In cases where the National Health Insurance Corporation provided health insurance benefits to the affected worker before the approval for additional medical care after occupational injury or disease occurred, whether it is possible to claim settlement payment to the Korea Workers' Compensation and Welfare Service pursuant to Article 90(1) of the Industrial Accident Compensation Insurance Act (affirmative), and the starting point of the statute of limitations of the right to claim settlement payment (=when

Article 42(1) of the Industrial Accident Compensation Insurance Act (hereinafter “Industrial Accident Insurance Act”) provides that “A person who has filed an application for medical care benefits under the Industrial Accident Compensation Insurance Act (hereinafter “Industrial Accident Insurance Act”) may receive medical care benefits under the National Health Insurance Act (hereinafter “health care benefits under the National Health Insurance Act”) before the Korea Workers’ Compensation and Welfare Service makes a decision on medical care benefits for industrial accident insurance (hereinafter “decision on approval for additional medical care”).” Article 90(1) of the Industrial Accident Compensation Insurance Act provides that “The Korea Workers’ Compensation and Welfare Service may pay the health care benefits first to the beneficiaries of the industrial accident insurance benefits pursuant to Article 42(1) of the Industrial Accident Compensation Insurance Act, if the National Health Insurance Corporation pays the health care benefits first, and claims the expenses, it may pay an amount equivalent to the health care benefits if the health care benefits are deemed equivalent to the health care benefits that can be paid pursuant to the Industrial Accident Insurance Act.” Article 112(1)5 provides that “The rights of the National Health Insurance Corporation under Article 90(1) of the Industrial Accident Insurance Act are extinguished by prescription

Article 53(1)4 of the National Health Insurance Act provides that no health insurance benefits need to be provided to a person eligible for industrial accident insurance benefits, and even if an employee injured or affected by a disease (hereinafter referred to as “repaid employee”) files an application for industrial accident insurance benefits due to occupational reasons, the health insurance benefits may not be provided for industrial accident insurance benefits until a decision on approval for additional medical care is rendered. In order to eliminate the gap in social insurance, Article 42(1) and Article 90(1) of the Industrial Accident Insurance Act provides that, in order to eliminate such gap in the social insurance, the National Health Insurance Corporation may request the Korea Workers’ Compensation and Welfare Service to pay the adjusted amount of the health care benefits if the injury or disease occurred from the time the occupational injury or disease occurred to the employee, until the Korea Workers’ Compensation and Welfare Service makes a decision on approval for additional medical care.

In light of the above provisions and purport of the Industrial Accident Insurance Act, if the National Health Insurance Corporation provides health insurance for the employees affected by occupational injury or disease before approval for additional medical care after the occurrence of occupational injury or disease, it may claim settlement of the amount to the Korea Workers' Compensation and Welfare Service pursuant to Article 90(1) of the Industrial Accident Insurance Act. Such right to claim settlement can only be exercised when the Korea Workers' Compensation and Welfare Service makes a decision to approve additional medical care. Thus, if it is not exercised for three years from the

Articles 42(1), 90(1), 112(1)5 of the Industrial Accident Compensation Insurance Act, Article 53(1)4 of the National Health Insurance Act

National Health Insurance Corporation (Attorney Song-young, Counsel for defendant-appellant)

Korea Labor Welfare Corporation

Daegu District Court Decision 2014Na1889 Decided June 12, 2014

The judgment below is reversed, and the case is remanded to the Daegu District Court Panel Division.

1. Where there is no precedent of the Supreme Court with regard to the interpretation of statutes applicable to a small case in a specific case, there is a case where a number of small claims, the issue of which is the interpretation of the same statutes, are pending in the lower court, and there is a case where the Supreme Court terminates the case without making a decision on the interpretation of the statutes on the grounds that it is a small amount case, it would be likely that the legal safety of people's lives would be harmed if the case is terminated without making a decision on the interpretation of the statutes on the grounds that it is a small amount case. In such special circumstances, even if the Supreme Court did not meet the requirement of "when it makes a decision contrary to the precedents of the Supreme Court" which can be a ground for appeal, it shall be deemed that the error in the interpretation and application of the substantive law can be determined at the level of performing the fundamental function of the Supreme Court, which is the unification of statutory interpretation (see Supreme Court Decision

