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대법원 89누2318

Revocation of Denial of Industrial Accident Medical Care Benefits Application산업재해요양신청불승인결정취소

Decided1989. 11. 14. Court대법원Worker won
AI-generated English translation (summary, key points, decision summary and full text) for reference only — not an official translation and without legal effect. The Korean original below is authoritative.
AI Easy read — AI summary of this decision
AI-generated summary for reference only — the Korean original below is authoritative.

This Supreme Court of Korea (대법원) precedent established the principle that a pre-existing medical condition can qualify as a work-related injury (업무상 재해) if it is aggravated by work duties. In this case, the worker's spinal cord tumor was worsened by a work-related lumbar strain, and the court ruled this qualified for industrial accident compensation (산재보상). The worker (plaintiff) won the case, and the denial of medical care benefits was overturned.

Key takeaways
  • CaseA worker with a pre-existing spinal cord tumor suffered a work-related lumbar strain that worsened the underlying condition, but the industrial accident agency denied the medical care benefits application.
  • OutcomeThe Supreme Court ruled that aggravation of a pre-existing illness due to work counts as a work-related injury, and ordered the denial decision to be reversed, allowing the claim within the valid time limits.
  • LessonWorkers with pre-existing health conditions that are worsened by work duties should not assume they are ineligible for industrial accident compensation, and should file claims promptly since benefit claims accrue daily during ongoing treatment.
Issues
  • Whether a pre-existing medical condition aggravated by work duties qualifies as a work-related injury (업무상 재해)
  • The scope of the statute of limitations for medical care benefit claims (요양급여청구권) when the work-related illness is ongoing
Key reasoning

The court held that even a pre-existing illness unrelated to work duties can be recognized as a work-related injury if work activities caused it to worsen, establishing a sufficient causal link. Because the worker's medical treatment was ongoing, the court determined that the statute of limitations (소멸시효) for medical care benefit claims (요양급여청구권) runs separately for each day of treatment received, rather than as a single clock starting from one point in time. As a result, claims for treatment within three years prior to the application date, as well as future treatment claims, remained valid and enforceable.

Summary of Decision (English, AI translation)

a.
An occupational injury or disease under Article 3(1) of the Industrial Accident Compensation Insurance Act (산업재해보상보험법) means an injury or disease sustained by a worker as a result of performing his or her duties, and thus there must be a causal relationship between the duties and the occurrence of the injury or disease. However, even if the injury or disease is a pre-existing condition that has no direct relation to the worker's duties, if that condition has been aggravated by another injury arising in connection with the performance of duties, then a causal relationship must be deemed to exist between the aggravation of the pre-existing condition and the duties.

b.
Under the Industrial Accident Compensation Insurance Act, the starting point for the extinctive prescription period for the right to receive insurance benefits is the time when the right can be exercised; in the case of the right to claim medical care benefits, this period runs day by day from the day following the date on which the specific cost of medical care is determined, that is, the day following the date on which the medical care was received. Therefore, where an illness caused by an occupational injury continues, even if the extinctive prescription has already been completed for the portion of the right to claim medical care benefits exceeding three years counted backward from the time the worker filed the application for medical care benefits, the running of the prescription period for the portion within three years and for the portion that will arise in the future is interrupted by the said application for medical care benefits.

Full text (English, AI translation) 4,124 chars

[Plaintiff, Appellee] Shin Dong-young
[Defendant, Appellant] Head of Ulsan Regional Labor Office

[Original Judgment]

Busan High Court Judgment 1989.3.10., 88Gu971

[Order]

The appeal is dismissed.
The costs of the appeal shall be borne by the Defendant.

[Reasoning]

As to the grounds of appeal,

1.
An occupational accident under Article 3(1) of the Industrial Accident Compensation Insurance Act (산업재해보상보험법) means an accident sustained by a worker arising from the performance of duties, and there must of course be a causal relationship between the duties and the occurrence of the accident. However, even where the injury in question is a pre-existing disease not directly related to the duties, if that disease has been further aggravated by another accident that occurred in connection with the duties, a causal relationship must be deemed to exist between the aggravation of the pre-existing disease and the duties.

The court below found that the Plaintiff, an employee of the non-party Korea Electric Power Corporation working as a substation worker, sustained a lumbar sprain injury by wrenching his back while performing the work described in the judgment on two occasions, namely on 1980.7.13. and 1984.9.3. The court below then determined that, although the spinal cord tumor at issue in this case was not caused by the aforementioned lumbar sprain, it is at least recognized that the progression of the tumor was accelerated and its symptoms were aggravated as a result thereof, and therefore the Plaintiff's spinal cord tumor also constitutes an occupational disease. This determination is in accordance with the purport set forth above and is correct, and there is no illegality therein due to misapprehension of the rules of evidence resulting in a mistake of fact, or misapprehension of the legal principles concerning causation, as argued in the grounds of appeal.

2.
Under the Industrial Accident Compensation Insurance Act, the right to receive insurance benefits is extinguished by prescription if not exercised within three years (Article 30(1) of the said Act). Here, the starting point of the prescriptive period is the time when the right may be exercised; in the case of the right to claim medical care benefits, this runs from day to day beginning on the day following the date on which the costs necessary for medical care are specifically determined, that is, the day following the day on which medical care was received. Accordingly, in the present case, where the disease resulting from the occupational accident is ongoing, even if the right to claim medical care benefits for the portion exceeding three years, calculated backward from the time the Plaintiff filed the application for medical care benefits (see Article 30-2(1)(1) and Article 9(2) of the said Act), has already been extinguished by prescription, the right to claim medical care benefits for the portion within three years and for the portion to accrue in the future must be deemed to continue to exist, as the running of the prescriptive period was interrupted by the filing of the application for medical care benefits in this case.

