후유장애
가해자, 피해자, 국민건강보험공단의 책임. 과연, 누가? 얼마만큼? 지나.

by 심상연 손해사정사님 · 3 개월전조회수 55

<p class="se-text-paragraph se-text-paragraph-align- " id="SE-8c50fabf-dc50-4407-92bb-528b371838c2" style="line-height: 2;"><span class="se-fs- se-ff- se-weight-unset " id="SE-8cffa4c4-3c03-4832-810c-72c03af2cdcf">-대법원 2018다287935 보험금 등 청구의 소-</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-2eb05656-1cb7-4995-a51d-cf1dc61755d3" style="line-height: 2;"><span class="se-fs- se-ff- se-weight-unset " id="SE-ebae8e27-91b4-4fab-97a6-f38cbffde5dd">​</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-05460289-e9e9-460d-8420-48ac813c4b20" style="line-height: 2;"><span class="se-fs- se-ff- se-weight-unset " id="SE-0f5873d7-5fe5-4bff-b79d-34f0eb472761">​</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-cbc78f9d-9674-4fd1-8c56-95c0fa0d5a61" style="line-height: 2;"><span class="se-fs- se-ff- se-weight-unset " id="SE-808cbc35-e063-408e-b140-4351cd23ce58">I. 사건개요</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-6c055338-426a-4753-8d55-790acebcadf4" style="line-height: 2;"><span class="se-fs- se-ff- se-weight-unset " id="SE-39dcec8a-4a25-4dbd-9c86-f92e1ce6cb56">​</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-b87b3609-2fb1-48a1-b076-c0da9859cb0c" style="line-height: 2;"><span class="se-fs- se-ff- se-weight-unset " id="SE-0c834a69-5fcb-4f73-8a11-e1c3b87f0f77">가해자가(사고 과실 30%) 오토바이 운전중 과실로 수급권자를(사고 과실 70%) 부상케하였다. 가해자가 자동차보험에 미가입하여, 수급권자가 국민건강보험으로 치료하였다. 수급권자의 총 발생 치료비는 1,000만 원 이다. </span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-1f039155-f649-4512-bda6-64a3e29fec09" style="line-height: 2;"><span class="se-fs- se-ff- se-weight-unset " id="SE-9ab94bb0-b18e-4130-9347-1d837ecbd41a">​</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-4c41a27c-5234-47d8-954f-54b83368520b" style="line-height: 2;"><span class="se-fs- se-ff- se-weight-unset " id="SE-d33a5dce-da16-4d5d-80b0-5971595b4695">수급권자가 건강보험처리 후 본인부담금 400만 원 부담. 건강보험공단이 600만 원을 부담한 상태이다. </span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-2a0449d4-58af-49b8-8f2a-cc079955e845" style="line-height: 2;"><span class="se-fs- se-ff- se-weight-unset " id="SE-105c4c6d-7a9c-4a7b-9c68-d37905191c03">​</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-d5c6e234-a282-45bd-bfb9-87c8d64bf7ea" style="line-height: 2;"><span class="se-fs- se-ff- se-weight-unset " id="SE-e116a782-c9e1-4b21-b306-199196760914">이를두고 누가 얼마를 부담해야 하는지가 이 사건의 문제로 대두되었다.</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-a47d4ff2-49e3-4e2c-b19c-838b2c3d5669" style="line-height: 2;"><span class="se-fs- se-ff- se-weight-unset " id="SE-4f042c1a-a8e9-4e6c-ae8c-7bded4074d86">​</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-8f874b2d-f307-4896-9527-e17365d45f70" style="line-height: 2;"><span class="se-fs- se-ff- se-weight-unset " id="SE-5e7c0307-4127-4f15-bf23-ca1e074d5aca">​</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-ef08c208-51c5-4aad-8ce5-f8e427fa5674" style="line-height: 2;"><span class="se-fs- se-ff- se-weight-unset " id="SE-296dd9b1-a100-4736-b567-4464443f6b2c">​</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-939e6701-63c0-4323-b768-5a2850519483" style="line-height: 2;"><span class="se-fs- se-ff- se-weight-unset " id="SE-94be0729-65ed-4efd-bcfc-0dd1f58f2bd4">II. 