Workbear재주넘는곰
대법원 91누10022

Revocation of Disapproval of Medical Care Benefits (요양불승인처분취소)요양불승인처분취소

Decided1992. 05. 12. Court대법원Case reversed and remanded (worker's claim for medical benefits to be reconsidered under a more flexible causation standard)
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 had been employed in a printing plant for 13 years developed bronchial asthma, but the exact medical cause could not be conclusively identified. The Supreme Court of Korea held that strict medical proof is not required to establish a 'substantial causal relationship (상당인과관계)' between work and illness for purposes of workers' compensation. The Court reversed and remanded the lower court's decision, ruling that causation could be inferred from a comprehensive assessment of factors such as the worker's health condition before employment, the presence of harmful substances in the workplace, the length of employment, and changes in symptoms following a department transfer.

Key takeaways
  • CaseA long-term printing plant worker developed bronchial asthma of undetermined medical origin and was denied workers' compensation medical benefits.
  • OutcomeThe Supreme Court ruled that causation can be inferred from circumstantial evidence even without definitive medical proof, and sent the case back for reconsideration.
  • LessonWorkers seeking compensation for occupational diseases do not need conclusive medical proof of causation—overall workplace and health circumstances can establish the required causal link.
Issues
  • What degree and method of proof are required to establish a 'substantial causal relationship (상당인과관계)' between work and an occupational disease
  • The standard for recognizing work-relatedness of an occupational disease when the precise medical cause remains scientifically unconfirmed
Key reasoning

The Court reasoned that in cases involving occupational diseases (업무상 질병), the causal relationship between work and illness need not be proven with scientific or medical certainty. Instead, causation may be established through indirect and circumstantial evidence, including the worker's health status prior to employment, the existence of hazardous substances in the workplace, the duration of exposure, and any change in symptoms after a change in job duties or department. If, upon reviewing these overall circumstances, a substantial causal relationship can reasonably be inferred, that should be deemed sufficient proof of occupational causation, even without a definitive medical explanation of the disease's precise cause.

Summary of Decision (English, AI translation)

[1] "Occupational accident" under Article 3(1) of the Industrial Accident Compensation Insurance Act (산업재해보상보험법) refers to an accident that occurs to an employee during the performance of his/her duties and is attributable to those duties. Where the accident in question is a disease, there must be a proximate causal relationship between the work and the disease, and the party asserting such causal relationship bears the burden of proving it. However, this causal relationship need not be clearly proven in a medical or natural scientific sense; even where such proof is not available, if, taking into account all relevant circumstances—such as the employee's state of health at the time of employment, whether a causative substance for the disease existed in the workplace, the length of the employee's service in a workplace where such causative substance existed, and whether the symptoms decreased after transferring to a different department—it can be inferred that there is a proximate causal relationship between the work and the disease, such proof should be deemed to have been established.

[2] While the plaintiff was working in the plate-making room for approximately 13 years, he developed bronchial asthma. Chromium gas and other substances are generated in the course of work in the plate-making room, and such substances are capable of inducing bronchial asthma. The plaintiff had no symptoms of bronchial asthma at the time he began working in the plate-making room, but developed bronchial asthma while working there, and his symptoms decreased after he transferred to a different department. In such a case, even though bronchial asthma can be induced by numerous substances other than chromium gas, and even though the precise cause of the plaintiff's bronchial asthma has not been medically established, if there are no special circumstances suggesting that the plaintiff was exposed to some other substance capable of inducing bronchial asthma, it can be inferred that the plaintiff's bronchial asthma was induced by chromium gas and other substances generated in the course of work in the company's plate-making room. Accordingly, it is correct to find that there is a proximate causal relationship between the above disease and the performance of the plaintiff's duties.

Full text (English, AI translation) 5,978 chars

[Plaintiff, Appellant]

[Defendant, Appellee] Head of Seoul Gwanak Regional Labor Office

[Judgment Below] Seoul High Court Decision 91Gu2863 rendered on August 22, 1991

[Order]

The judgment below is reversed, and the case is remanded to the Seoul High Court.

[Reasoning]

The grounds of appeal are examined.

