Whether it constitutes a ground for the termination of treatment in cases where treatment is required to prevent aggravation of a fixed symptoms, not to treat a worker who is under medical care for the purpose of supporting the injury or disease (affirmative)

Article 5 Subparag. 4 of the Industrial Accident Compensation Insurance Act provides that “The term “the treatment of an injury or disease is completely cured or the effect of the treatment is no longer expected, and the symptoms thereof are fixed.” In full view of the provisions and legislative purport of Articles 40 (Medical Care Benefits), 51 (Medical Care Benefits), 57 (Disability Benefits), and 77 (Preventive Management such as Mad, etc.) of the Industrial Accident Compensation Insurance Act, the term “the treatment of an employee under medical care is not a medical treatment to defend the injury or disease, but a case where the treatment is required to prevent the aggravation of the fixed symptoms, not a medical treatment to prevent the aggravation of the fixed symptoms.”

Article 5 subparag. 4, Articles 40, 51, 57, and 77 of the Industrial Accident Compensation Insurance Act

Supreme Court Decision 2007Du4810 Decided September 25, 2008

Plaintiff (Law Firm LLC, Attorneys Kim U-American et al., Counsel for the plaintiff-appellant)

Korea Labor Welfare Corporation

Seoul High Court Decision 2015Nu45276 decided January 23, 2017

The judgment below is reversed and the case is remanded to Seoul High Court.

The grounds of appeal are examined.

1. Article 5 Subparag. 4 of the Industrial Accident Compensation Insurance Act provides that “The term “the treatment of an injury or disease is completely cured or the effect of the treatment is no longer expected, and the symptoms thereof is fixed.” In full view of the contents and legislative purport of the respective provisions of Articles 40 (Medical Care Benefits), 51 (Medical Care Benefits), 57 (Additional Care Care Benefits), and 77 (Prevention Management of Mad, etc.) of the Industrial Accident Compensation Insurance Act, the cases where it is necessary for the treatment of an employee under medical care to prevent the aggravation of a fixed symptoms, not for the treatment of an employee under medical care, shall be deemed to fall under the cause for termination of medical treatment (see Supreme Court Decision 2007Du4810, Sept. 25, 2008).

2. On September 28, 2003, the court below acknowledged the payment of temporary layoff benefits to the Defendant on July 18, 2007, when the Plaintiff was receiving medical care benefits for the first approved injury and disease after receiving the first approved injury and disease from the Defendant due to occupational accidents on September 28, 2003 (hereinafter “the instant additional injury and disease”). ② At the time of the instant operation, the head of the ○○ Hospital diagnosed the Plaintiff as a need for medical care for three weeks after the operation, rehabilitation movement for about six months, and later, the first approved injury and disease and the instant additional injury and disease in the instant case on April 7, 2007 (hereinafter “the instant additional injury and disease”). However, the Defendant closed the Plaintiff’s request for temporary layoff benefits for the first approved injury and disease in the instant case on July 18, 2007 (hereinafter “the period of request for temporary layoff benefits”).

Furthermore, on the following grounds, the lower court determined that the instant disposition was unlawful on the grounds that the Plaintiff’s additional injury and disease of this case was difficult to be deemed to have fixed around April 7, 2008. (1) Even after April 7, 2008, the Plaintiff received outpatient treatment from △△ Medical Center by using the first approved injury and disease per se from △△ Medical Center until June 23, 2008; (3) from August 20, 2008 to March 11, 2013, the Plaintiff was treated abroad on the ground of “the shoulderer of the habitual disease” from 3) to 5 (5) a month, and received treatment from the right side and the right side of ○ Medical Center from April 25, 2012 to April 27, 2013.

② The medical record appraisal of the lower court revealed that “after April 7, 2008, the Plaintiff’s symptoms of the instant additional disease have not been fixed, so it was in a state that fundamental and active treatment was required for the improvement of the symptoms, and during the said period, it is deemed that the Plaintiff was unable to be employed due to the instant additional disease,” and that other medical doctors who treated the Plaintiff expressed their opinions that “the instant additional disease requires an surgery” around July 201 and around December 2012.

3. However, the lower court’s determination is difficult to accept for the following reasons.

First, the Plaintiff’s treatment cited by the lower court cannot be deemed as the basis to support the possibility of the instant additional injury and disease, as well as the first approved injury and disease. In other words, the Plaintiff’s treatment, which was received through a large amount of scale, after April 7, 2008, is irrelevant to whether to cure the instant additional injury and disease, and the content of the treatment seems to be merely a tracking observation after the surgery. The Plaintiff’s treatment of the said part of the disease and the instant additional injury and disease for the purpose of relaxing the pain seems to be merely a preservation treatment.

Next, the medical record appraisal by the lower court presented the opinion that “it is difficult to expect medical care due to the fixed condition of symptoms for three years after the surgery in 2007, although it was required to provide active treatment for three years after the surgery, it was given only one year, and it was difficult to provide appropriate treatment for the remaining two years after the surgery in 2010,” and it does not seem to have the purport of the need for medical treatment to defend the injury and disease within the instant period of request. Moreover, the opinion of other doctors who need medical treatment on or around July 2012 and December 2012 may be possible even in cases where the symptoms of the instant additional medical care were already fixed and thus, the additional medical care was needed as the result of the aggravation of the instant additional medical care, which was the healing condition, cannot be the grounds for not reaching the state of recovery on April 7, 2008.

Meanwhile, according to the reasoning of the lower judgment and the evidence duly adopted and examined by the lower court, ① the head of the ○ Hospital Hospital diagnosed the Plaintiff that the Plaintiff needs medical treatment and rehabilitation movement treatment for about three (3) weeks after the surgery, ② the first approved branch on April 7, 2008 and the first approved branch on April 7, 2008. ③ The first instance court’s appraisal of medical records presented the opinion that “the doctor of the ○○ Hospital shall be deemed to have closed the treatment because it would have become difficult to expect any more treatment effects and it would have become difficult to expect the symptoms to be fixed.”

In addition to these circumstances, in full view of the background leading up to the Plaintiff’s occupational accident, the details of the first recognized injury and the treatment process and timing thereof, it is difficult to recognize that the circumstances cited by the lower court alone, such as the circumstance cited by the lower court, were insufficient to deem that the symptoms of the first approved injury and the instant additional injury and disease were not fixed, or that rehabilitation treatment was required for the Plaintiff to defend the injury and disease, not to prevent the aggravation of the symptoms.

Therefore, the lower court determined that the instant disposition was unlawful on April 7, 2008, after examining whether the principal doctor of ○○ Hospital performed rehabilitation treatment more unreasonably than the ordinary rehabilitation treatment period after the surgery against the Plaintiff, and whether the period for nursing injury and disease rather than the prevention of aggravation of symptoms during the rehabilitation treatment period required for the Plaintiff was certain extent. Nevertheless, the lower court determined that the instant disposition was unlawful on the grounds as seen earlier. In so doing, the lower court erred by misapprehending the legal doctrine on the “cure” under the Industrial Accident Compensation Insurance Act, thereby failing to exhaust all necessary deliberations, thereby adversely affecting the conclusion of the judgment.

4. Therefore, without further proceeding to decide on the remaining grounds of appeal, the lower judgment is reversed, and 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 on the bench.

Justices Kwon Soon-il (Presiding Justice)