Whether “insured” who is jointly and severally liable with a person who has received insurance benefits pursuant to Article 84(2) of the Industrial Accident Compensation Insurance Act fails to meet the requirements of an insured, but includes a person who personally conducted activities as an employer in relation to the Korea Workers’ Compensation and Welfare Service and confirmed the occurrence of disasters (affirmative)

Article 84(1) and (2) of the Industrial Accident Compensation Insurance Act provides that, prior to the determination of the Service on an application for medical care benefits by an employee, the Industrial Accident Compensation Insurance Act provides that the employer may relatively accurately understand the circumstances of the accident in cases where the accident occurred in the area controlled and managed by the employer, and that the employer may have a legal and economic interest conflicting with the interests of the employee in relation to the recognition of the accident on duty, and thus, trust the employer’s confirmation or opinion. In addition, Article 84(1) and (2) of the Industrial Accident Compensation Insurance Act provides that the scope of collection by the Corporation shall be double the amount equivalent to the amount of benefits, and that the employer shall be jointly and severally liable with the person who received the insurance benefits, such as the insured on account of false reports and statements made by the employer in the course of determining the insurance benefits, taking into account the importance of the report and statement made by the employer in the course of determining the insurance benefits, thereby preventing the employer’s entrustment of insurance benefits and promoting industrial soundness by actively imposing the insurance benefits as if the disaster occurred.

Therefore, “insured” under Article 84(2) of the Industrial Accident Compensation Insurance Act, which is jointly and severally liable with a person who received insurance benefits under Article 84(2), includes not only a person who is recognized as having been insured in light of the substance of the pertinent fact, but also a person who, even if the person failed to meet the requirements of the insured in light of the substance of the relevant fact,

In addition, to ask the insured jointly and severally liable pursuant to Article 84(2) of the Industrial Accident Compensation Insurance Act, there is a subjective perception about false reports, etc. to the insured. If the report or confirmation is made by an agent or employee rather than the insured himself/herself, the existence of awareness about false reports, etc. should be determined based on not only the person himself/herself but also all relevant persons such as agents.

Articles 6, 41(1), 84(1) and (2) of the Industrial Accident Compensation Insurance Act; Article 20(1) and (3) of the Enforcement Rule of the Industrial Accident Compensation Insurance Act; Article 5(3) and Article 7 subparag. 2 of the Act on the Collection of Insurance Premiums for Employment Insurance and Industrial Accident Compensation Insurance

Plaintiff (Attorney Lee Jae-won, Counsel for the plaintiff-appellant)

Korea Labor Welfare Corporation

Seoul High Court Decision 2015Nu38964 decided March 9, 2016

The judgment below is reversed and the case is remanded to Seoul High Court.

The grounds of appeal are examined.

1. A. Article 84(1) of the Industrial Accident Compensation Insurance Act provides, “Where a person who has received insurance benefits falls under any of the following subparagraphs, the Service shall collect the amount equivalent to the amount of such benefits (in cases falling under subparagraph 1, the amount equivalent to twice the amount of such benefits).” In such cases, the Service shall exclude the amount of the benefits to be collected by a claim from the National Health Insurance Corporation, etc. pursuant to Article 90(2) of the Industrial Accident Compensation Insurance Act.” Article 84(1) provides, “Where the Service has received the insurance benefits by fraud or other improper means, the amount equivalent to twice the amount of benefits shall be collected by unjust enrichment.” Article 84(2) provides, “If the payment of the insurance benefits is due to a false report, diagnosis, or certification by a policyholder, industrial accident insurance-related medical institution, or vocational training institution, the insured, industrial accident insurance-related medical institution, or vocational training institution shall also

