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대법원 93다58622

Insurance Claim Case (보험금 – Bohyumgeum)보험금

Decided1994. 03. 11. Court대법원Plaintiff (the bereaved family/beneficiary) 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.

An employee died in a car accident while working for an employer that was not covered by the Industrial Accident Compensation Insurance Act (산업재해보상보험법). The Supreme Court ruled that the exclusion clause (면책조항) in the auto insurance policy—which normally bars claims for injuries already compensable as industrial accidents—did not apply in this case, because the deceased could not actually receive compensation under that Act. As a result, the insurer was ordered to pay the auto insurance benefits.

Key takeaways
  • CaseAn employee of a rehabilitation guidance program (not covered by industrial accident insurance) died in a car accident while working.
  • OutcomeThe Supreme Court ruled that the auto insurance exclusion clause did not apply, allowing the family to receive the insurance payout.
  • LessonWorkers at businesses excluded from industrial accident insurance coverage may still be able to claim compensation through other insurance policies, such as auto insurance, if the exclusion clause's purpose (preventing double payment) does not actually apply to their situation.
Issues
  • Scope of application of the exclusion clause (면책조항) in comprehensive auto insurance policies
  • Whether employees of businesses not covered by the Industrial Accident Compensation Insurance Act can still receive compensation for work-related accidents through other insurance
Key reasoning

Under Korean law, even if a death or injury qualifies as a 'work-related accident' (업무상 재해) under the Labor Standards Act (근로기준법), the auto insurance exclusion clause is meant to prevent double compensation only when the victim can actually receive benefits under the Industrial Accident Compensation Insurance Act. In this case, the deceased worked for a rehabilitation guidance program (갱생보호사업) that was not a business covered by that Act, meaning no industrial accident compensation was actually available. Since there was no risk of double recovery, the court held that applying the exclusion clause would unfairly deprive the family of any compensation. Therefore, the exclusion clause did not apply, and the auto insurer was required to pay the insurance benefits directly.

Summary of Decision (English, AI translation)

The provision of Article 10(2)(4) of the Standard Terms and Conditions for Automotive Comprehensive Insurance (자동차종합보험보통약관), which sets forth as a ground for the insurer's exemption from liability the case where the victim is an employee of the insured who bears liability and is a person entitled to receive disaster compensation under the Labor Standards Act (근로기준법), has its significance in the principle that disaster compensation arising in labor relations should in principle be compensated through Industrial Accident Compensation Insurance. Therefore, even if an injury constitutes an occupational injury under the Labor Standards Act, if it is a case where compensation cannot be received under the Industrial Accident Compensation Insurance Act (산업재해보상보험법), it must be excluded from the scope of application of the exemption ground.

Full text (English, AI translation) 4,309 chars

[Plaintiff, Appellee] Korea Rehabilitation Aid Association (갱생보호회), Litigation Representative: Samphoong Joint Law Office, Attorney Lee Yong-sik and 1 other

[Defendant, Appellant] Kukje Fire & Marine Insurance Co., Ltd. (국제화재해상보험 주식회사), Litigation Representative: Attorney Hyun Jong-chan

[Judgment Below] Seoul High Court Judgment 93Na17050, rendered October 21, 1993

[Order]

The appeal is dismissed.

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

[Reasoning]

As to the grounds of appeal:

Article 10, Paragraph 2, Item 4 of the Standard Terms and Conditions of the Comprehensive Automobile Insurance Policy (자동차종합보험 보통약관) in this case provides, as a ground exempting the insurer from liability, the case where the victim is an employee of the insured who bears liability for damages and is a person entitled to receive accident compensation under the Labor Standards Act (근로기준법). The meaning of this provision is as follows: with respect to damages arising from occupational accidents occurring in the employment relationship between an employer and an employee, the Labor Standards Act, which governs labor relations, provides for various compensation obligations of the employer, and, to secure such compensation obligations, the Industrial Accident Compensation Insurance Act (산업재해보상보험법) establishes the industrial accident compensation insurance system. Accordingly, the purpose of the provision is that, in principle, accident compensation arising in the employment relationship should be covered by industrial accident compensation insurance. Therefore, even if an accident constitutes an occupational accident under the Labor Standards Act, if compensation cannot be obtained therefor under the Industrial Accident Compensation Insurance Act, such case must be excluded from the scope of application of the above exemption clause (see this Court's Decisions 88Da29177, rendered November 14, 1989; 91Da6634, rendered May 14, 1991).

According to the reasoning of the judgment below, the court below found as follows: the deceased Nonparty 1, who died in the traffic accident in this case, was an employee affiliated with the Plaintiff's Masan Branch. On the day of the traffic accident, Nonparty 1, along with seven employees including Nonparty 2, the General Affairs Section Chief of the Masan Branch, boarded the vehicle in this case, which was affiliated with the Masan Branch, and was traveling to Miryang-eup to attend a monthly meeting held at the Plaintiff's Miryang Branch, during which the traffic accident occurred and Nonparty 1 died. Therefore, the death of Nonparty 1 constitutes an occupational accident. Furthermore, the Plaintiff's business constitutes a business or workplace to which the Labor Standards Act applies, and thus the deceased is a person entitled to receive accident compensation under the Labor Standards Act. However, the Plaintiff's rehabilitation aid business falls under health and social welfare business under the Korean Standard Industrial Classification, and pursuant to Article 4 of the Industrial Accident Compensation Insurance Act and Article 2, Paragraph 1, Item 2 of the Enforcement Decree of the same Act (동법시행령), it does not constitute a business or workplace subject to the Industrial Accident Compensation Insurance Act.