In this case, there is no Supreme Court precedent as to the scope of application of the right to claim settlement money under Article 90(1) of the Industrial Accident Compensation Insurance Act (hereinafter “Industrial Accident Insurance Act”) which is a key issue, and the period of extinctive prescription and the starting point of calculation thereof, and there is no lower court’s judgment as to this point. Thus, the lower court’s determination as to the scope of application of the right to claim settlement money under Article 90(1) of the Industrial Accident Insurance Act and the interpretation of the statute of limitations

2. Article 42(1) of the Industrial Accident Insurance Act provides that “A person who has filed an application for medical care benefits under the Industrial Accident Insurance Act (hereinafter “industrial accident insurance medical care benefits”) may receive medical care benefits under the National Health Insurance Act (hereinafter “health insurance medical care benefits”) before the Korea Workers’ Compensation and Welfare Service (the Defendant of this case) makes a decision on the medical care benefits for industrial accident insurance (hereinafter “decision on approval for additional medical care”).” Article 90(1) of the Industrial Accident Insurance Act provides that “The Korea Workers’ Compensation and Welfare Service (the Plaintiff of this case) preferentially pays health care benefits to the beneficiaries of industrial accident insurance benefits pursuant to Article 42(1) of the Industrial Accident Insurance Act and claims the expenses thereof, if the health insurance benefits are deemed equivalent to the health care benefits that can be paid pursuant to the Industrial Accident Insurance Act, the amount corresponding to such health care benefits may be paid.” Article 112(1)5 of the Industrial Accident Insurance Act provides that “If the rights of the National Health Insurance Corporation under Article 90(1) of the Industrial Accident Insurance Act are not exercised for three years.”

Article 53(1)4 of the National Health Insurance Act provides that no health insurance benefits need to be provided to a person eligible for industrial accident insurance benefits, and even if an employee injured or affected by a disease (hereinafter referred to as “repaid employee”) files an application for industrial accident insurance benefit due to occupational reasons, health insurance benefits may not be provided for industrial accident insurance benefits until a decision on approval for additional medical care is rendered. In order to eliminate the gap in social insurance, Article 42(1) and Article 90(1) of the Industrial Accident Insurance Act provides that, in order to eliminate such gap in the social insurance, health insurance benefits may not be provided for industrial accident insurance benefits even until the medical care benefits are rendered. In order to eliminate the gap in the social insurance, Article 42(1) and Article 90(1) of the Industrial Accident Insurance Act provides that, from the time occupational injury or disease occurred to the time the relevant employee first applied for health

In light of the above provisions and purport of the Industrial Accident Insurance Act, if the Plaintiff provided health insurance benefits to the affected worker before the approval of the additional medical care after occupational injury or disease was determined, the Plaintiff may claim settlement of the amount to the Defendant pursuant to Article 90(1) of the Industrial Accident Insurance Act. The right to claim settlement of the amount can only be exercised when the Defendant rendered a decision to approve the additional medical care. Thus, the extinctive prescription period shall expire unless it is exercised for three years from the time when the decision to approve the additional

3. The lower court acknowledged that, based on its adopted evidence, the Nonparty suffered injury due to an accident that occurred while performing his/her duties and received medical care benefits from the Plaintiff from April 13, 2010 to April 24, 2010, and from May 6, 2010 to May 28, 2010, the Defendant received the medical care benefits from the Plaintiff and received the decision to approve additional medical care from the Defendant on July 2, 2010. However, the lower court determined that the Plaintiff filed a claim against the Defendant for the settlement of the expenses for the medical care benefits in question pursuant to Article 90(1) of the Industrial Accident Insurance Act, on the ground that the period of extinctive prescription of the claim for such settlement was expired from the time when the Plaintiff provided medical care benefits, and thus, the claim for the settlement of the amount expired due to the Plaintiff’s failure to exercise it for three years from that time.

However, according to the foregoing legal doctrine, the extinctive prescription of the claim for the above settlement amount ought to run from the date following the date of the decision on approval for additional medical care. According to the records, the Plaintiff filed the instant lawsuit on June 21, 2013, which was six months from the date of the decision on approval for additional medical care. Thus, the extinctive prescription of the claim for the above settlement amount is deemed to have been interrupted by demanding the Plaintiff to pay the settlement amount within three years from July 3, 2010, which was the day following the date of the decision on approval for additional medical care, and within six months from the date of the decision on approval for additional medical care.

Therefore, in so determining, the lower court erred by misapprehending the legal doctrine on the starting point of calculating the extinctive prescription period for the right to claim the settlement of accounts under Article 90(1) of the Industrial Accident 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 Lee In-bok (Presiding Justice)