Whether the medical insurance association that paid insurance benefits to the affected workers can claim the return of unjust enrichment against the employer who is liable for accident compensation (negative)

In light of the public nature and function of the Medical Insurance Act and the purpose of the medical insurance and the fact that in the case of workplace medical insurance, the employer bears 50/100 of the premium for the workplace insured, it is reasonable to interpret that the premium payment provision of the Medical Insurance Act is more public than the Labor Standards Act which provides the employer's personal compensation, or that at least the amount of the insurance benefits under the Medical Insurance Act is not claimed for medical care expenses against the employer. Thus, even if the Medical Insurance Association paid the insurance benefits to the affected worker, it cannot be viewed that the employer has obtained any benefit without any legal cause, and thus, the employer cannot claim for restitution of unjust enrichment.

Medical Insurance Act Article 41(5) of the Medical Insurance Act; Article 87 of the former Labor Standards Act (amended by Act No. 5309 of March 13, 1997) (see current Article 90); Article 741 of the Civil Act

Incheon Medical Insurance Association of the First District of Incheon

Sil Dong Credit Union

Incheon District Court Decision 96Na85451 delivered on August 27, 1996

1. Of the judgment of the court of first instance, the part against the defendant ordering payment of the amount exceeding 603,738 won and the amount equivalent to 5% per annum from July 11, 1996 to May 9, 1997, and 25% per annum from the next day to the date of full payment shall be revoked and the plaintiff's claim corresponding to the revoked part shall be dismissed.

2. The defendant's remaining appeals and the plaintiff's incidental appeals are all dismissed.

3. The costs of the lawsuit shall be five minutes for both the first and second instances, and the two costs shall be borne by the defendant, and the remainder by the plaintiff.

The judgment of the court below that the defendant shall pay to the plaintiff 2,012,460 won with 25% interest per annum from the day following the service of a copy of the complaint of this case to the day of full payment.

The judgment of the court of first instance is revoked. The plaintiff's claim is dismissed.

Of the judgment of the court of first instance, the part against the plaintiff shall be revoked. The defendant shall pay to the plaintiff 804,980 won with 25% interest per annum from the following day from the service of a copy of the complaint of this case to the full payment day.

1. Facts of recognition;

The following facts do not conflict between the parties, or if there is no dispute between the parties, evidence Nos. 4 (Evidence No. 4, 11 (Evidence No. 4; hereinafter the same shall apply), 12 (Evidence No. 4), 13 (Evidence No. 6; hereinafter the same shall apply), 19 (Evidence No. 15), 20 (Evidence No. 3-1; hereinafter the same shall apply), 21, 22 (Evidence No. 3), 28 (Evidence No. 6; hereinafter the same shall apply), 29 (Evidence No. 6), 3 (Evidence No. 17), 9-3 (Evidence No. 5), 17 (Evidence No. 2), 3 (Evidence No. 7), 17 (Evidence No. 1), 3 (Evidence Protocol), 5 (Examination Protocol), 3 (Evidence No. 5), 17 (No evidence No.

A. At around 16:20 on October 12, 1994, Nonparty 2 was an employee of the Answer Credit Union (hereinafter referred to as the “Defendant Credit Union”) and completed the work of cutting back on the rooftop as well according to the direction of Nonparty 1, a regular manager of the Defendant Union, who is responsible for the management of the above building in order to keep away from the home door door of the water pipe located in the roof tower of the building used by the said union located in Jung-gu Incheon Metropolitan City, Jung-gu.

B. After the above work, it was examined whether the above non-party 1 was flooded, and the door was opened and opened by the transformation room. The above non-party 2 entered the said transformation room to confirm the place where water flows, and the head was back, while the head was coming back and the head was high voltage line (22,90V) in the transformation room and head part, the above non-party 2 suffered injuries, such as the electrical image image 15%, and the plenary signboard escape certificate.

C. The said transformation room is installed outside and inside the substation, even a door blocking the inside of the substation is installed, and on both sides of the entrances formed with the steel network, one mark of “special high pressure risk”, “22,905, and special high pressure risk”, and one mark of “special high pressure risk” is attached to the steel network, and only the electrical safety supervisor can enter the said substation.

D. The above non-party 2 received hospitalization and outpatient treatment at the Hansung Hospital for about 44 days after the accident in this case. The above non-party 2 purchased workplace medical insurance from July 5, 1993 to March 7, 1995, which is an employee of the defendant union, from the Incheon District Medical Insurance Association (hereinafter referred to as the "Plaintiff union"), and the plaintiff union paid 2,012,460 won to the non-party 2 on March 28, 1996, excluding the personal burden among the medical expenses at the Hansungsung Hospital for the above non-party 2.