Meanwhile, Article 41(1) of the Industrial Accident Compensation Insurance Act provides, “A person who intends to receive medical care benefits (excluding medical care benefits for pneumoconiosis) under Article 40(1) shall file an application for medical care benefits with COMWEL, along with documents stating his/her workplace, circumstances of the accident, medical opinions on the accident, and other matters prescribed by Ordinance of the Ministry of Employment and Labor. In such cases, the procedure and methods for filing an application for medical care benefits shall be prescribed by Ordinance of the Ministry of Employment and Labor.” Article 20(1) of the Enforcement Rule of the Industrial Accident Compensation Insurance Act provides, “The term “the matters prescribed by Ordinance of the Ministry of Employment and Labor” in Article 41(1) of the Act refers to the confirmation of the insured of the circumstances of the accident of the worker who intends to receive medical care benefits, and Article 41(3) of the same Act provides, “Where the Service receives an application for medical care benefits without confirmation of the insured under paragraph (1), he/she shall notify the insured to whom the relevant worker belongs.” In such cases,

B. According to Article 6 of the Industrial Accident Compensation Insurance Act, Articles 5(3) and 7(2) of the Act on the Collection of Insurance Premiums, etc. for Industrial Accident Compensation Insurance and Industrial Accident Compensation Insurance, in principle, all employers of businesses or places of business who employ workers are automatically insured of industrial accident compensation insurance. Whether employers who are insured and workers who receive insurance benefits in industrial accident insurance are determined based on the contents of the report to the Korea Workers' Compensation and Welfare Service, rather than on the basis of the substance of the pertinent fact (Supreme Court Decision 98Du2201 delivered on February 24, 199).

However, Article 84(1) and (2) of the Industrial Accident Compensation Insurance Act provides that the Industrial Accident Compensation Insurance Act provides that, prior to the determination by the Service on an employee’s application for medical care benefits, the procedure is essential to confirm the occurrence of the disaster or give an opportunity to present opinions. If an accident occurred in the area controlled and managed by the employer, the employer may relatively accurately understand the occurrence of the accident. In addition, the employer may have a legal and economic interest conflicting with the employee’s interests in recognition of occupational accidents, and thus, may have a trust in finding the employer’s confirmation or opinion. Furthermore, Article 84(1) and (2) of the Industrial Accident Compensation Insurance Act provides that the scope of collection of benefits by the Corporation shall be double the amount equivalent to the amount of benefits paid by the Corporation, and that the employer shall be jointly and severally liable with the person who received the insurance benefits if the payment was made by a false report and statement of the employer, etc. is determined in the process of determining the insurance benefits as above, it appears that the employer and the employee are subject to sanctions by actively confirming the occurrence of the accident.

Therefore, “insured” who is jointly and severally liable with a person who received insurance benefits pursuant to Article 84(2) of the Industrial Accident Compensation Insurance Act should be deemed as not only a person who is recognized as an insured in light of the substance of the pertinent fact, but also a person who confirmed the occurrence of an accident in relation to the Service, even if the person fails to meet the requirements of the insured in light of the substance of the pertinent fact.

In addition, to ask such a policyholder jointly and severally liable pursuant to Article 84(2) of the Industrial Accident Compensation Insurance Act, there should be subjective perceptions about false reports, etc. to the policyholder. If such reports or confirmations were made by an agent or employee rather than the policyholder himself/herself, the existence of awareness about false reports, etc. should be determined on the basis of not only the person himself/herself but also all relevant persons such as agents.

2. Nevertheless, on different premises, the lower court determined that the instant disposition, which the Defendant decided to collect double the amount of unlawful payment with the Plaintiff jointly and severally with the Plaintiff based on Article 84(2) of the Industrial Accident Compensation Insurance Act, was unlawful, on the ground that the Plaintiff was not deemed an insured under Article 84(2) of the Industrial Accident Compensation Insurance Act, since the Plaintiff had not been established with true insurance relationship between the Plaintiff and the Corporation at the time of the occurrence of the accident, and the Plaintiff, the owner, upon the request of the construction contractor, could not be deemed as an insured under Article 84(2) of the Industrial Accident Compensation Insurance Act, and the Plaintiff, the owner, was merely aware of the circumstances leading up to the occurrence of the disaster in the name of the Plaintiff. In so doing, it erred by misapprehending the legal doctrine

3. 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 Sang-ok (Presiding Justice)