Open Decision Ledger · Civil obligations & remedies
Traffic injury loss, fault-free treatment costs, and the health insurer's subrogation
Supreme Court, June 26, 2025, 2023Da231738 (judgment)
No holding summary · checked against points at issue. The official text publishes no summary of the holding for this decision. The quotation and factors in this record are copied verbatim from the points at issue; the evidence for each axis is taken from the points at issue, the order and the reasons.
Case name: 구상금
Official text on the National Law Information Center
Question
What is the meaning of the loss amount the compulsory liability insurer must pay under Article 3(1)(i) and (ii) of the Enforcement Decree of the Motor Vehicle Liability Compensation Act, may a victim claim the treatment-cost amount under the proviso of Article 3(1)(ii) regardless of their own fault, and when the Health Insurance Service subrogates under Article 58(1) of the National Health Insurance Act, how far does that subrogation reach?
Holding
The loss amount means the victim's actual loss, including treatment costs, lost earnings and mental damages, less the share attributable to the victim's fault and any contribution of a pre-existing condition. Where that amount falls below the treatment-cost amount, the victim may claim the treatment-cost amount within the limits of Schedule 1 regardless of their own fault, and where the victim dies during treatment, the amount payable is the loss incurred by the victim within the sum of the limit amounts under Article 3(1)(i) and (ii). The Health Insurance Service may subrogate only up to its own contribution, and only in the proportion corresponding to the tortfeasor's share for the part the tortfeasor originally had to bear, while it may subrogate in full for the part increased by the proviso regardless of the victim's fault.
Points at issue, verbatim
공단부담금의 한도 내에서, 책임보험금 중 원래 가해자가 부담하여야 할 손해배상액 부분에 대해서는 공단부담금 중 가해자의 책임비율에 해당하는 금액
Unofficial English translation
within the limit of the amount borne by the Service, as for the portion of the liability insurance proceeds corresponding to the amount of damages originally to be borne by the tortfeasor, the amount corresponding to the tortfeasor's share of liability within the amount borne by the Service
Disposition
Partly reversed and remanded Stated in the decision
원심판결 중 피고 패소 부분을 파기하고, 이 부분 사건을 수원지방법원에 환송한다.
Unofficial English translation
The judgment of the court below is reversed insofar as it ruled against the defendant, and this part of the case is remanded to the Suwon District Court.
Form of the test
Elements stated Read from the decision
그 대위의 범위는 공단부담금의 한도 내에서, 책임보험금 중 원래 가해자가 부담하여야 할 손해배상액 부분에 대해서는 공단부담금 중 가해자의 책임비율에 해당하는 금액으로 제한되고
Unofficial English translation
the scope of such subrogation is limited, within the limit of the amount borne by the Service, to the amount corresponding to the tortfeasor's share of liability within the amount borne by the Service as for the portion of the liability insurance proceeds corresponding to the amount of damages originally to be borne by the tortfeasor, and
Factors
- 자동차손해배상 보장법 시행령 제3조 제1항 제1호, 제2호에 따라 책임보험자가 지급하여야 할 금액인 ‘피해자에게 발생한 손해액’의 의미
- 교통사고 피해자가 교통사고 발생에 기여한 자신의 과실 유무나 다과와 관계없이 자동차손해배상 보장법 시행령 제3조 제1항 제2호 단서에 따른 진료비 해당액을 책임보험금으로 청구할 수 있는지 여부(적극)
- 제1항 제1호와 제2호에 따른 한도금액의 합산액 범위에서 피해자에게 발생한 손해액
- 공단부담금의 한도 내에서, 책임보험금 중 원래 가해자가 부담하여야 할 손해배상액 부분에 대해서는 공단부담금 중 가해자의 책임비율에 해당하는 금액
- 피해자 과실과 관계없이 위 단서 규정에 따라 증액된 나머지 부분에 대해서는 전액
Unofficial English translation
• The meaning of "the amount of damage incurred by the victim," which is the amount that the liability insurer must pay under Article 3, paragraph (1), subparagraphs 1 and 2 of the Enforcement Decree of the Motor Vehicle Accident Damage Compensation Act
• Whether the victim of a traffic accident may claim the amount corresponding to medical expenses under the proviso to Article 3, paragraph (1), subparagraph 2 of the Enforcement Decree of the Motor Vehicle Accident Damage Compensation Act as liability insurance proceeds, regardless of whether or to what degree the victim's own negligence contributed to the occurrence of the traffic accident (affirmative)
• the amount of damage incurred by the victim within the aggregate of the limit amounts under paragraph (1), subparagraphs 1 and 2
• within the limit of the amount borne by the Service, as for the portion of the liability insurance proceeds corresponding to the amount of damages originally to be borne by the tortfeasor, the amount corresponding to the tortfeasor's share of liability within the amount borne by the Service
• as for the remaining portion increased pursuant to the above proviso, regardless of the victim's negligence, the entire amount
Relation to precedent
Follows earlier decisions Stated in the decision
대법원 2025. 5. 15. 선고 2022다246146 판결(공2025하, 1034)
Unofficial English translation
Supreme Court Decision 2022Da246146 decided May 15, 2025 (Gong 2025 Ha, 1034)
Decisions referred to
[1][2] 대법원 2025. 5. 15. 선고 2022다246146 판결(공2025하, 1034) / [1] 대법원 2013. 10. 11. 선고 2013다42755 판결(공2013하, 2073), 대법원 2017. 10. 12. 선고 2017다231119 판결(공2017하, 2096) / [2][4] 대법원 2025. 5. 15. 선고 2022다235009 판결(공2025하, 1030) / [2] 대법원 2008. 12. 11. 선고 2006다82793 판결(공2009상, 14), 대법원 2012. 10. 11. 선고 2012다44563 판결, 대법원 2013. 11. 14. 선고 2013다47446 판결 / [3] 대법원 2025. 3. 13. 선고 2024다238217 판결(공2025상, 669)
Burden of proof
Not addressed Not in the decision
Open question and revisit condition
How should the victim's loss amount be fixed where the victim settled with the insurer for KRW 250,000,000 on 12 March 2020 and then died during treatment on 16 July 2020, and does that settlement alter the application of the floors?