According to the reasoning of the original judgment, the court below interpreted the starting point of the extinctive prescription period for the right to claim medical care benefits as the time when the accident occurred, thereby committing an error of misapprehension of the legal principles in this respect. However, even though its reasoning differs, the court below likewise determined that the Plaintiff's right to claim medical care benefits had not been entirely extinguished by prescription, and accordingly held the non-approval disposition in this case to be unlawful; the result of the judgment being thus correct, the aforementioned misapprehension of the legal principles has not affected the outcome of the original judgment.

3. As none of the grounds of appeal are well-founded, the Justices are unanimous in their opinion to dismiss this appeal, and it is so ordered as stated in the Order.

Justice Kim Ju-han (Presiding Justice), Lee Hoi-chang, Bae Seok, Kim Sang-won

【판결요지】

가. 산업재해보상보험법 제3조 제1항 소정의 업무상 재해라 함은 근로자가 업무수행에 기인하여 입은 재해를 뜻하는 것이어서 업무와 재해발생과의 사이에 인과관계가 있어야 하지만 그 재해가 업무와 직접 관련이 없는 기존의 질병이더라도 그것이 업무와 관련하여 발생한 다른 재해로 말미암아 더욱 악화되었다면 기존 질병의 악화와 업무와의 사이에는 인과관계가 존재한다고 보아야 한다.

나. 산업재해보상보험법상 보험급여를 받을 권리의 소멸시효기간의 기산점은 그 권리를 행사할 수 있는 때로서 요양급여청구권의 경우에는 요양에 필요한 비용이 구체적으로 확정된 날의 다음날, 즉 요양을 받은 날의 다음날부터 매일매일 진행한다고 할 것이므로 업무상 재해로 인한 질병이 계속되고 있는 경우에 있어서는 그 근로자가 요양급여의 신청을 한 때로부터 역산하여 3년이 넘는 부분에 대한 요양급여청구권은 이미 소멸시효가 완성되었더라도 3년 이내의 부분 및 장래 발생할 부분에 대한 요양급여청구권은 위 요양급여신청으로 인하여 시효의 진행이 중단된다.

【참조조문】

가. 산업재해보상보험법 제3조 제1항 / 나. 제30조 제1항, 제30조의2 제1항

【주문】·【이유】 전문 1,434자 · 펼쳐 보기

【원고, 피상고인】 신동영

【피고, 상고인】 울산지방노동사무소장

【원 판 결】 부산고등법원 1989.3.10. 선고 88구971 판결

【주 문】

상고를 기각한다.

상고소송비용은 피고의 부담으로 한다.

【이 유】 상고이유에 대하여,

1. 산업재해보상보험법 제3조 제1항 소정의 업무상 재해라 함은 근로자가 업무수행에 기인하여 입은 재해를 뜻하는 것이어서 업무와 재해발생과의 사이에 인과관계가 있어야 하는 것은 물론이지만 그 재해가 업무와 직접 관련이 없는 기존의 질병이라 하더라도 그것이 업무와 관련하여 발생한 다른 재해로 말미암아 더욱 악화되었다면 기존질병의 악화와 업무와의 사이에는 인과관계가 존재한다고 보아야 한다.

원심이 원고는 소외 한국전력공사 소속의 변전으로서 1980.7.13.과 1984.9.3.의 두차례에 걸쳐서 그 설시와 같은 작업을 하던중 허리를 삐어 요추염좌상의 부상을 입은 사실이 인정된다 하고 나서 이사건에서 문제로 되어 있는 원고의 척수종양이 위의 요추염좌상으로 인하여 발병한 겻은 아니지만 적어도 이로 인하여 그 진행이 촉진되고 증세가 악화된 사실만큼은 인정되므로 원고의 척수종양 또한 업무상 질병에 해당한다고 판단한 것은 위에서 밝힌바와 같은 취지에서 나온 것이어서 옳고, 여기에 소론과 같은 채증법칙위배로 인한 사실오인이나 인과관계에 관한 법리오해의 위법이 없다.

2. 산업재해보상보험법상의 보험급여를 받을 권리는 3년간 행사하지 아니하면 시효소멸하도록 되있는데( 위 법 제30조 제1항) 여기서 시효기간의 기산점은 그 권리를 행사할 수 있는 때로서 요양급여청구권의 경우에는 요양에 필요한 비용이 구체적으로 확정된 날의 다음날, 즉 요양을 받은 날의 다음 날부터 매일매일 진행한다고 할 것이므로 업무상 재해로 인한 질병이 계속되고 있는 이사건에 있어서는 원고가 요양급여의 신청을 한 때로부터( 위 법 제30조의2 제1항 제1호, 제9조 제2항 참조) 역산하여 3년이 넘는 부분에 대한 요양급여청구권은 이미 소멸시효가 완성되었다 하더라도 3년 이내의 부분 및 장래 발생할 부분에 대한 요양급여청구권은 이 사건 요양급여신청으로 인하여 시효의 진행이 중단되어 그대로 존속하고 있다할 것이다.

원판결이유에 의하면, 원심은 요양급여청구권의 소멸시효기산점을 재해를 당한때로 해석하고 있어 이 점에서 법리오해의 위법을 저지르고 있으나 원심도 이유는 다를망정 원고의 요양급여청구권이 전부 시효소멸한 것은 아니라 하여 이 사건 불승인처분을 위법하다고 판단하고 있어 그 결과는 정당하므로 위에서 본 법리오해가 원판결의 결과에 영항을 미친 바는 없다.

3. 논지는 어느것이나 이유없으므로 이 상고를 기각하기로 관여법관의 의견이 일치되어 주문과 같이 판결한다.

대법관 김주한(재판장) 이회창 배석 김상원

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