Workbear재주넘는곰
대법원 2000두4538

Revocation of Disapproval of Industrial Accident Medical Care Benefits (산재요양불승인처분취소)산재요양불승인처분취소

Decided2001. 07. 27. Court대법원Worker (plaintiff's family) 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.

A worker infected with Hepatitis B died after the illness worsened due to excessive workload and work-related stress. The Supreme Court (대법원) ruled that even though the initial Hepatitis B infection itself was unrelated to work, the worsening of the disease caused by overwork qualifies as an industrial accident (산업재해). The court held that a clear medical proof of causation is not required—only a reasonable probability of causal link (상당인과관계) needs to be established. As a result, the Korea Workers' Compensation and Welfare Service's (근로복지공단) decision to deny medical care benefits was overturned, and the worker's family won the case.

Key takeaways
  • CaseA worker already infected with Hepatitis B died after his illness worsened due to heavy workload and job-related stress.
  • OutcomeThe Supreme Court ruled this qualifies as an industrial accident (산재) and canceled the denial of medical care benefits.
  • LessonWorkers can claim industrial accident compensation even for pre-existing illnesses if work stress or overwork clearly worsened the condition, without needing absolute medical proof.
Issues
  • What standard should be used to determine reasonable probable causation (상당인과관계) between work and illness?
  • Can an industrial accident (산재) be recognized when work merely aggravates a pre-existing disease rather than causing it directly?
  • Can the right to receive medical care benefits be inherited by the deceased worker's family?
Key reasoning

The court reasoned that even if the primary cause of a disease is unrelated to work, if work-related overwork or stress accelerates the progression of an existing illness beyond its natural course, this can still be recognized as an industrial accident (산업재해). Strict medical certainty proving the causal link between work and the disease is not required; it is sufficient if a 'reasonable probable causation' (상당인과관계) can be inferred from the overall circumstances. Furthermore, the assessment of whether such aggravation occurred must be based on the specific worker's health condition and physical characteristics, not on a generalized medical standard. This means employers and insurers cannot deny compensation simply because the underlying disease originated outside the workplace, if work conditions worsened it significantly.

Summary of Decision (English, AI translation)

[1] The term "occupational accident" under Article 4 Subparagraph 1 of the former Industrial Accident Compensation Insurance Act (산업재해보상보험법) (before amendment by Act No. 6100 of December 31, 1999) refers to a disease that arose during the performance of an employee's duties and was caused by such duties, and thus there must be a causal relationship between the work and the disease that caused the death. However, even if the main cause of the disease is not directly related to the performance of duties, if at least work-related overexertion or stress is superimposed on the main cause of the disease and thereby induces or aggravates the disease, a causal relationship between them should be recognized. Such causal relationship need not be clearly proven medically or scientifically; it is sufficient if, considering all the circumstances, a proximate causal relationship between the work and the disease can be inferred. Furthermore, this includes cases where an underlying or pre-existing disease, which would normally allow for normal work performance, is rapidly aggravated beyond its natural rate of progression due to excessive work duties or similar causes. Whether there is a causal relationship between the work and the death should be determined not on the basis of an ordinary average person, but on the basis of the health and physical condition of the employee concerned.

[2] In a case where an employee infected with hepatitis B, while engaged in excessive work duties, was diagnosed with primary liver tumor and died, the court held that even though the hepatitis B infection itself was unrelated to the work, since continuous physical overexertion and mental stress caused by the ongoing work aggravated the hepatitis B beyond its natural rate of progression, leading to death, this constituted an occupational accident.

Full text (English, AI translation) 5,196 chars

[Plaintiffs, Appellees] Plaintiff 1 and 1 other (Attorney Jang Si-il, Counsel for the plaintiffs)
[Defendant, Appellant] Korea Workers' Compensation & Welfare Service
[Judgment Below] Daejeon High Court Decision 99Nu1005 decided May 12, 2000

[Order]

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

[Reasoning]

The grounds of appeal are examined.

1. As to Ground No. 1
Under Article 4, Subparagraph 1 of the former Industrial Accident Compensation Insurance Act (개정되기 전의 산업재해보상보험법) (before its amendment by Act No. 6100 of December 31, 1999), an "occupational accident" means a disease that arises out of and in the course of an employee's performance of his or her duties. Accordingly, there must be a causal relationship between the employee's work and the disease that caused death; however, even where the primary cause of the disease is not directly related to the performance of work, if occupational overwork or stress at least combined with the primary cause of the disease to induce or aggravate the disease, a causal relationship should be found to exist between them. Such causal relationship need not be clearly proven in a medical or scientific manner; it suffices if, considering all the circumstances, a proximate causal relationship between the work and the disease can reasonably be inferred. Moreover, this includes cases where an underlying or pre-existing disease, which would otherwise have permitted normal work performance, was caused by excessive workload or other work-related factors to rapidly deteriorate beyond its natural rate of progression. Whether there is a causal relationship between the work and the death must be determined not on the basis of an ordinary average person, but on the basis of the health and physical condition of the particular employee concerned (see Supreme Court Decision 2000Du3627, decided September 22, 2000).

