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(영문) 광주고등법원 (전주) 2018.06.11 2016누1597
요양급여불승인처분취소
Text

1. Revocation of the first instance judgment.

2. On August 1, 2014, the Defendant’s disposition of non-approval of medical care benefits rendered to the Plaintiff.

Reasons

1. The reasoning of the judgment by the court concerning this part of the disposition is identical to that of the judgment of the court of first instance, and thus, the judgment of the court of first instance shall be quoted in accordance with Article 8(2) of the Administrative Litigation Act and the main sentence of Article 4

2. Whether the disposition is lawful;

A. The reasoning of the judgment by the court concerning this part of the Plaintiff’s assertion is the same as that of the judgment of the court of first instance, and thus, the judgment of the court of first instance shall be quoted in accordance with Article 8(2) of the Administrative Litigation Act and the main sentence of

B. Determination 1) “Occupational accident” under Article 5 subparag. 1 of the Industrial Accident Compensation Act refers to an employee’s injury, disease, disability, or death resulting from his/her duties during the performance of his/her duties, and thus, there is a causal relationship between his/her duties and the disaster. In addition, such causal relationship is not necessarily required to be proved by medical or natural science, but if it is presumed that there is a proximate causal relationship between his/her duties and the disease, considering all circumstances, and the causal relationship should be proved if the basic disease or existing disease, which can be ordinarily worked at ordinary level, rapidly worsens at a natural speed or above due to excessive performance of his/her duties, should be determined based on the health and physical conditions of the relevant employee (see, e.g., Supreme Court Decisions 2006Du4912, Apr. 12, 2007; 2016Du56134, Apr. 28, 2017). 19).

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