Workbear재주넘는곰
대법원 94다4424

Insurance Claim Case보험금

Decided1995. 02. 10. 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.

A worker who was injured in a car accident filed a direct claim for insurance payout against the insurance company. The Korean Supreme Court (대법원) ruled that since the worker's workplace was not covered by Industrial Accident Compensation Insurance (산재보험), the exclusion clause (면책조항) in the auto insurance policy—which normally denies coverage when workers' compensation applies—did not apply in this case.

Key takeaways
  • CaseA worker injured in a car accident directly claimed insurance money from the auto insurance company, but the insurer refused, citing an exclusion clause related to industrial accident compensation.
  • OutcomeThe Supreme Court ruled in favor of the worker, holding that the exclusion clause does not apply when the worker's workplace was not covered by Industrial Accident Compensation Insurance in the first place.
  • LessonWorkers at workplaces not covered by Industrial Accident Compensation Insurance retain their right to claim compensation directly from an at-fault party's auto insurer, even if the insurer and employer settle matters separately.
Issues
  • Whether a final judgment between the insured (employer) and the insurance company affects a third-party victim's direct claim right (직접청구권) against the insurer
  • Whether the auto insurance exclusion clause (면책조항) applies to workers who are not eligible to receive Industrial Accident Compensation Insurance (산재보험) benefits
Key reasoning

The purpose of the exclusion clause in auto insurance policies is to avoid double compensation when a worker is already covered by Industrial Accident Compensation Insurance (산재보험). However, if a worker's workplace is not subject to this insurance system, the worker has no alternative means of compensation, so the exclusion clause should not apply to deny the worker's claim. Additionally, the Court held that a final judgment (확정판결) between the insured party (the employer) and the insurance company does not automatically bind a third-party victim, such as the injured worker, who has an independent direct claim right (직접청구권) against the insurer. This means the worker's right to claim compensation directly from the insurance company remains valid regardless of separate litigation outcomes between the employer and insurer.

Summary of Decision (English, AI translation)

가. As to comprehensive automobile insurance, which is a liability insurance, the direct claim right against the insurer that was recognized under the insurance clause before the enforcement of the amended Commercial Act (상법, Act No. 4470 of December 31, 1991) is based on, and has the same content as, the insured's right to claim insurance proceeds against the insurer; however, even if a judgment declaring the nonexistence of the insured's right to claim insurance proceeds against the insurer was rendered and became final between the insurer and the insured before the victim exercised the right to claim insurance proceeds against the insurer in compliance with the requirements set forth in the insurance clause, the effect of such judgment does not extend to the victim, who was not a party to that judgment, and therefore this fact alone does not necessarily preclude the victim from claiming the insurance proceeds.

나. The purport of the provision in the general terms and conditions of comprehensive automobile insurance, which stipulates as a ground for exemption from liability the case where an employee of the insured who bears the liability for compensation, and who is entitled to receive accident compensation under the Labor Standards Act (근로기준법), dies or is injured, is to have losses arising from occupational accidents occurring in labor relations compensated, in principle, through industrial accident compensation insurance; it is not intended to treat even cases where compensation cannot be received under the Industrial Accident Compensation Insurance Act (산업재해보상보험법), merely because the accident constitutes an occupational accident under the Labor Standards Act, as falling within the scope of application of the aforementioned ground for exemption from liability.

Full text (English, AI translation) 7,180 chars

[Plaintiff, Appellee]

[Defendant, Appellant] Korea Automobile Insurance Co., Ltd., Litigation Representative Attorney Jeong Man-jo

[Judgment Below] Daejeon High Court Decision 93Na2436 rendered on December 14, 1993

[Order]

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

[Reasoning] The grounds of appeal and the portion supplementing the grounds of appeal in the supplementary brief on the grounds of appeal submitted after the expiration of the period for submitting the grounds of appeal are examined together.