The judgment of the court of first instance, as cited by the court below, found that severe physical fatigue or mental stress can further weaken the liver function of a person who is positive for the hepatitis B antigen. It then found that the deceased, Nonparty, even after being found to be hepatitis B antigen-positive in 1994, continued to perform computer graphics work alone without any increase in personnel, and that around 1995, upon the purchase of a new computer graphics system, he went to another broadcasting company to learn how to operate it, among other things, thereby being subjected to a workload excessive in light of his health condition. The deceased was diagnosed with primary liver tumor on October 13, 1997, took honorable retirement effective January 15, 1998, and died on July 1 of that year. Given these circumstances, even if the deceased's contraction of hepatitis B in 1994 was unrelated to his work, the court held that his continued work while infected with hepatitis B thereafter caused sustained physical overwork and mental stress, which aggravated the hepatitis B beyond its natural rate of progression, resulting in his death, and thus determined that he died of an occupational disease. Upon examination of the record, such fact-finding and determination are justified, and there is no error of mistaken fact-finding or misapprehension of the legal principles as alleged in the grounds of appeal.

2. As to Ground No. 2
According to the reasoning of the judgment below, the court below determined that although medical care itself for an employee is a matter exclusively personal to that employee and cannot be received by another person on his or her behalf, the right to receive medical care benefits arising from such medical care has the character of a monetary claim that is paid, directly or indirectly, to the employee concerned through certain procedures, such as approval of medical care by the Korea Workers' Compensation & Welfare Service. Accordingly, where an employee received medical care for an occupational accident and the requirements for payment of medical care benefits have already been satisfied, and the employee dies either during or after the period of medical care, the right to receive such medical care benefits is inherited by the employee's heirs, regardless of whether the employee applied for approval of medical care while alive or died without having done so. Therefore, the court below held that it was lawful for the Plaintiffs, as heirs of the deceased, to file the instant lawsuit contesting the instant disposition. Upon reviewing the relevant provisions of the former Industrial Accident Compensation Insurance Act (before its amendment by Act No. 6100 of December 31, 1999) and its Enforcement Decree, such determination by the court below is justified, and there is no error of misapprehension of the legal principles as alleged in the grounds of appeal.

Therefore, the appeal is dismissed, and the costs of the appeal are to be borne by the Defendant, the losing party. This Judgment is rendered as set forth in the Order, with the unanimous concurrence of the Justices participating in the decision.

Justice Cho Mu-je (Presiding Justice), Lee Yong-woo, Kang Shin-wook (Justice in charge), Lee Kang-kook

【판결요지】

[1] 구 산업재해보상보험법(1999. 12. 31. 법률 제6100호로 개정되기 전의 것) 제4조 제1호 소정의 업무상 재해라고 함은 근로자의 업무수행중 그 업무에 기인하여 발생한 질병을 의미하는 것이므로 업무와 사망의 원인이 된 질병 사이에 인과관계가 있어야 하지만, 질병의 주된 발생원인이 업무수행과 직접적인 관계가 없더라도 적어도 업무상의 과로나 스트레스가 질병의 주된 발생원인에 겹쳐서 질병을 유발 또는 악화시켰다면 그 사이에 인과관계가 있다고 보아야 할 것이고, 그 인과관계는 반드시 의학적·자연과학적으로 명백히 입증하여야 하는 것은 아니고 제반 사정을 고려할 때 업무와 질병 사이에 상당인과관계가 있다고 추단되는 경우에도 그 입증이 있다고 보아야 하고, 또한 평소에 정상적인 근무가 가능한 기초질병이나 기존질병이 직무의 과중 등이 원인이 되어 자연적인 진행속도 이상으로 급격하게 악화된 때에도 그 입증이 있는 경우에 포함되는 것이며, 업무와 사망과의 인과관계의 유무는 보통평균인이 아니라 당해 근로자의 건강과 신체조건을 기준으로 판단하여야 한다.

[2] B형 간염에 감염된 근로자가 과중한 업무에 종사하다가 원발성 간종양 진단을 받고 사망한 경우, B형 간염에 감염된 것은 업무와 관련이 없다 하더라도 계속되는 근무로 인하여 육체적 과로와 정신적 스트레스가 지속되어 B형 간염이 자연적인 진행속도 이상으로 악화되어 사망하였다는 이유로 업무상 재해에 해당한다고 본 사례.

【참조조문】

[1] 구 산업재해보상보험법(1999. 12. 31. 법률 제6100호로 개정되기 전의 것) 제4조 제1호, 민사소송법 제187조, 제261조, 행정소송법 제8조 제2항, 제26조[입증책임]

[2] 구 산업재해보상보험법(1999. 12. 31. 법률 제6100호로 개정되기 전의 것) 제4조 제1호, 민사소송법 제187조, 제261조, 행정소송법 제8조 제2항, 제26조[입증책임]

【참조판례】

[1] 대법원 1998. 12. 8. 선고 98두12642 판결(공1999상, 144), 대법원 1999. 4. 23. 선고 97누16459 판결(공1999상, 1061), 대법원 2000. 5. 12. 선고 99두11424 판결(공2000하, 1431), 대법원 2000. 9. 22. 선고 2000두3627 판결, 대법원 2001. 4. 13. 선고 2000두9922 판결(공2001상, 1148)

【주문】·【이유】 전문 1,937자 · 펼쳐 보기

【원고, 피상고인】 원고 1 외 1인 (소송대리인 변호사 장시일)

【피고, 상고인】 근로복지공단

【원심판결】 대전고법 2000. 5. 12. 선고 99누1005 판결

【주 문】

상고를 기각한다.

