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The judgment below is reversed and the case is remanded to Seoul High Court.
Reasons
The grounds of appeal are examined.
1.(a)
Article 84(1) of the Industrial Accident Compensation Insurance Act provides that "if a person who has received insurance benefits falls under any of the following subparagraphs, the Service shall collect the amount equivalent to the amount of such benefits (in cases falling under subparagraph 1, the amount equivalent to twice the amount of such benefits). In such cases, the Service shall be excluded from the amount to be collected from the amount of claims filed by the National Health Insurance Corporation, etc. under Article 90(2)." Article 84(1) provides that "in cases where insurance benefits have been received by fraudulent or other illegal means, the Service shall collect the amount double the amount of benefits as unjust enrichment." Paragraph (2) of the same Article provides that "if the payment of insurance benefits is caused by a false report, diagnosis or certification filed by a medical institution covered by the insurance, industrial accident insurance, or vocational training institution, the insured, industrial accident insurance, or
Meanwhile, Article 41(1) of the Industrial Accident Compensation Insurance Act provides that "any person who intends to receive medical care benefits (excluding medical care benefits for pneumoconiosis) under Article 40(1) shall file an application for medical care benefits with the Service, along with documents stating his/her workplace, circumstances of the accident, medical opinion on the accident, and other matters prescribed by Ordinance of the Ministry of Employment and Labor. In such cases, the procedure and methods for filing an application for medical care benefits shall be prescribed by Ordinance of the Ministry of Employment and Labor." Article 20(1) of the Enforcement Rule of the Industrial Accident Compensation Insurance Act provides that "the term "matters prescribed by Ordinance of the Ministry of Employment and Labor" in Article 41(1) of the Act refers to the confirmation of the insured of the circumstances leading to the accident of the worker who intends to receive medical care benefits, and Article 41