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대법원 2011다64768

Claim for Damages (Automobile Accident Liability)손해배상(자)

Decided2011. 11. 24. Court대법원Case remanded (파기환송) — the lower court's ruling in favor of the mutual aid association was overturned, and the case was sent back for further fact-finding, giving the victim's family a chance to secure fuller compensation.
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.

A bus company employee died in a traffic accident while commuting home from work. The mutual aid association (공제조합, a bus companies' insurance cooperative similar to an auto insurer) refused to pay compensation, arguing that the employee's family would receive industrial accident compensation insurance (산재보험) benefits instead, which should be deducted from the damages. The Supreme Court of Korea (대법원) ruled that such a deduction could not be applied automatically when it was uncertain whether industrial accident insurance benefits would actually be paid, and remanded the case for further review.

Key takeaways
  • CaseA bus company worker died in a car accident on the way home from work, and the insurer refused to fully compensate the family, citing potential industrial accident insurance benefits.
  • OutcomeThe Supreme Court ruled that uncertain industrial accident insurance benefits cannot automatically be deducted from damages, and sent the case back for further review.
  • LessonInsurers seeking to reduce compensation based on other expected benefits must clearly prove that those benefits will actually be paid — mere possibility is not enough.
Issues
  • Requirements for applying the exemption clause (면책조항) in an automobile mutual aid (공제조합) insurance contract
  • Which party bears the burden of proving whether industrial accident insurance (산재보험) benefits will actually be paid
  • Whether uncertain future industrial accident insurance payments can be deducted when calculating damages
Key reasoning

The Court held that when a mutual aid association seeks to invoke an exemption clause (면책조항) in its insurance contract based on the availability of industrial accident compensation, it bears the burden of proving that the deceased employee was indeed eligible to receive such industrial accident insurance benefits (산재보험급여). Simply asserting that the victim could theoretically receive such benefits was not sufficient. Because it remained unclear whether the family would actually receive the industrial accident insurance payment, the court reasoned that this uncertain amount could not simply be deducted from the calculated damages award. This established a clear rule placing the evidentiary burden on the insurer seeking to reduce its liability through such exemption clauses.

Full text (English, AI translation) 8,093 chars

[Plaintiff, Appellant]

[Defendant, Appellee] Korea Bus Transport Business Cooperative Federation (전국버스운송사업조합연합회) (Attorney Jeong Seong-heum, Counsel for the defendant)

[Judgment Below] Seoul Central District Court Judgment 2011Na16201, decided July 12, 2011

[Order]

The judgment below is reversed, and the case is remanded to the Panel Division of the Seoul Central District Court.

[Reasoning]

The grounds of appeal are examined.

1. Where Personal Injury Mutual Aid Coverage II of an automobile mutual aid (insurance) contract contains an exemption clause to the effect that "losses of a person who is an employee of a member with liability for compensation and who is entitled to receive accident compensation under the Industrial Accident Compensation Insurance Act (산업재해보상보험법, hereinafter the "Industrial Accident Compensation Insurance Act") shall not be compensated (provided that excess losses beyond the scope of compensation under the Industrial Accident Compensation Insurance Act shall be compensated)," the purport of such provision should be interpreted as follows: With respect to losses arising from an occupational accident occurring in the labor relationship between an employer and an employee, the Labor Standards Act, which governs labor relations, provides for various compensation liabilities of the employer, and the Industrial Accident Compensation Insurance Act establishes the industrial accident insurance system to secure such compensation liabilities. Accordingly, losses suffered by an injured employee due to a work-related automobile accident subject to industrial accident insurance should also be compensated through industrial accident insurance, and to the extent that such compensation is available through industrial accident insurance, it is reasonable to interpret that such losses are intended to be excluded from the scope of personal injury liability coverage under automobile insurance, whose purpose is to indemnify liability to third parties (see Supreme Court en banc Decision 2003Da2802, decided March 17, 2005).