2. Judgment on the plaintiff's claim

(a) Claim for unjust enrichment

The plaintiff first, since the above non-party 2 suffered from the injury caused by the accident in the course of performing his duties, the defendant union is obligated to compensate for medical care pursuant to Article 78(1) of the Labor Standards Act. Meanwhile, according to Article 41(5) of the Medical Insurance Act, "the insurer shall not provide insurance benefits under this Act to the person who is entitled to receive insurance benefits or compensation pursuant to other Acts and subordinate statutes due to an occupational accident." However, the amount paid by the plaintiff as the insurer of the medical insurance bears without any legal cause the part that the defendant union should bear pursuant to the above provisions of the Labor Standards Act. Accordingly, the defendant union is claiming the return of the above amount as unjust enrichment because the plaintiff suffered from the profit equivalent to the above medical insurance amount and the amount equivalent to the above amount

According to Article 87 of the Labor Standards Act, if a person who is eligible to receive compensation for an occupational accident receives money or other valuables equivalent to the accident compensation under the Civil Act or other Acts and subordinate statutes for the same reason, the employer shall be exempted from liability for compensation within the extent of its value. In light of the public nature and function of the Medical Insurance Act, the purpose of the medical insurance, and the fact that the employer bears 50/100 of the premium for the workplace insured in the workplace medical insurance such as this case, it is reasonable to interpret that the payment provision of the insurance premium under the Medical Insurance Act is preferentially applied to the employer, or that the accident worker who received insurance benefits under the Medical Insurance Act is not entitled to claim medical expenses, etc. with respect to the amount equivalent to the amount thereof (in the event that the compensation under the Industrial Accident Compensation Insurance Act is combined with the compensation under the same Act, only the industrial accident compensation insurance claim and the two claims exist, and even if the opinion of the latter is obtained after the association's view, it cannot be interpreted that the plaintiff was not entitled to the industrial accident compensation claim under the Labor Standards Act.

(b) Claim for indemnity;

(1) According to the above facts, the accident of this case, which is the general manager of the building of this case, is caused by the negligence in the execution of the business that allowed the above non-party 2 to confirm the inundation of the above transformation room, on the ground that the accident of this case, as the above non-party 1, who is the general manager of the building of this case, can enter high pressure and only the safety manager could enter the transformation room, and it is caused by the negligence in the execution of the business that allowed the above non-party 2 to confirm the place where water flows, and let the above non-party 2 enter the transformation room. Thus, the above non-party 1's employer who is the above non-party 1, who manages the above transformation room, is liable to compensate the above non-party 2 for the damages caused by the above accident (refer to the evidence 8 and the mediation protocol). Thus, the accident of this case is caused by the accident of insurance benefits caused by the tort of the defendant association, which is the third party.

(2) As to this, in the case of damages claim for 95 Gohap2735 (former), which was brought by the above non-party 2 et al. to the above non-party 1 and the defendant association as co-defendant 2, the court below set up the damages claim for the above non-party 2 against the non-party 1,000,000 won to the non-party 3, and the non-party 1,000,000 won to the non-party 4, and the non-party 5 to the non-party 1,000,000 won to the non-party 5, and the non-party 6 to the non-party 1,00,000 won to the non-party 1 and the defendant association, the damages claim for the above non-party 2 against the non-party association ceased to exist, and there is no reason to acknowledge the plaintiff's defense that the non-party 2's compensation claim for damages was made under the premise that the non-party 2's compensation claim for damages claim was not asserted.

(3) Scope of indemnity

위에서 든 증거들에 의하면, 위 변전실 안에 물이 찼는지 여부는 변압기가 있는 변전실 안에 들어가지 않고 그 밖에서도 육안으로 확인이 가능한데, 위 소외 2는 위 소외 1의 명백한 지시가 없었음에도 위 변전실의 어느 부분에 물이 찼는지 보기 위하여 스스로 그 안에 들어갔으며, 위 소외 2보다 먼저 변전실 내에 들어갔던 위 소외 1은 아무런 사고를 당하지 아니하였으나 위 소외 2는 나오는 과정에서 머리를 드는 바람에 이 사건 사고를 당한 사실 등을 인정할 수 있는바, 그렇다면 위 소외 2의 위와 같은 잘못도 이 사건 사고의 발생에 있어서 중요한 하나의 원인이 되었다 할 것이고 그의 과실 비율은 위 인정 사실에 비추어 70％로 봄이 상당하므로, 피고 조합은 치료비 중에서 원고가 지급한 조합부담금의 범위 내에서 피고측의 과실 비율에 상당한 금액인 금 603,738원(＝2,012,460×0.3) 및 이에 대한 지연손해금을 구상할 의무가 있다 할 것이다.

3. Conclusion

Therefore, the defendant is obligated to pay to the plaintiff the above 603,738 won and the amount equivalent to 5% per annum under the Civil Act from July 11, 1996 to May 9, 1997, which is an obvious day after the ruling of the court of first instance, on the records that the above 603,738 won and the above 603,738 won are the next day after the delivery of the copy of the complaint of this case, and the amount equivalent to 25% per annum under the Special Act on the Promotion, etc. of Legal Proceedings from the next day to the day after the full payment is made (the plaintiff claimed damages for delay from the next day after the delivery of the copy of the complaint of this case to the date of the decision of the court of first instance, but it is reasonable to dispute about the existence and scope of the payment obligation, so the ratio under the above special Act is not applied to the above period, so the judgment of first instance which differs from this part of the judgment of the court of first instance is unfair. The plaintiff's remaining appeal and the plaintiff's appeal are dismissed.

Judges Kim Tae-dae (Presiding Judge)