근로복지공단이 산업재해보상보험법에 따라 재해근로자에게 보험급여를 한 다음 재해근로자의 제3자에 대한 손해배상청구권을 대위하는 경우 그 대위 범위

In the en banc decision 2018Da287935 delivered on March 18, 2021, the Supreme Court revised the precedent, which adopted the method of “deduction after assessment of contributory negligence,” by determining that in a case where the aggrieved party who received insurance benefits under the National Health Insurance Act files a claim for payment of damages against the offender, and where the aggrieved party is found to have also been negligent in causing the injury, the amount of damages payable to the aggrieved party for medical expenses incurred thus far ought to be calculated by first deducting the amount borne by the NHIC from the total amount of medical expenses incurred by the aggrieved party and then allocating responsibility according to the degree of fault which is so called “assessment of contributory negligence after deduction of the amount borne by the NHIC” method. Previously the Supreme Court determined that in a case where an injured worker who received insurance benefits pursuant to the Industrial Accident Compensation Insurance Act files a claim for damages against a third party, and where the said injured worker is found to have been at fault in causing the injury, thus necessitating the assessment of contributory negligence, calculation of the amount claimable by the NHIC ought to be carried out by first assessing contributory negligence in the amount of damages and then deducting insurance benefits, and that the insurance benefits so deducted cannot be subject to the assessment of contributory negligence (so called “deduction of the amount borne by the NHIC after the assessment of contributory negligence), and the scope of which the NHIC can subrogate the aggrieved party’s right to claim damages against a third party in accordance with Article 87(1) of the Industrial Accident Compensation Insurance Act should be the “amount of insurance benefits in full.” However, in the wake of the pronouncement of the Supreme Court en banc Decision 2018Da287936, the question arose as to whether the legal doctrine proclaimed in the said en banc decision concerning a national health insurance scheme must likewise be upheld in the case involving an industrial accident compensation insurance or instead be determined on the basis of different standards considering the nature of the industry accident compensation insurance as a liability insurance. This question becomes particularly perplexing when a business owner is at fault for the occurrence of an occupational accident. Given that an insurance premium of the industry accident compensation insurance has to be paid in full by an employer who has subscribed to the industry accident compensation insurance, unlike the national health insurance that requires only part of the premiums to be paid by an employer, one might inquire into whether seeking damages from the employer for the amount of insurance benefits corresponding to an aggrieved worker’s fault, in a case where an occupational accident has occurred due to a fault on the part of the business owner, is at odds with the nature of the industry accident compensation insurance as a liability insurance. However, the industry accident compensation insurance is a social insurance, and it is difficult to consider that it only has the features of a liability insurance. The fundamental difference between the method of “assessment of contributory negligence first and deduction later” and the method of “deduction first and assessment of contributory negligence later” depends on whether to consider the amount of the insurance benefits corresponding to an aggrieved worker (victim)’s fault as equivalent to “compensation for damages” suffered by the said aggrieved worker. The method of “assessment of contributory negligence first and deduction later” considers the amount of the insurance benefits corresponding to the aggrieved worker’s fault as equivalent to compensation for damages for civil wrongs, whereas the method of “deduction first and assessment of contributory negligence later” considers insurance benefits of the industry accident compensation insurance as different from compensation for civil damages. In the subject case, the Supreme Court determined as follows. The comprehensive examination of the language and text of Article 87 of the Industry Accident Compensation Insurance Act and its legislative purport, the purpose of the industry accident compensation insurance scheme and its nature as social security benefits, and the weighing and balancing of interests among the injured worker (including those entitled to insurance benefits, such as bereaved families), the NHIC, and the tortfeasor reveals that in a case where the NHIC pays insurance benefits to an injured worker on the grounds of a third party’s wrongdoing, the scope of which the NHIC　may exercise the injured worker’s right to claim compensation against the third party in lieu of the said injured worker pursuant to Article 87(1) of the Industry Accident Compensation Insurance Act is limited to the amount of the insurance benefits corresponding to the degree of the third party’s liability, with a maximum cap on the portion of the damages the third party is liable. As such, the NHIC cannot exercise the right of subrogation in lieu of the injured worker with regard to the amount of insurance benefits that corresponds to the percentage of liability on the part of the injured worker, and the NHIC ought to be responsible for the said amount for the injured worker who has not been compensated for his or her loss even after having received insurance benefits. Accordingly, in a case where an injured worker who has received insurance benefits in accordance with the Industry Accident Compensation Insurance Act files a claim for damages against a third party, and where the said injured worker was also at fault for causing the injury, the amount of damages claimable by the injured worker ought to be calculated by first deducting the paid insurance benefits from the amount of losses, which is of the same nature as the insurance benefits, and then taking into account the percentage of the insured’s fault, i.e., the method of “assessment of contributory negligence after deduction.” Based on this rationale, the Supreme Court changed the previous decisions. Furthermore, the Supreme Court stated in the subject case that in a case where an injury has occurred due to joint unlawful acts committed by the business owner, who owns the industry accident compensation insurance, and the third party, the NHIC can exercise the injured worker’s right to claim for damages against the said third party to the extent of the amount of insurance benefits that corresponds to the third party’s percentage of liability, with a maximum cap of the amount of damages, of which the third party is responsible for payment. Yet the Supreme Court confirmed that the part of the reasoning of the Supreme Court en banc Decision 2000Da62322 Decided March 21, 2002, which proclaimed a principle that the NHIC cannot exercise an injured worker’s right to claim damages against the third party for the amount corresponding to the degree of fault on the part of the business owner who owns the industry accident compensation insurance, in light of the purpose of encouraging procedural economy to prevent a repetitious cycle of lawsuits for indemnification, was still reasonable. As examined above, the subject case placed a reasonable limit up to which the NHIC can exercise in subrogation an injured worker’s right to claim for payment of damages against a third party by changing the previous Supreme Court decisions, thereby ensuring that an injured worker receives compensation for part of the losses at workplace for which he or she is at fault through the industry accident compensation insurance. In so doing, the subject case brought to mind that the industry accident compensation insurance, which was used to be summoned up only in relation to its characteristic as a liability insurance, also has the nature of a social insurance, while seeking to strike a balance between the two characteristics and ensuring that the industry accident compensation insurance serves its purpose of existence and intended role that aligns with the modern industrialized society.