fact that the National Health Insurance Act provides that the purpose of Article 1 is to improve citizens' health and promote social security by providing insurance benefits for the prevention, diagnosis, medical treatment, rehabilitation of diseases and injury, childbirth, death, and improvement of health, as specified in the above Act, the National Health Insurance Act must be strictly interpreted to be "serious negligence" as a ground for restriction on benefits under the above Act.

According to the reasoning of the judgment below, the court below acknowledged the following facts after compiling the adopted evidence of the plaintiff's limited liability, and recognized that the traffic accident of this case was caused by the negligence of the limited liability driver and the negligence of the limited liability driver, but cannot be seen as falling under the grounds for restrictions on insurance benefits provided for in Article 48 (1) 1 of the National Health Insurance Act, on the ground that the traffic accident of this case is concurrent with the accident of the limited liability driver and the gross negligence of the limited liability driver, and cannot be seen as falling under the grounds for restrictions on insurance benefits provided for in Article 48 (1) 1 of the National Health Insurance Act, on the ground that the accident of this case was caused by the gross negligence of the limited liability driver and the gross negligence of the limited liability driver.

Examining the relevant evidence in light of the above legal principles and the records, we affirm the above recognition and determination by the court below, and there is no error in the misapprehension of legal principles as to gross negligence and causation without failing to exhaust all necessary deliberations, as otherwise alleged in the ground of appeal.

The Supreme Court precedents cited in the grounds of appeal are not appropriate to be invoked in this case with different cases and purport.

On the other hand, the argument in the grounds of appeal that "the defendant has no legal interest to seek revocation of the disposition of this case against the plaintiff, who is a third party, since the defendant did not have any legal interest in claiming revocation of the disposition of this case," is only asserted in the final appeal. Since it is apparent in the record that the defendant had taken the disposition of this case against the plaintiff, the above argument is without merit without further review.

Therefore, the appeal is dismissed, and the costs of appeal are assessed against the losing party. It is so decided as per Disposition by the assent of all participating Justices on the bench.

Justices Yoon Jae-sik (Presiding Justice)