In the National Health Insurance Act, the right to demand reimbursemet is a legal system in which, if a beneficiary is injured by the actions of the third party, the National Health Insurance Corporation provides insurance benefits and obtains the right to claim damages against the third party withi...
In the National Health Insurance Act, the right to demand reimbursemet is a legal system in which, if a beneficiary is injured by the actions of the third party, the National Health Insurance Corporation provides insurance benefits and obtains the right to claim damages against the third party within the limit of the expenses. This is a system to prevent beneficiaries from getting overlapped benefits and the third party from avoiding the responsibility, and accordingly to coordinate damages among the beneficiaries, the third parties and the National Health Insurance Corporation. In the National Health Insurance Act, the right to demand reimbursement is not specifically defined. Therefore, the acquisition requirements of the right to demand reimbursement and the ranges of its exercise should be established through interpretations and precedents.
The right to demand reimbursement is obtained when the reasons for insurance benefits are caused by the actions of the third party and the National Health Insurance Corporation, the insurer, provides insurance benefits. The scope of the third party should be determined in consideration of the degree of the repro- achability of the third party's actions and the necessity of protecting the health insurance resources. It is also interpreted that a member of same household's can be the other party in the exercise of the right to demand reimbursement only when the action of the same household member is of intentional or grave negligence.
The range in the exercise of the right to demand reimbursement is deter- mined by the method of calculating the total treatment cost, applying the comparative negligence, and then deducting insurance cost. In this case, the 'loss (total treatment cost)' means the amount of damage within the range that the insurance benefit is identical to the provided insurance benefit, and specifically, the sum of Corporation copayment and copayment. It is not desirable for practitioners to make a decision in relation to comparative negligence because the application of the comparative negligence is a matter of professional and fair judgment. Therefore, as a legislative theory, it is desirable to consider the method of establishing a comparative negligence calculating committee to determine the negligence ratio. Furthermore, while there are different opinions on the 'deduction method of insurance benefit costs', it is preferable that all the cost the Corporation provided for insurance benefit(Corporation copayment) shall be first deducted, in view of the literally interpretation and the objective interpretation of Article 58 (1) of the National Health Insurance Act.
In order to exercise the right to demand reimbursement, it is necessary to first determine the acquisition time of the right to demand reimbursement. The current National Health Insurance Act adopts 'the time of providing insurance benefits'. As a legislative theory, the acquisition time of the right to demand reimbursement should be advanced to conform to the protection of beneficiaries and health insurance resources.
On the other hand, the Insurance Benefits after received Compensation for the Loss are a legal system that Corporation no longer provides insurance benefits when a beneficiary who is injured by an act of the third party receives compensation from the third party who is an offender. This system is also intended to prevent overlapped or unfair benefits of beneficiaries and to adjust economic benefits.
Restrictions occur on benefits after received Compensation for the Loss when the 'insured person' has 'already received compensation from the third party'. In this regard, the beneficiary may be entitled to a variety of methods such as a settlement and a law suit. It must be the case the beneficiary was compensated for all of the damages, or after being compensated for some of the damages and the beneficiary gave up, waived or lost the remaining damages.
As an effect of received Compensation for the Loss, the Corporation shall not provide insurance benefit up to the limit of the compensation a beneficiary received. The 'limit of compensation' refers to the exemption limit of the insurer, and means the limit of the same amount of compensation as the health insurance benefits that the National Health Insurance Corporation is exempted from in the compensation that a victim received from the third party. Regarding the 'scope of non-insurance benefits' (redemption scope), it should be established interpretively whether insurance benefits are not provided even for the damages incurred by beneficiary's negligence. In this regard, the Supreme Court recently made the judgment that insurance benefits are not provided when the damages are incurred by beneficiary's negligence. However, the object of the damages burdened with an offender is to the extent of the damage corresponding to the offender's own negligence rate, not to the extent of the damage corresponding to the negligence rate of a victim. Therefore, the negligent ratio of the beneficiary who is a victim is interpreted as not 'in case of damages already received from the offender', and insurance benefits should still be provided accordingly.
Further, although the Insurance Benefits after received Compensation for the Loss is necessary to prevent unjust profits, the problem is that most of the beneficiaries do not know the benefits can be permanently limited in the case of the Insurance Benefits after received Compensation for the Loss. Thus, it is necessary to improve the system for protection of Insurance benefits to be in line with the ideology of the Constitution and Social Security Law.