According to the reasoning of the judgment below, the court below found as follows: the Plaintiff joined the non-party Kukjeong Textbook Co., Ltd. (국정교과서주식회사) on May 9, 1969, and while working in the printing plate room of the said company from around December 30, 1970, developed bronchial asthma on February 15, 1984; chromium gas and the like are generated during the work process in the said printing plate room, and this can induce bronchial asthma; the Plaintiff had no symptoms of bronchial asthma at the time he began working in the said printing plate room, and his symptoms of bronchial asthma decreased after he was transferred to another department; however, bronchial asthma can also be induced by metals such as nickel and platinum and numerous other chemical or organic substances besides the chromium gas mentioned above, and the cause of the Plaintiff's bronchial asthma has not been identified. Having found these facts, the court below determined that, given that bronchial asthma can be induced by numerous kinds of metals, chemicals, and organic substances as described above, and that the cause of the Plaintiff's bronchial asthma has not been identified, the mere facts that the Plaintiff worked for a long period in the said company's printing plate room, where chromium gas and the like that can be one cause of bronchial asthma is generated, that he had no symptoms of bronchial asthma before working in the printing plate room, and that his symptoms decreased after he was transferred to another department, are not sufficient to conclude that there is a substantial causal relationship between the Plaintiff's bronchial asthma and his work in the printing plate room. On this basis, the court below determined that the Defendant's disposition in this case disapproving medical care benefits was lawful.

However, "occupational accident" under Article 3, Paragraph 1 of the Industrial Accident Compensation Insurance Act (산업재해보상보험법) refers to an accident that occurs to a worker in the course of performing his duties and that is attributable to those duties; therefore, where the accident is an illness, there must be a substantial causal relationship between the work and the illness. In such a case, the causal relationship between the worker's work and the illness must be proven by the party asserting it; however, such causal relationship need not necessarily be clearly proven in medical or natural-scientific terms. Even where the existence of a substantial causal relationship between the work and the illness can be inferred by considering all relevant circumstances—such as the worker's state of health at the time of employment, whether a causative substance was present in the workplace, the length of the worker's service in a workplace where the causative substance was present, and whether symptoms decreased after transfer to another department—such proof should be deemed to have been established.

It appears that the court below's determination that the cause of the Plaintiff's bronchial asthma had not been identified was based on Exhibit B No. 4-3 (medical opinion) prepared by Non-party 1, a physician, and Exhibits B No. 2-2 and 2-4 (medical certificate and medical opinion) prepared by Non-party 2, a physician of ○○○○ Hospital; however, the content of these documents is, in essence, merely a medical opinion stating that it cannot be determined whether or not the Plaintiff's asthma is occupational in nature.

Even according to the findings of the court below itself, the Plaintiff worked in the said company's printing plate room for approximately 13 years from around December 30, 1970, and developed bronchial asthma around February 15, 1984; chromium gas and the like are generated during the work process in the said printing plate room, and this can induce bronchial asthma; the Plaintiff had no symptoms of bronchial asthma at the time he began working in the said printing plate room, but developed bronchial asthma as described above while working in the printing plate room, and his symptoms decreased after he was transferred to another department. In light of these facts, even though bronchial asthma can also be induced, besides the aforementioned chromium gas, by the numerous other substances mentioned in the judgment, and even though the precise cause of the Plaintiff's bronchial asthma has not been medically established, in this case, where there are no special circumstances suggesting that the Plaintiff was exposed to any other substance that induces bronchial asthma, it can be inferred that the Plaintiff's bronchial asthma was induced by the chromium gas and the like generated during the work process in the said company's printing plate room. Accordingly, it would be correct to find that there is a substantial causal relationship between the Plaintiff's illness and the performance of his duties.

The court below, having instead concluded that it could not be determined that there was a substantial causal relationship between the Plaintiff's illness in this case and his work, committed an error of misunderstanding the legal principles concerning the causal relationship required for "occupational accident" under Article 3, Paragraph 1 of the Industrial Accident Compensation Insurance Act, or an error of failing to fully examine this issue.

