Plaintiff

Heung-gu Fire Insurance Co., Ltd. (Attorney Kang Sung-sung, Counsel for the plaintiff-appellant)

April 18, 2008

Seoul Central District Court Decision 2006Gadan223134 Decided May 31, 2007

1. The plaintiff (Counterclaim defendant)'s appeal is dismissed.

2. According to the counter-claim claim filed in the trial, the plaintiff (Counterclaim defendant) pays to the defendant (Counterclaim plaintiff) 8,351,870 won with 5% per annum from May 21, 2006 to November 30, 2007, and 20% per annum from the next day to the day of full payment.

3. The costs of appeal and the costs of counterclaim shall be borne by the plaintiff.

4. Paragraph 2 can be provisionally executed.

1. Purport of claim

A. The principal lawsuit is confirmed on April 28, 2006, that there is no obligation to pay medical expenses based on the decision of the Motor Vehicle Insurance Dispute Council on April 28, 2006 against the Defendant (Counterclaim Plaintiff; hereinafter “Defendant”) by the Plaintiff (Counterclaim Defendant; hereinafter “Plaintiff”).

B. Counterclaim: It is identical to the Disposition No. 2 (the defendant filed a counterclaim at the trial).

2. Purport of appeal

Judgment of the first instance shall be revoked. Judgment such as the purport of the claim in the principal lawsuit shall be revoked.

A principal lawsuit and a counterclaim shall be deemed simultaneously.

1. Basic facts

A. On October 14, 2005, the Nonparty: (a) hospitalized in (name omitted) hospital operated by the Plaintiff on November 8, 2005, by suffering from traffic accidents (hereinafter “instant traffic accident”) from the Defendant’s insured vehicles under the direction of the front line of Dong-dong, Jung-gu, Seoul, the Dong-dong Road; and (b) discharged the Defendant on November 16, 2005, after receiving an artificial disc-circuling and pelverging the escape from the front line of the front line of Dong-dong, Jung-gu, Seoul; (c) hospitalized in (name omitted); and (d) discharged on November 16, 2005.

B. On November 17, 2005, the Defendant paid KRW 8,183,200 of the insurance money equivalent to the medical expenses to the Nonparty, and on November 23, 2005, the Nonparty paid KRW 8,180,000 out of the above insurance money to the Plaintiff (hereinafter “instant medical expenses”). The Defendant received the claim from the Plaintiff for the payment of KRW 2,564,140 against the Nonparty for motor vehicle insurance medical expenses, and paid KRW 2,479,530 to the Plaintiff on December 21, 2005.

C. The Defendant filed a petition for review of the instant medical expenses with the Motor Vehicle Insurance Medical Fee Dispute Resolution Council (hereinafter “Council”). On April 28, 2006, the Council rendered a review and determination (hereinafter “instant review and determination”) on the following: “The Plaintiff refunded KRW 7,550,00 among the instant medical expenses, and delayed payment thereof, to the Defendant; and paid KRW 801,870 by May 20, 2006.”

【Ground of recognition】 without any dispute, entry of Gap evidence 1, 3, 7, 8-1, 2, 3, 9, Eul evidence 1-2, 2, 3, and 4, and the purport of the whole pleadings

2. Determination

A. Determination on the main claim

(1) The argument

The plaintiff, for the treatment of the non-party's scopic escape from the scopic of the Non-party's scopic witness, conducted artificial disc scopic and scopic convergence, and the plaintiff directly received the treatment and operation expenses from the non-party, so the medical expenses of this case are not subject to examination by the Council, and even though the part of KRW 7,550,000 out of the medical expenses of this case did not fall under the subject of examination by the Council, the Council accepted the defendant's request for review and decision of this case, and argued that it is unreasonable to accept the non-party's request for review and make a decision of this case, and that there is no obligation to return the medical

(2) Whether the Council is subject to examination

The standards for motor vehicle insurance medical fees established by delegation of the Guarantee of Automobile Accident Compensation Act (hereinafter “the standards for medical fees”) apply even in cases where a motor vehicle accident patient who received or is to receive insurance money, etc. or advance payment from an insurer, etc. pays medical expenses to a medical institution (Article 3(1)2 of the Standards for Medical Fees). The fact that the non-party paid the instant medical fees to the medical institution with the money that the non-party received from the defendant as insurance money is as seen earlier. Thus, the standards for medical fees for the instant medical fees are applied, and this

The medical expenses for the king should be excluded from the medical fees pursuant to the main sentence of Article 5(2)2 of the Medical Fee Standard. Thus, if the medical expenses of this case were paid with the medical expenses for the Nonparty’s king, the Plaintiff is obligated to return the whole medical expenses of this case, and this is subject to review by the Council.

The above argument that the medical expenses of this case are not subject to examination by the Council is without merit.

(2) Appropriateness of the review of the instant case

Of the instant medical expenses, the parts KRW 7,550,00 among the 7,50,000 of the instant medical expenses are within the scope that is essential and reasonable to treat the escape certificate of a compactical signboard that was suffered by the Nonparty due to the instant traffic accident, each of the statements in the health class A, A, 4, 5, 6, 11, and 12 is insufficient to recognize it, and there is no other evidence to acknowledge it. Therefore, the aforementioned

Considering the purpose of the formation of the Council, details of the composition and operation of the Council, personal composition and commissioning procedures of the Deliberation Committee, details of the composition of the Special Committee and qualifications of expert members, deliberation procedures, etc., it is reasonable to deem

B. Determination on the counterclaim

According to the above facts, without any legal cause, the Plaintiff obtained profit from 8,351,870 won (7,550,000 won in the amount of return decision of the instant medical expenses + 801,870 won in the amount of review fees) and suffered damages from the Defendant. As such, the Plaintiff is obligated to pay to the Defendant unjust enrichment amounting to 8,351,870 won and damages for delay calculated at each rate of 20% per annum under the Civil Act from May 21, 2006 to November 30, 207, the delivery date of a duplicate of the instant counterclaim as sought by the Plaintiff, from May 21, 2006 to November 30, 2007, and from the next day to the day of full payment.

3. Conclusion

Therefore, the plaintiff's claim of this case is dismissed as it is without merit, and the judgment of the court of first instance that shares the same conclusion is justifiable. Therefore, the plaintiff's appeal is dismissed as it is without merit, and the defendant's counterclaim raised in the court of first instance is accepted as it is decided as per Disposition.

Judges Park Jong-chul (Presiding Judge)