Where the injured party has received insurance benefits pursuant to the National Health Insurance Act due to a third party's tort, and the injured party's negligence competes with each other, the scope of the injured party's claim for damages against the third party.

Article 58 of the National Health Insurance Act, Articles 396 and 763 of the Civil Act

[Plaintiff-Appellant] Plaintiff 2002Da50149 decided Dec. 26, 2002 (Gong2003Sang, 481)

Dongbu Fire Marine Insurance Co., Ltd. (Law Firm Vindication, Attorney Jeon Jae-in, Counsel for plaintiff-appellant)

Defendant (Counterclaim Plaintiff)

Busan High Court Decision 2014Na1614, 1621 decided September 3, 2014

1. The part of the judgment of the court below against the plaintiff (Counterclaim defendant) is reversed, and that part of the case is remanded to Busan High Court.

2. The remaining appeals are dismissed.

The grounds of appeal are examined.

1. Regarding ground of appeal No. 1

Examining the reasoning of the lower judgment in light of the relevant legal principles and records, the lower court cannot be deemed to have either erred by misapprehending the legal doctrine regarding the limitation of liability, or by unfairly determining the limitation of liability ratio, for limiting the Plaintiff (Counterclaim Defendant; hereinafter “Plaintiff”)’s liability with respect to the occurrence of the instant accident to 80%, by taking account of the circumstances as indicated in its reasoning.

2. Regarding ground of appeal No. 2

A. In full view of the adopted evidence, the lower court recognized that the Defendant (Counterclaim Plaintiff; hereinafter “Defendant”)’s active damages incurred by the instant accident, excluding the medical expenses borne by the National Health Insurance Corporation, were KRW 2,963,680 of the king’s medical expenses paid by the Defendant himself and KRW 3,540,533 of the future medical expenses, and determined that the Plaintiff, the insurer, is liable to compensate the Defendant for the amount equivalent to 80% of the total amount of the medical expenses.

B. However, we cannot accept the judgment of the court below for the following reasons.

(1) When the victim received the insurance benefits under the National Health Insurance Act due to a third party's tort, the National Health Insurance Corporation shall subrogate and acquire the victim's damage liability to the extent of the amount of such benefits. In the event that the victim's negligence competes with the victim's negligence, the National Health Insurance Corporation shall first set off the amount of damages calculated, and then the National Health Insurance Corporation shall subrogate and acquire the victim's damage liability for the whole amount of the insurance benefits within the scope of the amount of damages calculated, and the National Health Insurance Corporation shall, within the scope of the amount of damage compensation (see Supreme Court Decision 2002Da50149, Dec.

(2) According to the reasoning of the lower judgment and the record, in the course of treating the injury caused by the instant accident, the Defendant directly bears only KRW 2,963,680, and the National Health Insurance Corporation bears KRW 1,798,684 as insurance benefits, and required KRW 4,762,364 as the total medical expenses. The Plaintiff asserted that, in the statement of grounds for appeal as of May 15, 2014, the Defendant may claim damages from the remainder after deducting the amount of the Corporation’s charges from the total medical expenses, including the Corporation’s charges, from the total medical expenses. Accordingly, in light of the aforementioned legal principles, the Defendant may claim against the Plaintiff only the amount calculated by deducting the Corporation’s charges from the amount equivalent to the scope of the Plaintiff’s liability out of the total medical expenses, including the Corporation.

(3) Nevertheless, the lower court, without omitting the judgment on the Defendant’s aforementioned assertion, recognized that KRW 2,963,680 of the medical expenses incurred by the Defendant himself was the amount of damages incurred by the Defendant. In so determining, the lower court erred by misapprehending the legal doctrine on the right to indemnity under the National Health Insurance Act, or omitting judgment, and there is a justifiable ground for appeal pointing this out.

3. Conclusion

Therefore, the part of the judgment of the court below against the plaintiff is reversed, and that part of the case is remanded to the court below for further proceedings consistent with this Opinion. The remaining appeals are dismissed. It is so decided as per Disposition by the assent of all participating Justices on the bench.

Justices Ko Young-han (Presiding Justice)