1. With respect to comprehensive automobile insurance, which is a liability insurance, the right to directly claim insurance proceeds that was recognized under the insurance policy terms before the enforcement of the amended Commercial Act (Act No. 4470 of December 31, 1991) is based on, and has the same content as, the insured's right to claim insurance proceeds against the insurer. However, even if, before the victim exercised the right to claim insurance proceeds against the insurer by satisfying the requirements set forth in the insurance policy terms, a judgment was rendered between the insurer and the insured declaring that the insured's right to claim insurance proceeds against the insurer does not exist, and that judgment became final and conclusive, the effect of that judgment does not extend to the victim, who was not a party to that judgment, and therefore this fact alone does not naturally preclude the victim from claiming insurance proceeds. Res judicata originally refers to the effect that prevents a court or the parties from making assertions or judgments in the same case that are inconsistent with the determination made in a prior judgment; it does not, by itself, cause a substantive right of claim that existed to be extinguished, nor does it cause a substantive right of claim that did not exist to newly arise. Therefore, even if in the prior judgment between the insurer and the insured it was determined that the insured has no right to claim insurance proceeds due to the existence of a cause for exemption from liability as provided in the insurance policy terms, in a case where the victim, having satisfied the requirements set forth in the insurance policy terms, directly claims insurance proceeds against the insurer, it is necessary to re-examine, independently of the prior judgment, whether the insured has a right to claim insurance proceeds against the insurer.

The court below, in the same vein, held that the effect of the final judgment between the Defendant, the insurer, and Nonparty 1, the insured, does not extend to this case, and accordingly re-examined and determined anew the existence or non-existence of Nonparty 1's right to claim insurance proceeds against the Defendant; this is proper. Furthermore, on the premise that the victim's direct right to claim insurance proceeds can be exercised only where the insured's right to claim insurance proceeds is established, the court below, after going through a lawful process of evaluating evidence, did not adopt the prior judgment between Nonparty 1 and the Defendant as evidence, and instead, based on other evidence, rejected all of the Defendant's assertions that Nonparty 1 had no right to claim insurance proceeds due to the existence of a cause for exemption from liability, and thereby lawfully recognized the Plaintiffs' direct right to claim insurance proceeds. Accordingly, it cannot be said that the judgment below erred in its legal interpretation regarding the victim's direct right to claim insurance proceeds, nor that it omitted to make a judgment. The portion of the grounds of appeal pointing to this issue is without merit.

2. Examining the reasoning of the judgment below in light of the record, it is proper and acceptable that the court below found that Plaintiff 1 was not in a relationship of jointly operating the business referred to in its holding as "Sejeong" together with Nonparty 1, but was merely an employee of said Nonparty 1, and thus was not in the position of an operator of the vehicle involved in this accident; there is no violation of the rules of evidence in the process of evaluating evidence undertaken in reaching this conclusion. Furthermore, given the court below's finding that Plaintiff 1, as an employee of said Nonparty 1, was merely riding in the passenger seat of the accident vehicle at the time of this accident, then even if, as pointed out by the Defendant in the grounds of appeal, said Plaintiff had driven the vehicle the day before the accident as the person in charge of the work being performed at that time, such circumstance alone cannot render said Plaintiff a person falling under the cause for exemption from liability provided in Article 10, Paragraph 2, Item 3 of the insurance policy terms as a consenting insured under Article 11 of this insurance policy terms. The portion of the grounds of appeal pointing to this issue is also without merit.

3. The purport of Article 10, Paragraph 2, Item 4 of the insurance policy terms, which provides as a cause for exemption from liability the case where an employee of the insured who bears liability for compensation and who is entitled to receive disaster compensation under the Labor Standards Act (근로기준법) dies or is injured, is to have losses arising from occupational accidents occurring in labor relations compensated in principle through industrial accident compensation insurance; it is not intended to treat cases falling under an occupational accident under the Labor Standards Act, but which cannot be compensated under the Industrial Accident Compensation Insurance Act (산업재해보상보험법), as also subject to the application of the above cause for exemption from liability. This is the established view that the Supreme Court has repeatedly set forth (see Supreme Court Decisions 91Da6634 rendered on May 14, 1991; 93Daka25499 rendered on January 21, 1992 [sic]; 91Da38297 rendered on August 18, 1992; 93Da5192 rendered on June 8, 1993; 93Da58622 rendered on March 11, 1994, among others), and there is no reason to change it. According to the facts as determined by the court below, although the business called "Sejeong," where Plaintiff 1 was working at the time of this accident, is a wholesale and retail business dealing in electric motor parts and is a workplace to which the Labor Standards Act applies, it does not fall under a business that is a mandatory subscriber under the Industrial Accident Compensation Insurance Act and its Enforcement Decree as in effect at the time, nor had the business owner voluntarily subscribed to said insurance. Therefore, it cannot be said that this accident falls under the subject of exemption from liability provided in the above insurance policy terms. The portion of the grounds of appeal pointing to this issue is also without merit.

4. Therefore, the Justices unanimously agree to dismiss the appeal and to have the costs of the appeal borne by the Defendant, the Appellant, and render judgment as stated in the Order.

