Plaintiff (Attorney Park Jong-type et al., Counsel for the plaintiff-appellant)

Korea Labor Welfare Corporation

March 8, 2013

1. The Defendant’s disposition of refusal to grant medical care to the Plaintiff on August 24, 2011 is revoked.

2. The costs of the lawsuit are assessed against the defendant.

The same shall apply to the order.

1. Details of the disposition;

The following facts are not disputed between the parties:

A. On June 30, 2010, the Plaintiff was an employee employed by the ○○ Commercial Association (hereinafter “Nonindicted Company”), and was engaged in the delivery business by driving a motor vehicle (motor vehicle number omitted) under the business owner’s name (hereinafter “instant motor vehicle”), and was under medical care at the Daegu-gu Hospital from June 30, 2010 to October 5, 2010.

B. The instant vehicle was subscribed to the automobile insurance operated by Samsung Fire and Marine Insurance Co., Ltd. (hereinafter “ Samsung Fire”) with the content as indicated below, and accordingly, the Plaintiff had Samsung Fire pay KRW 25,282,208 to the said hospital as medical care costs.

The insured period included in the main sentence shall be KRW 100,000,000,000 won per person (per person) 100,000 won of death (per person) who is not a 100,000,000 won, which is not a 100,000 won of his/her own physical or mental accident, i.e., the personal injury Ⅱ (the personal injury Ⅱ) in the attached insurance period;

C. On August 5, 2011, the Plaintiff asserted that the instant traffic accident constituted occupational accidents, and filed an application for medical care benefits for each of the above injury and disease with the Defendant.

D. On August 24, 2011, the Defendant rendered the instant disposition rejecting medical care benefits to the Plaintiff on the ground that “The automobile insurance for one’s own physical accidents is characterized by non-life insurance to which the principle of compensation for loss applies, and thus, the insurance proceeds for one’s own physical accidents paid to the affected employee should be deducted from the industrial accident compensation insurance benefits. However, given that the Plaintiff received the insurance proceeds for one’s own physical accidents equivalent to medical care benefits on the ground of the instant traffic accident, there is no medical care benefits payable to the Plaintiff.

2. Whether the disposition is lawful;

A. The plaintiff's assertion

"Money and valuables received under the Civil Act or other Acts and subordinate statutes" deducted from industrial accident compensation insurance benefits means money and valuables paid in order to compensate for any damage which is the object of civil compensation.

However, since self-physical accident insurance is pure accident insurance rather than liability insurance to guarantee liability for damages, the insurance money received accordingly shall not be deducted from the industrial accident compensation insurance benefit.

Therefore, the instant disposition made on a different premise is unlawful.

B. Determination

According to Article 80(3) of the former Industrial Accident Compensation Insurance Act (amended by Act No. 11141, Dec. 31, 2011), when a beneficiary receives money and valuables equivalent to insurance benefits under this Act for the same reason under the Civil Act or other Acts and subordinate statutes, the Corporation shall not pay the money and valuables received within the limit of the amount converted by the method prescribed by Presidential Decree.

The purpose of the above provision is to directly compensate the employee for the loss caused by the occupational accident of the employee who is liable to compensate for the insurance benefits under the Industrial Accident Compensation Insurance Act, so it is reasonable to deduct the money and other valuables received by the employee due to the performance of the liability for accident compensation or the liability for damages caused by the occupational accident from the benefits of the industrial accident compensation insurance in question, with the purport that the occupational accident which is the cause of the insurance benefits, concurrently satisfies the requirements for accident compensation or liability for damages of the

Therefore, the term "the same reason" under the Industrial Accident Compensation Insurance Act refers not simply to the same accident-related damage, but to the case where the damage subject to industrial accident compensation insurance benefits and the damage which is compensated by the Civil Act and other Acts and subordinate statutes are the same nature (see Supreme Court Decision 90Da11776 delivered on July 23, 191).

However, insurance money due to one’s own physical accident is not a liability insurance for securing the liability for damages, etc. to be borne by the employee to the employee in question under the Civil Act and other Acts and subordinate statutes (see Supreme Court Decision 2008Da8430, Jun. 12, 2008). Therefore, Samsung Fire is liable for the payment of insurance money in accordance with the insurance contract with the non-party who is the insured due to the accident of insured automobile that occurred while the non-party who is the employer owns, uses, and manages the insured automobile under the self-physical accident insurance contract with the non-party who is the employer, and it does not pay insurance money to the non-party who is the non-party.

Therefore, the above insurance money for self-physical accidents cannot be seen as money to be paid under the Civil Code or other Acts and subordinate statutes stipulated in Article 80(3) of the Industrial Accident Compensation Insurance Act.

Therefore, the instant disposition made on a different premise is unlawful.

3. Conclusion

Therefore, we decide to accept the Plaintiff’s claim of this case and decide as per Disposition.

Judge Lee Jong-hoon