공제 후 과실상계 방식</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-c075b445-a1e4-40a5-bd5e-ec81c90caecf" style="line-height: 2;"><span class="se-fs- se-ff- se-weight-unset " id="SE-f8f38508-22d9-44cf-b543-37bb2dcaae92">​</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-224e16ba-c068-456a-8dd1-ebf7b237c700" style="line-height: 2;"><span class="se-fs- se-ff- se-weight-unset " id="SE-8cec0777-ecf2-4bd0-9d0f-bc6e1ee1f653">1. 수급권자: 가해자에 대하여 본인 일부부담금 400만 원 중 가해자의 책임비율 30%에 해당하는 120만 원을 손해배상으로 청구.</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-e0f64d39-f68f-4fc7-8ff3-1166fe6642f7" style="line-height: 2;"><span class="se-fs- se-ff- se-weight-unset " id="SE-b14e5dbb-5a06-4127-b084-ae3395a4e4cf">2. 공단: 공단부담금 600만 원 중, 가해자 책임비율 30%에 해당하는 180만 원을 대위하여 가해자에게 구상.</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-2d0d879b-8072-4d7a-8acc-aab2d50a4595" style="line-height: 2;"><span class="se-fs- se-ff- se-weight-unset " id="SE-dab24e0d-04aa-404c-ab28-d64b022411d4">3. 결과</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-95c0c2a3-7de4-4381-a4b4-c64c12d09714" style="line-height: 2;"><span class="se-fs- se-ff- se-weight-unset " id="SE-d2a5d7a4-2293-4c20-9f02-8b4f1bdc3dde">1) 가해자: 300만 원(= 피해자에 대한 손해배상금 120만원+공단에 대한 구상금 180만 원) 부담.</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-d835e9ec-e055-4cfe-ac83-ebe259598bcb" style="line-height: 2;"><span class="se-fs- se-ff- se-weight-unset " id="SE-63ddef4f-32ce-49dd-8ff2-9a3fd509a0e6" style="color: rgb(255, 0, 0);">2) 공단: 420만 원(= 공단부담금 600만 원-가해자로부터 받은 구상금 180만 원) 부담.</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-b670df50-7fde-46ec-b396-3871ba95bf6f" style="line-height: 2;"><span class="se-fs- se-ff- se-weight-unset " id="SE-418ec8a0-50db-4909-82c1-2f22d544f18b" style="color: rgb(255, 0, 0);">3) 수급권자: 280만 원(= 본인일부부담금 400만 원-가해자로부터 받은 손해배상금 120만 원) 부담.</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-7576de20-24b9-45c4-95b5-640f9b6a5a47" style="line-height: 2;"><span class="se-fs- se-ff- se-weight-unset " id="SE-087168e5-799b-49f7-be49-55b7f5cb1f51">​</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-a310dd2d-99c4-44ee-8d00-a91b92ddb179" style="line-height: 2;"><span class="se-fs- se-ff- se-weight-unset " id="SE-2d4796f1-a0e9-41e2-9d3d-165b7849e938">​</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-a5c8fca2-c678-4f85-acde-478066cc3938" style="line-height: 2;"><span class="se-fs- se-ff- se-weight-unset " id="SE-09914966-54b4-4943-a732-7da94dfa0de5">​</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-a3c9e682-fb2a-454a-8ad6-234e116b61c4" style="line-height: 2;"><span class="se-fs- se-ff- se-weight-unset " id="SE-52d865c1-6393-42f4-92fa-9c58a25adf1c">III. 종전 대법원 판례 (공단이 공단부담금 전액에 대하여 수급권자를 대위할 수 있다는 방식)</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-7c2a4e48-02d3-43d5-b7bc-80bcfb777d7d" style="line-height: 2;"><span class="se-fs- se-ff- se-weight-unset " id="SE-c0896785-fdfc-43a0-9bc4-82b4b803bd67"> </span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-6e88108f-24dc-4953-b3d0-a6f636bc53cd" style="line-height: 2;"><span class="se-fs- se-ff- se-weight-unset " id="SE-e038b547-0768-4345-aa94-4c0ad71c3b1d">결과,</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-64bb213b-9f62-4bb7-bf6d-70dce9284468" style="line-height: 2;"><span class="se-fs- se-ff- se-weight-unset " id="SE-b1a5b2c8-ae59-4957-8c92-d2ae5e2a29e3">1) 가해자: 300만 원(= 1,000만 원×30%, 공단에 전액 구상) 부담.