[1] The meaning of "a case arising from a criminal act committed by intention or gross negligence" under Article 48 (1) 1 of the National Health Insurance Act, which provides the grounds for the restriction of insurance benefits

[2] The case affirming the judgment of the court below which acquitted a person not guilty of the above facts charged in a case where he was prosecuted for fraud by receiving insurance benefits from the National Health Insurance Corporation, by making a false statement as to the circumstance of the injury inflicted upon another person's assault and received medical treatment at

[1] Article 48 (1) 1 of the National Health Insurance Act provides that insurance benefits shall be limited in cases where an insured incident is caused either intentionally or by gross negligence or intentionally, and Article 1 of the same Act provides that the purpose of the Act is to improve public health and promote social security by providing citizens with insurance benefits for the prevention, diagnosis, medical treatment, rehabilitation, childbirth, death, and improvement of health of the disease and injury, as specified in Article 1 of the same Act. In light of the purport of the Act, the requirements for the restriction on benefits under the above Article 48 (1) 1 of the same Act should be strictly construed. Thus, the "case arising from a criminal act caused by intention or gross negligence" should be construed as "where an insured incident occurred solely due to one's own criminal act caused by intention or gross negligence or where one's criminal act caused by gross negligence."

[2] The case affirming the judgment of the court below which acquitted the defendant of the above facts charged on the ground that the above injury cannot be deemed as "the injury wholly or mainly caused by the criminal act of the defendant," in case where the patient was prosecuted for fraud by receiving insurance benefits from the National Health Insurance Corporation by making false statements as to the circumstances in which the injury was inflicted upon another person's assault and receiving treatment at the hospital

[1] Article 347 of the Criminal Act; Articles 1 and 48(1)1 of the National Health Insurance Act / [2] Article 347 of the Criminal Act; Article 48(1)1 of the National Health Insurance Act

[1] Supreme Court Decision 2002Du12175 Delivered on February 28, 2003

Defendant

Defendant and Prosecutor

Seoul Central District Court Decision 2009No3734 Decided January 21, 2010

All appeals are dismissed.

We examine the grounds of appeal.

1. As to the prosecutor's grounds of appeal

Article 48(1)1 of the National Health Insurance Act provides that insurance benefits shall be limited in cases where a criminal act committed intentionally or by gross negligence or intentionally causes an insurance accident. In light of the purport of Article 1 of the same Act, the National Health Insurance Act is to improve citizens' health and promote social security by providing citizens with insurance benefits for the prevention, diagnosis, medical treatment, rehabilitation, childbirth, death, and improvement of health (see, e.g., Supreme Court Decision 2002Du12175, Feb. 28, 2003). Thus, Article 48(1)1 of the Act provides that "where an insurance accident occurred due to a criminal act committed solely by intention or gross negligence, or by gross negligence, caused an insurance accident by intention or gross negligence," it shall be interpreted that "where an insurance accident occurred solely due to his own criminal act caused by intention or gross negligence, or one's criminal act caused by intention or gross negligence," as stated in Article 1 of the same Act.

Examining the reasoning of the judgment of the court below and the judgment of the court of first instance maintained by the court below in light of the above legal principles and records, it is just to maintain the judgment of the court of first instance which acquitted the defendant of this part of the facts charged on the ground that the injury of this case suffered by the defendant's assault by the non-indicted cannot be entirely or mainly caused by the defendant's criminal act based on the facts and circumstances as stated in its holding, and there is no error of misapprehending the legal principles on the interpretation of Article 48 (1) 1 of the National Health Insurance

2. As to the Defendant’s ground of appeal

Examining the reasoning of the judgment below in light of the records, it is just for the court below to find the defendant guilty of the offense of insult of this case on its grounds as stated in its reasoning, and there is no error in the rules of evidence, misapprehension of legal principles as to political party

3. Conclusion

Therefore, all appeals are dismissed. It is so decided as per Disposition by the assent of all participating Justices on the bench.

Justices Lee Hong-hoon (Presiding Justice)