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(영문) 대법원 2020.12.10 2019다279962
자동차보험진료수가지급
Text

All appeals are dismissed.

The costs of appeal are assessed against the defendant.

Reasons

The grounds of appeal are examined.

1. Case summary and key issue

A. The reasoning of the lower judgment reveals the following circumstances.

(1) The plaintiffs are medical specialists in film and video who operate a film department, and the defendant is a private taxi mutual aid business operator.

(2) In a case where a medical institution receives the insurance money (including mutual aid money; hereinafter “insurance money, etc.”) from an insurance company (including a mutual aid business operator; hereinafter “insurance money, etc.”) for the medical treatment of a person who suffered an accident caused by the operation of a motor vehicle (hereinafter “motor vehicle accident patient”), the amount calculated according to the provisions of the Guarantee of Automobile Accident Compensation Act (hereinafter “Act on the Guarantee of Automobile Accident Compensation”) shall be paid, and such amount shall be “motor vehicle insurance medical fees”.

(A) (3) The Plaintiffs, upon receiving a request from another medical institution for medical treatment for patients suffering from a traffic accident, performed the film reading service by using the Computerization-based photographing device (CT), self-scopic image photographing device (MRI), double-electronic group photographing device (PET), etc. and then conducted the video screen reading service.

Before the amendment of the Motor Vehicle Liability Insurance Act in 2012, the Plaintiffs filed a claim for motor vehicle insurance medical fees directly with the insurer, etc., and the insurer, etc. directly examined the legality thereof or paid motor vehicle insurance medical fees to the Plaintiffs following the dispute mediation procedure of the Motor Vehicle Insurance Medical Fee Review Council

(4) Upon the amendment of the Automobile Loss Act by Act No. 11369 on February 22, 2012, insurance companies, etc., pursuant to Article 12-2, were able to entrust the review and adjustment of motor vehicle insurance medical fees to the Health Insurance Review and Assessment Agency, which is a specialized review agency.

On June 14, 2013, the Health Insurance Review and Assessment Service entered into an entrustment contract with insurance companies including the defendant, etc., and took charge of the review of motor vehicle insurance medical fees from July 1, 2013.

(v).

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