</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-f286e23c-f96d-4b28-a3bf-0df5c5653a89" style="line-height: 2;"><span class="se-fs- se-ff- se-weight-unset " id="SE-e7f243ea-9ed9-4c91-b141-a40acdba2271" style="color: rgb(255, 0, 0);">2) 공단: 300만 원(= 공단부담금 600만 원-가해자로부터 받은 구상금 300만 원) 부담.</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-f4657452-7a3a-4ebe-bc5e-0a348fa278f8" style="line-height: 2;"><span class="se-fs- se-ff- se-weight-unset " id="SE-e2a3506d-8e52-4804-912c-be0c4e397cba" style="color: rgb(255, 0, 0);">3) 수급권자: 400만 원(= 본인일부부담금 400만 원-가해자로부터 받은 손해배상금 0원)을 부담.</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-44fc8914-4366-46aa-8e8f-2283e08ee9fd" style="line-height: 2;"><span class="se-fs- se-ff-system se-weight-unset " id="SE-67eaad98-2bfc-4e65-8fec-78a0db884f65" style="color: rgb(0, 0, 0);">​</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-eebfdafb-0df4-4954-8415-d0631f3dfe05" style="line-height: 2;"><span class="se-fs- se-ff-system se-weight-unset " id="SE-c42e7954-400b-4b0d-a369-fc245a5426bd" style="color: rgb(0, 0, 0);">​</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-8e9821fb-2c4c-4894-bc3c-4c8054f4964d" style="line-height: 2;"><span class="se-fs- se-ff-system se-weight-unset " id="SE-fdabac14-d185-4e69-a2d5-73e298d55788" style="color: rgb(0, 0, 0);">​</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-6c4fd6c4-3598-49c3-bd6e-bdd61b912189" style="line-height: 2;"><span class="se-fs- se-ff-system se-weight-unset " id="SE-f12eff8c-c90f-44e0-a9e8-b5967314cac5" style="color: rgb(0, 0, 0); background-color: rgb(255, 255, 255);">Ⅳ. 대법원 판결내용</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-449403ca-f4b1-4660-970e-890c3f8df1ef" style="line-height: 2;"><span class="se-fs- se-ff-system se-weight-unset " id="SE-a1cc0a31-a844-47b6-aaa3-3d762b8814a9" style="color: rgb(0, 0, 0);">​</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-0b34e826-852f-4836-8241-23786471edad" style="line-height: 2;"><span class="se-fs- se-ff-system se-weight-unset " id="SE-0df661d7-96f1-40e0-b0aa-27c8c539b553" style="color: rgb(0, 0, 0); background-color: rgb(255, 255, 255);">국민건강보험공단은 수급권자의 총 발생 치료비 중 공단부담금에 대하여, 본래 수급권자의 치료비 중 공단이 부담할 몫을 부담하는 것이 형평에 맞고 온당한 것이된다.</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-4a189e97-9e39-4089-b586-b30f9fe3f5c5" style="line-height: 2;"><span class="se-fs- se-ff-system se-weight-unset " id="SE-c01df86c-8677-4018-9bb9-167a0e682386" style="color: rgb(0, 0, 0);">​</span></p><!-- } SE-TEXT --><!-- SE-TEXT { --><p class="se-text-paragraph se-text-paragraph-align- " id="SE-bc63cf9b-6fd4-4568-a0a8-b99335d78612" style="line-height: 2;"><span class="se-fs- se-ff-system se-weight-unset " id="SE-3ad3e712-44fa-43cf-9c64-732ca274248f" style="color: rgb(0, 0, 0); background-color: rgb(255, 255, 255);">따라서, 공단은 공단이 부담한 금액만을 기준하여 가해자(제3자인 배상의무자)에게 해당 과실부담비 만큼 구상하여야 한다. (즉, "II. 공제 후 과실상계 방식"이 맞는것임.)</span><div class="autosourcing-stub-extra" style="-ms-zoom: 1; opacity: 1;"></div><p></p><p><br></p>

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