Therefore, if there is a portion of the loss to be compensated by the mutual aid cooperative under the mutual aid contract that can be indemnified by industrial accident insurance benefits, such portion shall, absent special circumstances, be exempted from the cooperative's liability for damages pursuant to the above exemption clause and shall instead be indemnified through industrial accident insurance benefits. However, the burden of proving that the case falls under "a person who is an employee of a member with liability for compensation and who is entitled to receive accident compensation under the Industrial Accident Compensation Insurance Act," which is a requirement for the application of the exemption clause, lies with the mutual aid cooperative asserting the application of the exemption clause. Furthermore, even though it is not necessarily required that the compensation amount has actually been paid or that a decision to pay industrial accident insurance benefits has been made in order to deduct an amount equivalent to such compensation from the amount of damages on the ground that the case falls under a case where accident compensation may be received under the Industrial Accident Compensation Insurance Act, such deduction should not be made arbitrarily where whether such compensation will be paid is uncertain.

2. The court below, based on the evidence it adopted, found the following facts as stated in its reasoning: the deceased, an employee of Boyoung Unsu Co., Ltd. (hereinafter the "non-party company"), a member cooperative that had entered into the defendant's automobile mutual aid contract (hereinafter "the instant mutual aid contract"), died in a work-related traffic accident caused by the operation of a bus covered by the instant mutual aid contract, and the plaintiff is his heir; Personal Injury Mutual Aid Coverage II of the instant mutual aid contract contains an exemption clause to the effect that compensation shall not be paid where the case falls under "a person who is an employee of a member with liability for compensation and who is entitled to receive accident compensation under the Industrial Accident Compensation Insurance Act" (provided that excess losses beyond the scope of compensation under the Industrial Accident Compensation Insurance Act shall be compensated) (hereinafter "the instant exemption clause"); the deceased finished operating the bus at around 23:43 on the day of the instant accident, drove home on his own motorcycle around midnight after finishing work, and was struck and killed at around 00:05 the following day by a bus driven by another driver employed by the non-party company; the deceased had been commuting to and from work using his own motorcycle, and the non-party company did not provide any separate means of commuting transportation to its drivers, etc. Based on these findings, the court below held that the deceased's death due to the instant traffic accident constituted a work-related accident, and accordingly deducted from the amount of pecuniary damages to be compensated by the defendant the funeral expenses of KRW 3,000,000 and the survivor's benefits of KRW 137,750,600 (KRW 105,962 × 1,300 days), which fall within the scope of compensation that the deceased or the plaintiff may receive under the Industrial Accident Compensation Insurance Act.

However, according to the record, the following facts can be ascertained: the deceased joined the non-party company on September 1, 2006 and had worked as a standby driver; at the time of the instant accident, the deceased's residence was located approximately 3 km from his workplace; the plaintiff filed a claim with the Korea Workers' Compensation and Welfare Service for survivor's benefits and funeral expenses in connection with the deceased's death, but was notified by the Korea Workers' Compensation and Welfare Service to the effect that "the deceased's death does not constitute a work-related accident, and therefore survivor's benefits, etc. cannot be paid," after which the plaintiff filed the instant action for damages against the defendant; and whether the case falls under "a case where accident compensation may be received under the Industrial Accident Compensation Insurance Act," to which the instant exemption clause applies, has been disputed since the first instance of this case, and the first instance court rejected the defendant's assertion regarding the application of the instant exemption clause. In light of the legal principles set forth above, examining these facts, it is difficult to conclude, based solely on the circumstances cited by the court below, that the payment of industrial accident insurance benefits is certain, or that the requirements for the application of the instant exemption clause—namely, that the deceased falls under a person who is an employee of a member with liability for compensation and who is entitled to receive accident compensation under the Industrial Accident Compensation Insurance Act—have been sufficiently proven.