Supreme Court Justice Park Jun-seo (Presiding Justice), Park Man-ho, Kim Hyeong-seon, Lee Yong-hun (Justice in Charge)

【판결요지】

가. 책임보험인 자동차종합보험에 관하여 개정상법(1991.12.31. 법률 제4470호)의 시행 전에 그 약관에 의하여 인정되던 보험금 직접청구권은 피보험자의 보험자에 대한 보험금청구권에 바탕을 두고 그와 내용을 같이 하는 것이기는 하지만, 피해자가 그 약관에서 정한 요건을 갖추어 보험자에게 보험금청구권을 행사하기 이전에 보험자와 피보험자 사이에 피보험자의 보험자에 대한 보험금청구권이 부존재한다는 판결이 선고되고 그 판결이 확정되었다고 하여도 그 판결의 당사자가 아닌 피해자에 대하여서까지 판결의 효력이 미치는 것이 아니어서 이 사유만으로 당연히 보험금을 청구하지 못하게 되는 것은 아니다.

나. 배상책임의무가 있는 피보험자의 피용자로서 근로기준법에 의한 재해보상을 받을 수 있는 사람이 죽거나 다친 경우를 면책사유로 규정하고 있는 자동차종합보험보통약관의 취지는 노사관계에서 발생하는 업무상 재해로 인한 손해에 대하여 원칙적으로 산업재해보상보험에 의하여 전보받도록 하려는 데 그 취지가 있는 것이지, 근로기준법상의 업무상 재해라고 하여 산업재해보상보험법에 의하여 보상을 받을 수 없는 경우까지 위 면책사유의 적용대상에 해당하는 것으로 취급하려는 것이 아니다.

【참조조문】

가.나. 구 상법 제659조 제2항(1991.12.31. 법률 제4470호로 삭제) / 가. 상법 제724조 제2항, 민사소송법 제202조 / 나. 산업재해보상보험법 제1조, 제4조

【참조판례】

가. 대법원 1992.11.27. 선고 92다12681 판결(공1993상,244), 1993.4.13. 선고 93다3622 판결(공1993상,1397) , 1993.5.11. 선고 92다2530 판결(공1993하,1665) / 나. 대법원 1993.11.9. 선고 93다23107 판결(공1994상,76), 1994.1.11. 선고 93다5376 판결(공1994상,679), 1994.3.11. 선고 93다58622 판결(공1994상,1190)

【주문】·【이유】 전문 2,632자 · 펼쳐 보기

【원고, 피상고인】

【피고, 상고인】 한국자동차보험주식회사 소송대리인 변호사 정만조

【원심판결】 대전고등법원 1993.12.14. 선고 93나2436 판결

【주 문】

상고를 기각한다.

상고비용은 피고의 부담으로 한다.

【이 유】 상고이유와 상고이유서 제출기간 경과후에 제출된 상고이유보충서 중 상고이유를 보충하는 부분을 함께 판단한다.

1. 책임보험인 자동차종합보험에 관하여 개정상법(1991.12.31. 법률 제4470호)의 시행전에 그 약관에 의하여 인정되던 보험금 직접청구권은 피보험자의 보험자에 대한 보험금청구권에 바탕을 두고 그와 내용을 같이 하는 것이기는 하지만, 피해자가 그 약관에서 정한 요건을 갖추어 보험자에게 보험금청구권을 행사하기 이전에 보험자와 피보험자 사이에 피보험자의 보험자에 대한 보험금청구권이 부존재한다는 판결이 선고되고 그 판결이 확정되었다고 하여도 그 판결의 당사자가 아닌 피해자에 대하여서 까지 판결의 효력이 미치는 것이 아니어서 이 사유만으로 당연히 보험금을 청구하지 못하게 되는 것은 아니다. 원래 기판력이라 함은 법원이나 당사자가 동일한 사건에 관하여 전소판결의 판단에 배치되는 주장이나 판단을 할 수 없게 하는 효력이지 이에 의하여 존재하던 실체법상 청구권이 소멸되거나 존재하지 아니하던 실체법상 청구권이 새로 생겨나는 것이 아니기 때문에, 보험자와 피보험자 사이의 전소판결에서 비록 약관에서 정한 면책사유의 존재로 인하여 피보험자에게 보험금청구권이 없다고 판단되었다고 하더라도 피해자가 그 약관에서 정한 요건을 갖추어 보험자를 상대로 하여 보험금을 직접 청구하는 사건의 경우에 있어서는 전소판결과 관계없이 피보험자가 보험자에 대하여 보험금청구권이 있는지 여부를 다시 따져보아야 하는 것이다.

