In a case where the victim of a traffic accident claims direct damage to an insurance company, etc. through a lawsuit, whether the motor vehicle insurance medical fee is an absolute standard for calculating the amount of damage for medical expenses (negative), and whether the court can calculate the amount of damage for medical expenses to a reasonable extent

Article 2 subparag. 7 of the Guarantee of Automobile Accident Compensation Act, Articles 12(2) and 15 of the Guarantee of Automobile Accident Compensation Act

Supreme Court Decision 2002Da63411 Decided February 14, 2003 (Gong2017Ha, 1846) Supreme Court Decision 2016Da265511 Decided August 29, 2017

Plaintiff (Attorney Shin-han, Counsel for the plaintiff-appellant)

Samsung Fire and Marine Insurance Co., Ltd. (Law Firm Subdivision, Attorneys Kim Young-soo et al., Counsel for the plaintiff-appellant)

Seoul Central District Court Decision 2016Na15531 Decided April 11, 2017

The appeal is dismissed. The costs of appeal are assessed against the defendant.

The grounds of appeal are examined.

Article 2 subparag. 7 of the Guarantee of Automobile Accident Compensation Act provides that "The expenses incurred by a person who has suffered an accident caused by the operation of a motor vehicle (hereinafter "motor vehicle accident patient") shall be the expenses incurred by the medical treatment at a medical institution under the Medical Service Act, and the relevant expenses shall be paid with the insurance proceeds (including mutual aid money; hereinafter "insurance proceeds, etc.") of an insurance company (including a mutual aid business operator; hereinafter "insurance proceeds, etc.") (including item (a)), the relevant expenses shall be paid with the compensation for the business of guaranteeing automobile accident compensation under Article 30 (including item (b)), and the relevant expenses shall be paid with the compensation for the motor vehicle accident compensation business under Article 30 (including the compensation under Article 30) (including the compensation under item (c))."

Accordingly, Article 15 of the Guarantee of Automobile Accident Compensation Act provides that “The Minister of Land, Infrastructure and Transport may establish and publicly notify the standards for motor vehicle insurance medical fees (hereinafter “motor vehicle insurance medical fees standards”) in order to guarantee appropriate medical treatment for motor vehicle accident patients and to prevent disputes over medical fees between insurance companies, etc., medical institutions, and motor vehicle accident patients.” Article 12(2) of the Guarantee of Automobile Accident Compensation Act provides that “The scope of recognition of motor vehicle insurance medical fees, procedures for filing procedures and payment, and other matters determined by Ordinance of the Ministry of Land, Infrastructure and Transport shall be included in the motor vehicle insurance medical fees,” and Article 12(2)

According to the above provisions, the motor vehicle insurance medical fees standard has meaning as a standard to prevent disputes between the motor vehicle accident patient and the medical institution in the event that the motor vehicle accident patient pays the medical fees incurred from the relevant traffic accident to the medical institution after the dispute over the medical expenses of the motor vehicle accident patient between the insurance company, etc. and the medical institution.

Meanwhile, in a case where the victim of a traffic accident claims direct damages to an insurance company, etc. through a lawsuit, medical expenses incurred in the traffic accident can be compensated for the actual amount of damages within the scope of proximate causal relation with the tort. Therefore, the scope of medical expenses incurred in the pertinent treatment should be reasonably determined in consideration of various circumstances, such as the degree of injury, treatment details, frequency of treatment, and medical insurance fees, etc. (see Supreme Court Decision 2002Da63411, Feb. 14, 2003).

In full view of these facts, in a case where the victim of a traffic accident claims direct damages to an insurance company, etc. through a lawsuit, the motor vehicle insurance medical fees may serve as the basis for calculating the amount of damages, but cannot be considered as an absolute standard. Even if the court did not calculate the amount of damages for medical fees according to motor vehicle insurance medical fees, it cannot be said that there is a proximate causal relation if the amount of damages for medical expenses is calculated within reasonable scope after taking into account the degree of injury and disability of the victim of the traffic accident, the treatment content, the frequency of treatment, the general level of medical expenses in the medical society, the possibility of the application of motor vehicle insurance medical fees for the relevant injury and disability, or the appropriateness thereof, etc. (see Supreme Court Decision 2016Da26511, Aug. 2

Examining the record in accordance with the aforementioned legal doctrine, the lower court did not err by misapprehending the legal doctrine on motor vehicle insurance medical fees as prescribed by the Guarantee of Automobile Accident Compensation Act, etc., in calculating the Plaintiff’s urine treatment costs based on the Plaintiff’s request for physical examination.

Therefore, the appeal is dismissed, and the costs of appeal are assessed against the losing party. It is so decided as per Disposition by the assent of all participating Justices on the bench.

Justices Cho Jae-chul (Presiding Justice)