When a medical institution claims medical fee covered by automobile accident insurance to the insurer, etc., it constitutes a violation of Article 11 (3) of the Guarantee of Automobile Accident Compensation Act by claiming fee for video diagnosis without preparing and keeping a statement of opinion on video diagnosis.

Articles 11(3) and 38(3) of the Guarantee of Automobile Accident Compensation Act

Supreme Court Decision 2006Do2959 Delivered on July 13, 2006

Defendant

Defendant

Attorney Park Gyeong-soo

Daegu District Court Decision 2004No4057 Decided April 20, 2006

The part of the lower judgment against the Defendant is reversed, and that part of the case is remanded to the Daegu District Court Panel Division.

The grounds of appeal are examined.

1. Article 11(3) of the Guarantee of Automobile Accident Compensation Act (hereinafter “the Act”) provides that “A medical institution shall file a claim against an insurer, etc. for medical fees covered by automobile accident insurance pursuant to the provisions of Article 11(2) of the Act according to the medical records for medical treatment as prescribed by Article 21 of the Medical Service Act.” Article 38(3) of the Act provides that “A medical institution that claims medical fees covered by automobile accident insurance differently from the medical records based on medical records in violation of Article 11(3) of the Act shall be punished against the “medical institution that claims medical fees covered by automobile accident insurance”. A medical institution’s claim for medical fees covered by automobile accident insurance violates Article 11(3) of the Act without preparing and keeping a statement of opinion of opinion of opinion of opinion of opinion of opinion of opinion of opinion of opinion of opinion of opinion of opinion of opinion of opinion of opinion of opinion of opinion of opinion of opinion of opinion of opinion of opinion of opinion of opinion of opinion of opinion of opinion of opinion of opinion of opinion of opinion of opinion of opinion of opinion of opinion of opinion of opinion of opinion of the Supreme Court.

In light of the above legal principles and records, there are cases where the medical records prepared concerning the patients at issue as to the falsity of the request for the reading fee in this case read X-ray photographs or CT photographs, and there are cases where the opinion of opinion is expressed, and there are cases where the reading of X-ray photographs or CT photographs can be seen as referring to the result even though there is no express statement about the reading. As such, if the medical records indicate that there was a reading of the video examination, this cannot be said to be a claim for medical fee for automobile insurance differently from the medical records of the medical records.

Nevertheless, the court below found the Defendant guilty of the part of the medical fee claim stated in the attached Table 2 of the judgment of the court of first instance (hereinafter “Attachment of the judgment of the court of first instance”) among the facts charged against the Defendant by deeming that the Defendant could not claim the fee without preparing and keeping a written opinion of reading on the video diagnosis without examining whether or not there is a statement that can be known that there was a reading on the video diagnosis. Thus, the court below erred by failing to exhaust all necessary deliberations or by misapprehending the legal principles on the violation of the Guarantee of Automobile Accident Compensation Act by failing to exhaust all necessary deliberations, which affected the conclusion of the judgment.

2. As above, the part which the court below found the Defendant guilty of the part of the medical fee claim as stated in the annexed Table 2 among the facts charged in the case against the Defendant should be reversed. The court below found the Defendant guilty of all of the above part of the medical fee claim as stated in the annexed Table 1, and sentenced one punishment by deeming that the whole part of the above part constitutes a single comprehensive crime. Thus, the judgment of the court below against the Defendant is reversed in its entirety.

3. Therefore, the part of the lower judgment against the Defendant is reversed, and that part of the case is remanded to the lower court. It is so decided as per Disposition by the assent of all participating Justices on the bench.

Justices Kim Nung-hwan (Presiding Justice)