The grounds of appeal pointing this out are with merit.

Therefore, the judgment below is reversed, and the case is remanded to the court below, this Decision being rendered by the unanimous opinion of the participating Justices, as stated in the Order.

Justice Kim Ju-han (Presiding Justice), Choi Jae-ho, Yoon Kwan, Kim Yong-jun

【판결요지】

가. 산업재해보상보험법 제3조 제1항 소정의 “업무상의 재해”라 함은 근로자가 업무수행중 그 업무에 기인하여 발생한 재해를 말하는 것이므로 그 재해가 질병인 경우에는 업무와 질병 사이에 상당인과관계가 있어야 하고, 이 경우 근로자의 업무와 질병 간의 인과관계에 관하여는 이를 주장하는 측에서 입증하여야 하는 것이지만, 그 인과관계는 반드시 의학적, 자연과학적으로 명백히 입증되어야만 하는 것은 아니고, 근로자의 취업 당시의 건강상태, 작업장에 발병 원인물질이 있었는지의 여부, 발병 원인물질이 있는 작업장에서의 근무기간, 근무부서를 옮긴 후의 증세의 감소 여부 등 제반 사정을 고려할 때 업무와 질병 사이에 상당인과관계가 있다고 추단되는 경우에도 그 입증이 있다고 보아야 할 것이다.

나. 원고가 제판실에서 약 13년 간 근무하던 중 기관지천식이 발병하였는바, 제판실에서의 작업과정에서 크롬가스 등이 발생하게 되고 이는 기관지천식을 유발할 수 있는 것이고, 원고는 위 제판실에서의 근무시작 당시 기관지천식의 증세가 없었는데 제판실에 근무하던 동안 기관지천식이 있었고, 다른 근무부서로 옮긴 후에는 그 증세가 감소되었다는 것이라면, 비록 기관지천식이 크롬가스 등 외에도 수많은 물질들에 의하여서도 유발될 수 있고, 원고의 기관지천식의 정확한 원인규명이 의학적으로 증명되지 아니하였다 하더라도 원고가 기관지천식을 유발하는 다른 물질에 노출되었다는 특단의 사정을 엿볼 수 없다면 원고의 위 기관지천식은 위 회사 제판실에서의 작업과정에서 발생한 크롬가스 등에 의하여 유발되었다고 추단할 수 있고, 따라서 위 질병과 업무수행 사이에는 상당인과관계가 있다고 보는 것이 옳을 것이라고 한 사례.

【참조조문】

가.나. 산업재해보상보험법 제3조 제1항 / 가. 행정소송법 제26조[입증책임]

【참조판례】

가. 대법원 1989.7.25. 선고 88누10947 판결(공1989,1308) / 나. 대법원 1992.2.25. 선고 91누8586 판결(공1992,1184)

【주문】·【이유】 전문 2,129자 · 펼쳐 보기

【원고, 상고인】

【피고, 피상고인】 서울관악지방노동사무소장

【원심판결】 서울고등법원 1991.8.22. 선고 91구2863 판결

【주 문】

원심판결을 파기하고 사건을 서울고등법원에 환송한다.

【이 유】 상고이유를 판단한다.

원심판결 이유에 의하면 원심은, 원고가 1969.5.9. 소외 국정교과서주식회사에 입사하여 1970.12.30.경부터 위 회사 제판실에서 근무하던 중 1984.2.15. 기관지천식이 발병하였는바, 위 제판실에서의 작업과정에서 크롬가스 등이 발생하게 되고 이는 기관지천식을 유발할 수 있으며, 원고는 위 제판실에서의 근무시작 당시 기관지천식의 증세가 없었고, 원고가 다른 근무부서로 옮긴 후에는 기관지천식의 증세가 감소된 사실, 그런데 기관지천식은 위 크롬가스 등 외에도 니켈, 백금 등 금속과 기타 수많은 화학물이나 유기물에 의하여서도 유발될 수 있고, 원고의 위 기관지천식의 원인은 밝혀지지 아니한 사실을 인정한 후, 위와 같이 기관지천식이 수많은 종류의 금속, 화학물, 유기물 등에 의하여 유발될 수 있고, 원고의 기관지천식의 원인이 밝혀지지 아니한 이상, 원고가 기관지천식의 한 원인이 될 수 있는 크롬가스 등이 발생하는 위 회사 제판실에서 장기간 근무하였고, 제판실에 근무하기 전에는 기관지천식증세가 없었으며, 근무부서를 옮긴 후에는 그 증세가 감소되었다는 사정만으로는 원고의 기관지천식이 제판실에서의 근무와 상당인과관계가 있다고 단정할 수 없다 하여 피고의 이 사건 요양 불승인 처분을 적법하다고 판단하고 있다.

