Where a medical institution provides medical treatment to a motor vehicle accident patient with a certificate, the scope of medical fees covered by motor vehicle insurance claims by the insurance company, etc.

Articles 12(2) and 15 of the Guarantee of Automobile Accident Compensation Act

National University of School (Law Firm Sejong, Attorneys Kim Sun-soo et al., Counsel for the defendant-appellant)

Dongbu Fire Marine Insurance Co., Ltd. (Law Firm Vindication, Attorneys Jeon Jae-in et al., Counsel for the plaintiff-appellant

Seoul Central District Court Decision 2012Na17140 decided October 19, 2012

The part of the judgment below against the defendant is reversed, and that part of the case is remanded to the Panel Division of the Seoul Central District Court.

The grounds of appeal are examined.

Article 12(2) of the Guarantee of Automobile Accident Compensation Act (hereinafter “the Act”) provides that “A medical institution in receipt of notice from an insurance company, etc. of the intention to pay medical fees covered by automobile accident insurance may file a claim for medical fees covered by automobile accident insurance in accordance with the standards publicly notified by the Minister of Land, Transport and Maritime Affairs pursuant to Article 15 of the Act.” Article 5(1) of the “Standards for Medical Fees Covered by Automobile Accident Insurance” (Ministry of Land, Transport and Maritime Affairs Notice No. 2008-39) provides that “The criteria for medical treatment for patients suffering from automobile accident and the scope of recognition of medical expenses shall be based on medical care benefits and other equivalent value points publicly notified by the Minister of Health, Welfare and Family Affairs under the National Health Insurance Act and the Ministry.” Article 12(2)2 of the Act provides that “The medical expenses for symptoms before the occurrence of a traffic accident even in cases of expenses within the scope recognized by the provisions of paragraph (1) shall be excluded from the scope of recognition.”

A medical institution's claim for medical fee covered by automobile accident insurance against an insurance company, etc. should be recognized within the scope of the victim's claim for medical fee covered by automobile accident insurance. However, in light of the fact that it is reasonable to charge the victim a corresponding amount of compensation out of the victim's damages according to the degree that the victim contributed to the occurrence of the accident, and the contents of the above provisions as to the scope of medical fee covered by automobile accident insurance, it is reasonable to view that the medical institution can claim medical fee covered by automobile accident insurance with the insurance company, etc. within the scope of the additional medical fee due to the aggravation of the king certificate caused by automobile accident.

According to the reasoning of the judgment below, the plaintiff, a medical institution, performed the instant surgery to remove conical signboards between 3-4 and inserting artificial disks against the non-party, who is the patient of the instant traffic accident. The continuous pains between 3-4 and the symptoms of the non-party, which are symptoms of the non-party, are aggravated due to the traffic accident of this case. In light of the above legal principles, the plaintiff can claim medical fees for automobile accident insurance against the defendant, the insurance company, within the scope of medical expenses added due to the aggravation of the non-party's above king evidence caused by the traffic accident of this case.

Nevertheless, the court below did not examine the scope of medical expenses added due to the aggravation of the Non-party's above symptoms caused by the traffic accident in this case, and determined that the defendant is obligated to pay the whole medical expenses of this case to the plaintiff as medical fees under automobile insurance for the reasons stated in its reasoning. In so doing, the court below erred by misapprehending the legal principles as to the scope of medical fees claim for automobile insurance against the insurance company, etc. of medical institution, which affected the conclusion of

Therefore, the part of the lower judgment against the Defendant is reversed, and that part of 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.

Justices Kim Yong-deok (Presiding Justice)