In the National Health Insurance Act, the right to demand reimbursemet is a legal system in which, if a beneficiary is injured by the actions of the third party, the National Health Insurance Corporation provides insurance benefits and obtains the right to claim damages against the third party within the limit of the expenses. This is a system to prevent beneficiaries from getting overlapped benefits and the third party from avoiding the responsibility, and accordingly to coordinate damages among the beneficiaries, the third parties and the National Health Insurance Corporation. In the National Health Insurance Act, the right to demand reimbursement is not specifically defined. Therefore, the acquisition requirements of the right to demand reimbursement and the ranges of its exercise should be established through interpretations and precedents.
The right to demand reimbursement is obtained when the reasons for insurance benefits are caused by the actions of the third party and the National Health Insurance Corporation, the insurer, provides insurance benefits. The scope of the third party should be determined in consideration of the degree of the repro- achability of the third party's actions and the necessity of protecting the health insurance resources. It is also interpreted that a member of same household's can be the other party in the exercise of the right to demand reimbursement only when the action of the same household member is of intentional or grave negligence.
The range in the exercise of the right to demand reimbursement is deter- mined by the method of calculating the total treatment cost, applying the comparative negligence, and then deducting insurance cost. In this case, the 'loss (total treatment cost)' means the amount of damage within the range that the insurance benefit is identical to the provided insurance benefit, and specifically, the sum of Corporation copayment and copayment. It is not desirable for practitioners to make a decision in relation to comparative negligence because the application of the comparative negligence is a matter of professional and fair judgment. Therefore, as a legislative theory, it is desirable to consider the method of establishing a comparative negligence calculating committee to determine the negligence ratio. Furthermore, while there are different opinions on the 'deduction method of insurance benefit costs', it is preferable that all the cost the Corporation provided for insurance benefit(Corporation copayment) shall be first deducted, in view of the literally interpretation and the objective interpretation of Article 58 (1) of the National Health Insurance Act.
In order to exercise the right to demand reimbursement, it is necessary to first determine the acquisition time of the right to demand reimbursement. The current National Health Insurance Act adopts 'the time of providing insurance benefits'. As a legislative theory, the acquisition time of the right to demand reimbursement should be advanced to conform to the protection of beneficiaries and health insurance resources.
On the other hand, the Insurance Benefits after received Compensation for the Loss are a legal system that Corporation no longer provides insurance benefits when a beneficiary who is injured by an act of the third party receives compensation from the third party who is an offender. This system is also intended to prevent overlapped or unfair benefits of beneficiaries and to adjust economic benefits.
Restrictions occur on benefits after received Compensation for the Loss when the 'insured person' has 'already received compensation from the third party'. In this regard, the beneficiary may be entitled to a variety of methods such as a settlement and a law suit. It must be the case the beneficiary was compensated for all of the damages, or after being compensated for some of the damages and the beneficiary gave up, waived or lost the remaining damages.
As an effect of received Compensation for the Loss, the Corporation shall not provide insurance benefit up to the limit of the compensation a beneficiary received. The 'limit of compensation' refers to the exemption limit of the insurer, and means the limit of the same amount of compensation as the health insurance benefits that the National Health Insurance Corporation is exempted from in the compensation that a victim received from the third party. Regarding the 'scope of non-insurance benefits' (redemption scope), it should be established interpretively whether insurance benefits are not provided even for the damages incurred by beneficiary's negligence. In this regard, the Supreme Court recently made the judgment that insurance benefits are not provided when the damages are incurred by beneficiary's negligence. However, the object of the damages burdened with an offender is to the extent of the damage corresponding to the offender's own negligence rate, not to the extent of the damage corresponding to the negligence rate of a victim. Therefore, the negligent ratio of the beneficiary who is a victim is interpreted as not 'in case of damages already received from the offender', and insurance benefits should still be provided accordingly.
Further, although the Insurance Benefits after received Compensation for the Loss is necessary to prevent unjust profits, the problem is that most of the beneficiaries do not know the benefits can be permanently limited in the case of the Insurance Benefits after received Compensation for the Loss. Thus, it is necessary to improve the system for protection of Insurance benefits to be in line with the ideology of the Constitution and Social Security Law.
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