In cases where the National Health Insurance Corporation, after receiving insurance benefits from a victim of a tort, subrogates the victim's perpetrator or the insurer for damage, the scope of subrogation, and whether the perpetrator or the insurer can deduct the amount of money paid to the victim as compensation after receiving insurance benefits from the National Health Insurance Corporation (negative)

Article 58 (1) of the National Health Insurance Act

Supreme Court Decision 2010Da7294 Decided April 29, 2010, Supreme Court Decision 2012Da39103 Decided September 13, 2012, Supreme Court Decision 2013Da208524 Decided October 24, 2013 Supreme Court Decision 2015Da23028 Decided December 10, 2015

National Health Insurance Corporation

D non-life insurance Co., Ltd. (former trade name: Dong Fire Insurance Co., Ltd.) (Attorney Won-hee et al., Counsel for the plaintiff-appellant)

Busan District Court Decision 2014Na44717 Decided July 17, 2015

The judgment below is reversed and the case is remanded to Busan District Court.

The grounds of appeal are examined.

1. Medical care benefits under the National Health Insurance Act are, in principle, in the form of spot benefit that provides medical care until a disease or injury is cured by a medical care institution. Accordingly, when an insured under medical care institution receives medical care, the National Health Insurance Corporation shall obtain the right to indemnity from a third party within the limit of the insurance benefits. In addition, when the National Health Insurance Corporation provides insurance benefits to the injured party due to a tort and then subrogates the injured party or the insurer of the damage claim against the injured party or the insurer thereof, it may subrogate the injured party or the insurer of the damage claim for the whole amount of the insurance benefits within the limit of the damage claim calculated based upon the injured party’s negligence, etc. In this context, the offender or the insurer after the insurance benefits of the National Health Insurance Corporation cannot deduct the amount paid to the injured party for the purpose of compensation (see, e.g., Supreme Court Decisions 2010Da7294, Apr. 29, 2010; 2012Da39103, Sept. 13, 2013).

2. According to the records, the defendant was the insurer who entered into a comprehensive water-related leisure insurance contract (hereinafter “instant insurance contract”) with the non-party 1 (hereinafter “non-party 1”) to compensate for the damage to another person during the possession, use, or management of water leisure crafts by making the insured the non-party 1 as the non-party 1. The victim was the insurer who entered into the instant insurance contract within the limit of KRW 100 million. The victim 2 was the non-party 1 on July 28, 2012 when he was aboard the water-related leisure craft operated by the non-party 1 and landed the water-related leisure craft on the sea (hereinafter “the instant accident”), and the non-party 1 was the accident falling down at the wind operated by the non-party 1 (hereinafter “the instant accident”) on the water-related leisure craft and paid KRW 370 million to the non-party 20 billion in total to the non-party 20.37 billion won, and the plaintiff paid the total medical expenses to the non-party 258.25 billion won.

3. Examining the above facts in light of the legal principles as seen earlier, the Plaintiff, who provided insurance benefits, may seek reimbursement against the Defendant, who is the insurer of Nonparty 1, within the scope of the victim’s damage claim. Nevertheless, the lower court, based on its reasoning, did not allow the Plaintiff to exercise the Plaintiff’s right of indemnification by deeming that the Defendant was exempted from the payment of insurance proceeds to the victim in the instant case where the victim’s remaining amount of damage exceeds the Defendant’s insurance payment limit. In so doing, the lower court erred by misapprehending the legal doctrine on the exercise of the right of indemnification under Article 58(1) of the National Health Insurance

4. Therefore, 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 Park Jung-hwa (Presiding Justice)