Accordingly, the court below held that, since the deceased cannot receive compensation for his death caused by the traffic accident in this case under the Industrial Accident Compensation Insurance Act, he is excluded from the scope of the exemption clause under Article 10, Paragraph 2, Item 4 of the above Comprehensive Automobile Insurance Standard Terms and Conditions.

The above findings and determination of the court below are consistent with the legal principles set forth above and are justified, and there is no error of law, as argued in the grounds of appeal, in misinterpreting the exemption clause of automobile insurance. The argument is without merit.

Therefore, the appeal is dismissed, and the costs of the appeal are to be borne by the losing party. This judgment is rendered as stated in the Order by the unanimous opinion of the participating Justices.

Presiding Justice Park Jun-seo, Justice Kim Sang-won, Justice Yoon Young-cheol (Presiding Justice for Deliberation), Justice Park Man-ho

【판결요지】

자동차종합보험보통약관 제10조 제2항 제4호가 피해자가 배상책임 있는 피보험자의 피용자로서 근로기준법에 의한 재해보상을 받을 수 있는 사람인 경우를 보험자의 면책사유로 규정한 것은 노사관계에서 발생하는 재해보상에 대하여는 원칙적으로 산업재해보상보험에 의하여 전보받도록 하자는 데 그 의미가 있는 것이므로, 근로기준법상의 업무상 재해라고 하더라도 산업재해보상보험법에 의하여 보상받을 수 없는 경우에는 면책사유의 적용대상에서 제외하여야 한다.

【참조조문】

상법 제659조, 산업재해보상보험법 제1조, 제4조

【참조판례】

대법원 1993.6.8. 선고 93다5192 판결(공1993하,2004), 1993.11.9. 선고 93다23107 판결(공1994상,76), 1994.1.11. 선고 93다5376 판결(공1994상,679)

【주문】·【이유】 전문 1,392자 · 펼쳐 보기

【원고, 피상고인】 갱생보호회 소송대리인 법무법인 삼풍합동법률사무소 담당변호사 이용식 외 1인

【피고, 상고인】 국제화재해상보험 주식회사 소송대리인 변호사 현종찬

【원심판결】 서울고등법원 1993.10.21. 선고 93나17050 판결

【주 문】

상고를 기각한다.

상고비용은 피고의 부담으로 한다.

【이 유】 상고이유에 대하여

이 사건 자동차종합보험 보통약관 제10조 제2항 제4호가 피해자가 배상책임있는 피보험자의 피용자로서 근로기준법에 의한 재해보상을 받을 수 있는 사람인 경우를 보험자의 면책사유로 규정한 것은, 사용자와 근로자의 노사관계에서 발생한 업무상 재해로 인한 손해에 대하여는 노사관계를 규율하는 근로기준법에서 사용자의 각종 보상책임을 규정하는 한편, 이러한 보상책임을 담보하기 위하여 산업재해보상보험법으로 산업재해보상보험제도를 설정하고 있으므로, 노사관계에서 발생하는 재해보상에 대하여는 원칙적으로 산업재해보상보험에 의하여 전보받도록 하자는데 그 의미가 있는 것이므로, 근로기준법상의 업무상 재해라고 하더라도 산업재해보상보험법에 의하여 보상받을 수 없는 경우에는 위 면책사유의 적용대상에서 제외하여야 할 것이다(당원 1989.11.14. 선고 88다카29177 판결; 1991.5.14. 선고 91다6634 판결 참조).

원심판결 이유에 의하면, 원심은 이 사건 교통사고로 사망한 소외 1은 원고의 마산지부 소속 직원으로서 이 사건 교통사고 당일 마산지부의 총무과장인 소외 2를 비롯한 7명의 직원들이 마산지부 소속인 이 사건 자동차에 탑승하여 원고의 밀양지부에서 열리는 월계회에 참석하기 위하여 밀양읍으로 가던 중 이 사건 교통사고로 사망하였으므로, 위 소외 1의 사망은 업무상 재해가 된다고 할 것이고, 또 원고의 사업은 근로기준법이 적용되는 사업 또는 사업장이라 할 것이어서 위 망인은 근로기준법에 의한 재해보상을 받을 수 있는 사람이라 할 것이나, 한편 원고의 갱생보호사업은 한국산업표준분류표상 보건 및 사회복지사업에 해당하여 산업재해보상보험법 제4조, 동법시행령 제2조 제1항 제2호의 규정에 의하여 산업재해보상보험법의 적용대상인 사업 또는 사업장에 해당하지 아니한다 할 것이다.

따라서 위 망인은 이 사건 교통사고에 의한 위 망인의 사망에 대하여 위 산업재해보상보험법에 의하여 보상받을 수 없으므로, 위 자동차종합보험 보통약관 제10조 제2항 제4호의 면책대상에서 제외된다고 판시하였다.

원심의 위와 같은 인정판단은 앞에서 본 법리에 따른 것으로 정당하고, 소론과 같은 자동차보험의 면책약관에 관한 해석을 잘못한 위법은 없다. 논지는 이유 없다.

그러므로 상고를 기각하고 상고비용은 패소자의 부담으로 하여 관여 법관의 일치된 의견으로 주문과 같이 판결한다.

대법관 박준서(재판장) 김상원 윤영철(주심) 박만호

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