Nevertheless, the court below, based solely on the circumstances stated in its reasoning, accepted the defendant's argument and excluded from the amount of damages payable to the plaintiff the amount equivalent to industrial accident insurance benefits, such as survivor's benefits, the payment of which remains uncertain. Such determination by the court below is erroneous in that it misapprehended the legal principles concerning the burden of proof and the degree of proof required in applying an exemption clause of an automobile mutual aid contract, and thereby failed to exhaust the necessary examination. The ground of appeal pointing out this error is with merit.

3. Accordingly, without examining the remaining grounds of appeal, the judgment below is reversed, and the case is remanded to the court below for further hearing and determination, as set forth in the Order.

Justice Yang Chang-soo (Presiding Justice), Jeon Su-an (Justice in Charge), Lee Sang-hoon

【참조조문】

[1] 산업재해보상보험법 제1조, 민사소송법 제288조

[2] 산업재해보상보험법 제1조, 민사소송법 제288조

【참조판례】

[1] 대법원 2005. 3. 17. 선고 2003다2802 전원합의체 판결(공2005상, 586)

【주문】·【이유】 전문 2,661자 · 펼쳐 보기

【원고, 상고인】

【피고, 피상고인】 전국버스운송사업조합연합회 (소송대리인 변호사 정성흠)

【원심판결】 서울중앙지법 2011. 7. 12. 선고 2011나16201 판결

【주 문】

원심판결을 파기하고, 사건을 서울중앙지방법원 합의부에 환송한다.

【이 유】 상고이유를 판단한다.

1. 자동차공제계약의 대인공제 II에서 “배상책임이 있는 조합원의 피용자로서 산업재해보상보험법(이하 ‘산재보험법’이라 한다)에 의한 재해보상을 받을 수 있는 사람의 손해는 보상하지 아니한다(다만 산재보험법에 의한 보상범위를 넘어서는 초과손해는 보상함)”는 취지의 면책조항을 두고 있는 경우, 그 규정의 취지는 사용자와 근로자의 노사관계에서 발생한 업무상 재해로 인한 손해에 대하여는 노사관계를 규율하는 근로기준법에서 사용자의 각종 보상책임을 규정하는 한편 이러한 보상책임을 담보하기 위하여 산재보험법으로 산재보험제도를 설정하고 있으므로, 산재보험 대상인 업무상 자동차사고에 의한 피해 근로자의 손해에 대하여도 산재보험에 의하여 전보받도록 하고, 이처럼 산재보험에 의한 전보가 가능한 범위에서는 제3자에 대한 배상책임을 전보하는 것을 목적으로 하는 자동차보험의 대인배상 범위에서 이를 제외하려는 데 있는 것으로 해석함이 상당하다( 대법원 2005. 3. 17. 선고 2003다2802 전원합의체 판결 참조).

따라서 공제조합이 공제계약에 의하여 보상할 손해 중 산재보험급여로 전보될 수 있는 부분이 있다면 이는 특별한 사정이 없는 한 위 면책조항에 기하여 공제조합의 손해배상책임에서 면제되고 산재보험급여로 전보되어야 할 것이나, 위 면책조항의 적용요건인 ‘배상책임이 있는 조합원의 피용자로서 산재보험법에 의한 재해보상을 받을 수 있는 사람’에 해당된다는 점은 그 면책조항의 적용을 주장하는 공제조합 측이 증명하여야 하고, 나아가 산재보험법에 의한 재해보상을 받을 수 있는 경우에 해당한다고 하여 그 보상액 상당액을 손해배상액에서 공제하기 위해서는 반드시 그 보상액을 현실로 지급받았거나 산재보험급여 지급결정이 있었을 필요는 없다고 하더라도 그 보상 여부가 불확실한 경우에는 함부로 이를 공제하여서는 안 될 것이다.

