National Health Insurance Corporation

Korea Labor Welfare Corporation

May 20, 2014

Daegu District Court Decision 2013Gau8701 Decided January 3, 2014

1. The plaintiff's appeal is dismissed.

2. The costs of appeal shall be borne by the Plaintiff.

The defendant shall pay to the plaintiff 240,700 won with 5% interest per annum from July 1, 2010 to the service date of a copy of the complaint, and 20% interest per annum from the next day to the day of complete payment.

1. Basic facts

The non-party, who is an employee of Youngdo C&C, was treated for injury on October 27, 2009 due to an accident that occurred during the performance of his/her duties, and the plaintiff paid 14,030 won of medical expenses from April 13, 2010 to April 24, 2010, and 96,760 won of medical expenses from May 6, 2010 to May 28, 2010 to the hospital that treated the non-party on June 1, 2010 and the same month. The defendant approved the industrial accident of the non-party on November 16, 2009, and the plaintiff decided to provide additional medical care benefits on July 2, 2010 to the non-party on June 21, 2013, and the purport of the whole statement can be acknowledged if there is no dispute between the parties concerned or if there is no dispute between the parties concerned.

2. The parties' assertion

A. The plaintiff's assertion

The defendant is obligated to pay the above non-party medical expenses due to industrial accident. Since the plaintiff paid them as national health insurance benefits and the defendant obtained unjust gains from exempting the defendant from paying them without any legal cause, the defendant is obligated to pay the above amount of medical expenses to the plaintiff pursuant to Article 741 of the Civil Act.

B. Defendant’s assertion

Article 90(1) of the former Industrial Accident Compensation Insurance Act (amended by Act No. 11141, Dec. 31, 201; hereinafter “Industrial Accident Compensation Insurance Act”) provides for the sharing of expenses between the Plaintiff and the Defendant. This is a special clause which takes precedence over the unjust enrichment provisions of the Civil Act. The Plaintiff filed a claim against the Defendant for settlement of the said medical expenses after the lapse of three years under Article 112(1)5 of the Industrial Accident Compensation Insurance Act from the period of the said medical care to the Nonparty for the said period after the lapse of three years under Article 112(1)5 of the Industrial Accident Compensation Act. As such, the Defendant is not obliged to pay the Plaintiff the settlement of the said medical expenses.

3. Determination

A. Relevant provisions

【former National Health Insurance Act (wholly amended by Act No. 1141, Dec. 31, 201)

Article 48 (Restriction on Benefits)

(1) When a person who is eligible to receive insurance benefits falls under any of the following subparagraphs, the NHIS shall not provide any insurance benefit:

4. Where a person receives insurance benefits, compensation or compensation pursuant to other Acts and subordinate statutes due to an occupational or official disease, injury, or accident.

【former Industrial Accident Compensation Insurance Act (amended by Act No. 11141, Dec. 31, 201)

Article 40 (Medical Care Benefits)

(1) Medical care benefits shall be paid to any worker who suffers from an injury or disease caused by reason of his/her duties.

(2) Medical care benefits referred to in paragraph (1) shall be provided by an industrial accident insurance-related medical institution referred to in Article 43 (1): Provided, That in extenuating circumstances, medical care expenses may be provided in lieu of medical care.

Article 42 (Preferential Application of Health Insurance)

(1) Any person who applies for medical care benefits pursuant to Article 41 (1) may receive medical care benefits under Article 39 of the National Health Insurance Act before the Service makes a decision on medical care benefits under this Act.

Article 90 (Settlement of Medical Care Benefit Costs)

(1) Where the National Health Insurance Corporation or a beneficiary of medical care benefits under Article 12 of the National Health Insurance Act preferentially pays health insurance, medical care benefits, etc. and claims such expenses to the beneficiary of medical care benefits under this Act pursuant to Article 42 (1), the NHIS may pay the amount equivalent to the medical care benefits in which the health insurance, medical care benefits, etc. are payable pursuant to this Act,

Article 112 (Prescription)

(1) The following rights shall be extinguished by prescription, unless exercised within three years:

5. Rights of the National Health Insurance Corporation, etc. under Article 90 (1);

(2) The Civil Act shall apply to the extinctive prescription under paragraph (1), except as otherwise provided for in this Act.

B. Determination on the assertion

In the event that the plaintiff paid benefits corresponding to medical care benefits to the worker suffering from occupational accidents, the defendant obtains unjust enrichment that would be exempted from medical care benefits under the Industrial Accident Compensation Act within its scope. Article 90(1) of the Industrial Accident Compensation Act is a provision specifying the settlement relationship between the plaintiff and the defendant with respect to unjust enrichment arising from the above circumstances, and Article 112 of the Industrial Accident Compensation Act provides that the period of extinctive prescription of the settlement amount under Article 90(1) of the Industrial Accident Compensation Act shall be three years and only the other part shall be governed by the Civil Act. In light of the above settlement under the Industrial Accident Compensation Act and the fact that one of the unjust enrichment under the Civil Act, which is the general law, can be alternatively exercised by the plaintiff, the above provision of the Industrial Accident Compensation Act shall be deemed to fall under a special provision applicable in preference to the unjust enrichment under the Civil Act, and therefore, the settlement amount of medical expenses to the plaintiff seeking the return of the medical expenses shall be applied to the period of extinctive prescription under Article 112(1) of the Industrial Accident Compensation Act.

In addition, since health insurance benefits are provided in the form of spot benefit, insurance benefits are practically provided when the insured receives medical treatment from a health care institution (see Supreme Court Decision 2012Da39103, Sept. 13, 2012). As the Plaintiff can exercise his/her right under Article 90(1) of the Industrial Accident Compensation Act from that time, the extinctive prescription is not the date of approval of the Defendant’s industrial accident, but the insured’s “when he/she receives medical treatment.”

As to the instant case, since the Plaintiff paid medical care benefits to the Nonparty during the period from April 13, 2010 to April 24, 2010, and from May 6, 2010 to May 28, 2010, the Defendant is obligated to settle and return the amount equivalent to the medical care benefits cost to the Plaintiff from that time. However, as seen earlier, the Plaintiff claimed the return of the said medical expenses to the Defendant on June 21, 2013 after that three years passed from that time. Therefore, the settlement amount for the said medical expenses claimed by the Plaintiff was extinguished by prescription.

As to this, the plaintiff cannot make a claim for the settlement of accounts against the defendant before the defendant's approval for industrial accident is granted, and it is inevitable to believe that the claim for the settlement of accounts itself is an unsound one. Thus, despite special circumstances where it is difficult to expect the plaintiff's exercise of right, the defendant's assertion of extinctive prescription based on the period of medical care is contrary to the good faith principle, but the defendant's claim for the settlement of accounts based on the premise of industrial accident approval is not impossible, but the claim for the settlement of accounts based on the premise of industrial accident approval is not possible, and even if counting from the date of industrial accident compensation approval

4. Conclusion

Therefore, the plaintiff's claim is dismissed as it is without merit, and the judgment of the court of first instance is just, and the plaintiff's appeal is dismissed as it is without merit. It is so decided as per Disposition.

Judges Kim Hyun-chul (Presiding Judge)