CONTENTS
- 1. Administrative Appeal and Administrative Litigation, What Were the Detailed Circumstances?
- - Administrative Appeal and Administrative Litigation, What Is the Relevant Legal Information?
- 2. Administrative Appeal and Administrative Litigation, What Was the Court's Determination?
- 3. Administrative Appeal and Administrative Litigation, Daeryun's Strategy
1. Administrative Appeal and Administrative Litigation, What Were the Detailed Circumstances?
A, who brought this administrative appeal and administrative litigation matter, was riding a motorcycle at approximately 112 km/h, exceeding the speed limit by 20 km/h, around August 2022, when, while changing lanes, A collided with a taxi traveling ahead and sustained injuries, including a fracture of the heel bone.
The National Health Insurance Service (hereinafter the NHIS) had paid the Service's portion of A's treatment costs, amounting to approximately 29.7 million won. The NHIS, however, determined that A's speeding fell within the twelve categories of gross negligence prescribed in the Act on Special Cases concerning the Settlement of Traffic Accidents, and it issued a disposition to recover the Service's portion as unjust enrichment.
Disputing this, A filed an administrative litigation, arguing that “although A was speeding, the accident occurred because the other vehicle abruptly applied the brakes, sharply reduced its traveling speed, and then suddenly changed lanes without activating its turn signal,” and that, “because the accident did not result from A's intent or gross negligence, it does not fall within the grounds for limiting insurance benefits.”
Administrative Appeal and Administrative Litigation, What Is the Relevant Legal Information?
🔗Administrative Appeal and Administrative Litigation Below, we explain the litigation that may be brought against the National Health Insurance Service.
Citizens of the Republic of Korea are generally enrolled in the National Health Insurance, and when an enrollee develops an illness or sustains an injury, national health insurance benefits are paid in the first instance.
If, however, the reason the benefits were paid falls within a ground for limiting benefits prescribed in Article 53 of the National Health Insurance Act, the National Health Insurance Service issues a recovery notice against the enrollee for the national health insurance benefits paid, and the enrollee must return the insurance benefits received.
The grounds for limiting benefits representatively include, as set out above, cases in which the cause lies in a criminal act resulting from intent or gross negligence, or in which the accident was caused intentionally. In the case of a traffic accident, the twelve categories of gross negligence fall within this category.
If a person considers this recovery disposition to be improper, that person may (i) file an objection or (ii) file an administrative appeal. If the matter is not resolved through this process, the person may, as in the case above, (iii) file an administrative litigation.
▣ Article 90 of the National Health Insurance Act (Administrative Litigation) A person who has an objection to a disposition of the Service or of the Review and Assessment Service, or who is dissatisfied with a decision on an objection under Article 87 or on a request for adjudication under Article 88 (a request contesting an administrative action before an agency prior to court litigation, comparable to seeking administrative review), may file an administrative litigation as provided in the Administrative Litigation Act. |
2. Administrative Appeal and Administrative Litigation, What Was the Court's Determination?
The Administrative Court that heard this administrative appeal and administrative litigation matter ruled in A's favor in the action A brought against the NHIS to revoke the disposition collecting the unjust enrichment, entering a judgment for the plaintiff.
The court held that “on the evidence submitted by the NHIS alone, it is difficult to find that the plaintiff's injury fell within a criminal act resulting from ‘intent or gross negligence,’ a ground for limiting national health insurance benefits.”
According to the dashcam footage, the driver of the other vehicle reduced speed and then suddenly changed lanes without activating the turn signal, at which moment the vehicle collided with A's motorcycle. The court therefore found that the other vehicle's negligent breach of the duty of care was a significant factor in the occurrence of the traffic accident.
The court added that “considering the purpose for which insurance benefits are provided, the requirement of ‘gross negligence’ that serves as a ground for limiting benefits must be construed strictly,” and that “in determining a ground for limiting insurance benefits, the circumstances at the time of the accident, including how and in what manner the accident occurred, the driver's driving ability, and the driver's efforts to prevent the traffic accident, must be considered comprehensively.”
3. Administrative Appeal and Administrative Litigation, Daeryun's Strategy
We have analyzed an Administrative Court judgment holding that the mere fact of speeding does not, on its own, fall within a ground for limiting national health insurance benefits.
Administrative litigation is a judicial procedure for providing relief where a citizen's rights or interests are infringed by an unlawful disposition or exercise of public authority by an administrative agency, and for resolving disputes concerning legal relationships under public law or the application of the law.
Such an action may be filed only within 90 days from the day on which the person became aware that the disposition had been made, and within one year from the day on which the disposition was made, so a prompt response is important.
In addition, because administrative litigation involves complex legal procedures, it may be advisable to obtain the assistance of an attorney experienced in administrative matters.
The 🔗Administrative Group of Daeryun Law Firm LLP includes attorneys experienced in administrative matters who have accumulated extensive practical experience in the fields of administrative litigation and administrative relief, and they actively assist clients. If you need related help, you are welcome to visit Daeryun at any time.