2. 원심은, 그 채택 증거에 의하여 피고의 자동차공제계약(이하 ‘이 사건 공제계약’이라 한다)에 가입된 버스의 운행으로 발생한 업무상 교통사고로 인하여 그 조합원인 보영운수 주식회사(이하 ‘소외 회사’라 한다)의 피용자인 망 소외인이 사망하였고 원고는 그 상속인인 사실, 이 사건 공제계약의 대인공제 II에서는 ‘배상책임이 있는 조합원의 피용자로서 산재보험법에 의한 재해보상을 받을 수 있는 사람’인 경우에는 보상하지 않는다(다만 산재보험법에 의한 보상범위를 넘어서는 초과손해는 보상함)는 취지의 면책조항(이하 ‘이 사건 면책조항’이라 한다)을 둔 사실, 망인은 이 사건 사고 당일 23:43경 버스운행을 마치고 자정 무렵 자신의 오토바이를 운전하여 퇴근하였다가 다음 날 00:05경 소외 회사 소속의 다른 운전기사가 운전하는 버스에 치어 사망한 사실, 망인은 자신의 오토바이를 이용하여 출·퇴근을 해 왔으며, 소외 회사는 그 소속 운전기사 등에게 출·퇴근을 위한 별도의 통근수단을 제공하지 않았던 사실 등 그 판시와 같은 사실을 인정한 다음, 이 사건 교통사고로 인한 망인의 사망이 업무상 재해에 해당한다는 이유로 망인 또는 원고가 산재보험법에 따라 보상받을 수 있는 범위 내의 장의비 3,000,000원과 유족급여 137,750,600원(105,962원 × 1,300일)을 피고가 보상하여야 할 재산상 손해액에서 공제하였다.

그런데 기록에 의하면, 망인이 2006. 9. 1. 소외 회사에 입사하여 대기 기사로 근무해 왔고, 이 사건 사고 당시 망인의 주거지는 근무지로부터 3㎞ 정도 떨어진 곳에 있었던 사실, 원고는 근로복지공단에 망인의 사망과 관련된 유족급여 및 장의비를 청구하였으나 근로복지공단으로부터 ‘망인의 사망은 업무상 재해에 해당하지 않아 유족급여 등을 지급할 수 없다’는 취지의 통고를 받고 그 후 피고를 상대로 이 사건 손해배상청구의 소를 제기한 사실, 이 사건 제1심에서부터 이 사건 면책조항이 적용되는 ‘산재보험법에 의한 재해보상을 받을 수 있는 경우’에 해당되는지 여부가 다투어졌는데 제1심에서는 이 사건 면책조항 적용 주장이 배척되기도 한 사실 등을 알 수 있는바, 이러한 사실관계를 앞서 본 법리에 비추어 살펴보면 원심이 든 사정만으로는 산재보험급여의 지급이 확실하다거나 이 사건 면책조항 적용의 요건, 즉 망인이 배상책임이 있는 조합원의 피용자로서 산재보험법에 의한 재해보상을 받을 수 있는 사람에 해당된다는 점이 충분히 증명되었다고 보기는 어렵다.

그럼에도 원심은 그 판시와 같은 사정만으로 피고의 주장을 받아들여, 원고에 대한 손해배상액에서 장차 그 보상 여부가 불확실한 유족급여 등 산재보험급여 해당액을 제외하였으니, 이러한 원심의 판단에는 자동차공제계약 보상면책조항을 적용함에 있어서의 증명책임과 증명의 정도에 관한 법리를 오해하여 필요한 심리를 다하지 아니한 잘못이 있고, 이 점을 지적하는 취지가 포함된 상고이유의 주장은 이유 있다.

3. 그러므로 나머지 상고이유에 대한 판단을 생략한 채 원심판결을 파기하고 사건을 다시 심리·판단하게 하기 위하여 원심법원에 환송하기로 하여, 주문과 같이 판결한다.

대법관 양창수(재판장) 전수안(주심) 이상훈

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