그러나 산업재해보상보험법 제3조 제1항 소정의 “업무상의 재해”라 함은 근로자가 업무수행중 그 업무에 기인하여 발생한 재해를 말하는 것이므로 그 재해가 질병인 경우에는 업무와 질병 사이에 상당인과관계가 있어야 하고, 이 경우 근로자의 업무와 질병간의 인과관계에 관하여는 이를 주장하는 측에서 입증하여야 하는 것이지만, 그 인과관계는 반드시 의학적, 자연과학적으로 명백히 입증되어야만 하는 것은 아니고, 근로자의 취업 당시의 건강상태, 작업장에 발병 원인물질이 있었는지의 여부, 발병 원인물질이 있는 작업장에서의 근무기간, 근무부서를 옮긴 후의 증세의 감소 여부 등 제반사정을 고려할 때 업무와 질병 사이에 상당인과관계가 있다고 추단되는 경우에도 그 입증이 있다고 보아야 할 것이다.

원심이 원고의 기관지천식의 원인이 밝혀지지 아니하였다고 판단한 것은 의사 소외 1 작성의 을 제4호증의 3(소견서)와 ○○○○병원 의사 소외 2 작성의 을 제2호증의 2,4(진단서, 소견서)에 근거한 것으로 보이는바, 그 내용은 요컨데 원고의 천식이 직업성인지 아닌지 여부를 알 수 없다는 의학적 소견에 불과한 것이다.

원심이 인정하고 있는 바에 의하더라도 원고는 1970.12.30.경부터 약 13년간 위 회사 제판실에서 근무하던 중, 1984.2.15.경 기관지천식이 발병하였는바, 위 제판실에서의 작업과정에서 크롬가스 등이 발생하게 되고, 이는 기관지천식을 유발할 수 있는 것이고, 원고는 위 제판실에서의 근무시작 당시 기관지천식의 증세가 없었는데 제판실 근무하는 동안에 위와 같이 기관지천식이 있었고, 다른 근무부서로 옮긴 후에는 그 증세가 감소되었다는 것인바, 위와 같은 사실관계에 비추어 볼 때 비록 기관지천식이 위 크롬가스 등 외에도 판시와 같은 수많은 물질들에 의하여서도 유발될 수 있고, 원고의 기관지천식의 정확한 원인규명이 의학적으로 증명되지 아니하였다 하더라도 원고가 기관지천식을 유발하는 다른 물질에 노출되었다는 특단의 사정을 엿볼 수 없는 이 사건에 있어서는 원고의 위 기관지천식은 위 회사 제판실에서의 작업과정에서 발생한 크롬가스 등에 의하여 유발되었다고 추단할 수 있고, 따라서 원고의 위 질병과 업무수행 사이에는 상당인과관계가 있다고 보는 것이 옳을 것이다.

원심이 이와 달리 원고의 이 사건 질병과 업무와의 사이에 상당인과관계가 있다고 단정할 수 없다고 판단하고 말았음은 산업재해보상보험법 제3조 제1항 소정의 “업무상 재해”의 인과관계에 관한 법리를 오해하거나, 이 점에 관한 심리를 다하지 아니한 위법의 소치라 할 것이다.

이 점을 지적하는 논지는 이유 있다.

그러므로 원심판결을 파기하고 사건을 원심법원에 환송하기로 하여 관여 법관의 일치된 의견으로 주문과 같이 판결한다.

대법관 김주한(재판장) 최재호 윤관 김용준

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