원심이 같은 취지에서 보험자인 피고와 피보험자인 소외 1간의 확정판결의 효력이 이 사건에 미치지 않는다고 하여 피보험자인 소외 1의 피고에 대한 보험금청구권의 유무를 다시 심리·판단하였음은 정당하고, 나아가 원심이 피해자의 보험금 직접청구권은 피보험자의 보험금청구권이 성립하는 경우에만 행사할 수 있다는 전제 아래, 적법한 증거판단의 과정을 거쳐 소외 1과 피고 사이의 전소판결을 증거로 채용치 않고 다른 증거들에 의하여 면책사유의 존재로 인하여 소외 1에게 보험금청구권이 없다는 피고의 주장을 모두 배척한 뒤 원고들의 보험금 직접청구권을 적법하게 인정하고 있는 이상 원심판결에 피해자의 보험금 직접청구권에 관한 법리오해나 판단유탈의 위법이 있다고 할 수 없다. 상고이유 중 이 점을 지적하는 부분은 이유 없다.

2. 원심판결 이유를 기록에 비추어 살펴보면, 원심이 원고 1은 그 판시의 “세정”이라고 하는 업체를 소외 1과 공동으로 경영하는 관계에 있지 아니하고 단지 위 소외 1의 피용자에 지나지 아니 할 뿐이어서 이 사건 사고 자동차에 대한 운행자의 지위에 있지 아니 하였다고 인정한 것은 정당한 것으로 수긍이 가고, 그 과정에서 거친 증거판단에 채증법칙 위배의 위법이 있다고 할 수 없으며, 원심이 인정한 바와 같이 원고 1이 위 소외 1의 피용자로서 이 사건 사고 당시 단지 사고자동차의 조수석에 탑승 중에 있었던 것일 뿐이라면, 피고가 상고이유에서 지적한 바와 같이 설사 위 원고가 그 당시 수행중이던 업무의 책임자로서 사고 전날 그 자동차를 운전한 일이 있다고 하더라도 그러한 사정만으로는 위 원고가 이 사건 보험약관 제11조 소정의 승낙피보험자로서 보험약관 제10조 2항 3호 소정의 면책사유가 있는 경우에 해당한다고 할 수 없는 것이다. 상고이유 중 이 점을 지적하는 부분도 이유 없다.

3. 배상책임의무가 있는 피보험자의 피용자로서 근로기준법에 의한 재해보상을 받을 수 있는 사람이 죽거나 다친 경우를 면책사유로 규정하고 있는 보험약관 제10조 제2항 제4호의 취지는 노사관계에서 발생하는 업무상 재해로 인한 손해에 대하여 원칙적으로 산업재해보상보험에 의하여 전보받도록 하려는데 그 취지가 있는 것이지, 근로기준법상의 업무상재해라고 하여 산업재해보상보험법에 의하여 보상을 받을 수 없는 경우까지 위 면책사유의 적용대상에 해당하는 것으로 취급하려는 것이 아니라는 점은 대법원이 누차에 걸쳐 판시하여온 확립된 견해(대법원 1991.5.14. 선고 91다6634 판결; 1992.1. 21. 선고 93다카25499 판결; 1992.8.18. 선고 91다38297 판결; 1993.6.8. 선고 93다5192 판결; 1994.3.11. 선고 93다58622 판결등 참조)로서 변경할 아무런 이유가 없다. 원심이 확정한 사실에 의하면 이 사건 사고 당시 원고 1이 근무하고 있었다는 “세정”이라고 하는 업체는 전기모터 부속품을 판매하는 도소매업체로서 근로기준법이 적용되는 사업장이기는 하지만 그 당시 시행되던 산업재해보상보험법 및 그 시행령에서 정하고 있는 당연보험가입대상인 사업체에는 해당하지 아니 할 뿐더러 사업주가 임의로 위 보험에 가입하고 있었던 것도 아니라는 것이므로 이 사건 사고가 위 약관 소정의 면책대상에 해당한다고 할 수 없다. 상고이유 중 이 점을 지적하는 부분도 이유 없다.

4. 그러므로 상고를 기각하고 상고비용은 상고인인 피고의 부담으로 하기로 관여 법관의 의견이 일치되어 주문과 같이 판결한다.

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