상고비용은 피고의 부담으로 한다.

【이 유】 상고이유를 판단한다.

1. 제1점에 대하여

구 산업재해보상보험법(1999. 12. 31. 법률 제6100호로 개정되기 전의 것) 제4조 제1호 소정의 업무상 재해라고 함은 근로자의 업무수행중 그 업무에 기인하여 발생한 질병을 의미하는 것이므로 업무와 사망의 원인이 된 질병 사이에 인과관계가 있어야 하지만, 질병의 주된 발생원인이 업무수행과 직접적인 관계가 없더라도 적어도 업무상의 과로나 스트레스가 질병의 주된 발생원인에 겹쳐서 질병을 유발 또는 악화시켰다면 그 사이에 인과관계가 있다고 보아야 할 것이고, 그 인과관계는 반드시 의학적·자연과학적으로 명백히 입증하여야 하는 것은 아니고 제반 사정을 고려할 때 업무와 질병 사이에 상당인과관계가 있다고 추단되는 경우에도 그 입증이 있다고 보아야 하고, 또한 평소에 정상적인 근무가 가능한 기초질병이나 기존질병이 직무의 과중 등이 원인이 되어 자연적인 진행속도 이상으로 급격하게 악화된 때에도 그 입증이 있는 경우에 포함되는 것이며, 업무와 사망과의 인과관계의 유무는 보통평균인이 아니라 당해 근로자의 건강과 신체조건을 기준으로 판단하여야 할 것이다(대법원 2000. 9. 22. 선고 2000두3627 판결 참조).

원심이 인용한 제1심판결은, 심한 육체적 피로나 정신적 스트레스는 B형 간염 항원양성자의 간기능을 더욱 약화시킬 수 있음을 인정한 다음, 망 소외인은 B형 간염 항원양성자임이 밝혀진 1994년 이후에도 인원의 충원 없이 컴퓨터그래픽 작업 등을 혼자서 해 왔고, 1995년경에는 새로운 컴퓨터그래픽 기종을 구입함에 따라 이를 제대로 운영하기 위하여 다른 방송사에 가서 그 사용법 등을 배우는 등 망인의 건강상태에 비하여 과중된 업무에 시달려 오던 중, 1997. 10. 13. 원발성 간종양 진단을 받아 1998. 1. 15. 자로 명예퇴직을 한 후, 같은 해 7월 1일 사망에 이르렀고, 사정이 이러하다면 망인이 1994년에 B형 간염에 감염된 것은 업무와 관련이 없다 하더라도 그 이후 B형 간염에 감염된 상태에서 계속되는 근무로 인하여 육체적 과로와 정신적 스트레스가 지속되어 B형 간염이 자연적인 진행속도 이상으로 악화되어 사망하였다고 보아 업무상 질병으로 사망한 것으로 판단하였는바, 기록에 비추어 살펴보면, 이러한 사실인정과 판단은 정당하고, 거기에 상고이유에서 주장하는 바와 같은 사실오인이나 법리오해의 위법이 있다고 할 수 없다.

2. 제2점에 대하여

원심판결 이유에 의하면 원심은, 근로자의 요양 자체는 일신전속적인 것으로서 다른 사람이 대신 요양받을 수는 없는 것이지만, 요양으로 인한 요양급여의 수급권은 근로복지공단의 요양승인 등 일정한 절차를 거쳐서 당해 근로자에게 직접 또는 간접으로 지급되는 금전채권의 성격을 지닌 것으로, 근로자가 업무상 재해로 요양을 받아 이미 요양급여의 지급요건이 충족된 경우로서 요양 도중이나 요양 후에 당해 근로자가 사망한 경우에는 당해 근로자가 생전에 요양승인신청을 했는지, 미처 하지 못한 채 사망했는지를 불문하고 그 요양급여의 수급권은 당해 근로자의 상속인에게 상속되므로, 원고들이 망인의 상속인으로서 이 사건 처분에 불복하여 이 사건 소를 제기한 것은 적법하다고 판단하고 있는바, 구 산업재해보상보험법(1999. 12. 31. 법률 제6100호로 개정되기 전의 것) 및 그 시행령의 관계 조문을 검토하여 보면 원심의 이러한 판단은 정당하고, 거기에 상고이유에서 주장하는 바와 같은 법리오해의 위법은 없다.

그러므로 상고를 기각하고, 상고비용은 패소자인 피고의 부담으로 하기로 관여 대법관의 의견이 일치되어 주문과 같이 판결한다.

대법관 조무제(재판장) 이용우 강신욱(주심) 이강국

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