The remand judgment of the Suwon District Court will show how the loss amount and the treatment-cost amount are computed in practice and how the subrogation is split. Any amendment to Article 3 of the Enforcement Decree of the Motor Vehicle Liability Compensation Act or to Article 58(1) of the National Health Insurance Act, or a later decision refining the boundaries set in Supreme Court Decision 2022Da235009, would require this entry to be read again.
Cross-family AI independent reading & axis check
7 of 8 axes matched GPT-6 Astra (OpenAI, codex CLI) · 2026-10-25
A reader from another model family (GPT-6 Astra), given the official text but not the primary reading, agreed on 7 of the 8 axes; the readings differed on axis 8 (open question and revisit condition).
Axis 8 (Open question and revisit condition): Primary “How should the victim's loss amount be fixed where the victim settled with the insurer for KRW 250,000,000 on 12 March 2020 and then died during treatment on 16 July 2020, and does that settlement alter the application of the floors?” vs Independent “What amount may the Service ultimately recover after the victim's loss, medical expenses, and applicable statutory floors are determined on remand?”
The primary asks how the loss amount should be fixed given the earlier settlement and death during treatment and whether the settlement affects the floors, while the independent asks what final amount the Service may recover on remand.
공단부담금의 한도 내에서, 책임보험금 중 원래 가해자가 부담하여야 할 손해배상액 부분에 대해서는 공단부담금 중 가해자의 책임비율에 해당하는 금액Raw responses and comparison record: Protocol · Blind readings (JSONL) · Axis comparison (JSONL) · SHA-256 (JSON)
Lower-court contrast & scope of application
Lower-court reading vs. Supreme Court holding
Lower-court context: The Suwon District Court, in its judgment of 13 April 2023 (2022Na72663), held that the liability insurance limit under Article 3(2)(i) and Article 3(1)(i) and (ii) of the Enforcement Decree was KRW 180,000,000, and that the plaintiff could subrogate in full, regardless of the victim's fault, to the victim's claim against the insurer up to the KRW 64,611,120 the plaintiff had paid as the health insurance share of the treatment costs through 11 March 2020. It therefore found for the plaintiff on that amount.
Supreme Court standard: The Supreme Court held that the court below had not examined whether the victim's loss amount fell below the treatment-cost amount, or whether it fell below the sum of the floors of Article 3(1)(i) and (ii), before allowing full subrogation. That was a misreading of the law on setting liability insurance proceeds under Article 3 of the Decree and on the recourse right under Article 58(1) of the National Health Insurance Act, and a failure to deliberate on what was needed, so the part of the judgment in which the insurer lost was reversed and remanded to the Suwon District Court.
Distinguishing conditions
- A case in which the victim's loss amount, after deducting the victim's fault share and any contribution of a pre-existing condition, is not below the treatment-cost amount, so the proviso of Article 3(1)(ii) does not come into play.
- A claim that is not brought in subrogation by the Health Insurance Service under Article 58(1) of the National Health Insurance Act, since the subrogation limits the Court set reach only that party.
- A claim exceeding the health insurance share the plaintiff actually paid, since the subrogation reaches only up to that amount.
Record verification notes
Rebuild the victim's loss from the file: treatment costs, lost earnings during the treatment period and mental damages, then deduct the victim's fault ratio and any pre-existing condition contribution. The treatment-cost amount is generally the sum of the health insurance share and the patient's own share under the standards for automobile insurance medical charges, so take that as the yardstick and set the two figures against the floors of Article 3(1)(i) and (ii) and against Schedule 1. Only then split the amount claimed between the part corresponding to the tortfeasor's share, where the subrogation is proportionate, and the part increased by the proviso, where it is in full.
From the official text
Points at issue
[1] 자동차손해배상 보장법 시행령 제3조 제1항 제1호, 제2호에 따라 책임보험자가 지급하여야 할 금액인 ‘피해자에게 발생한 손해액’의 의미 [2] 교통사고 피해자가 교통사고 발생에 기여한 자신의 과실 유무나 다과와 관계없이 자동차손해배상 보장법 시행령 제3조 제1항 제2호 단서에 따른 진료비 해당액을 책임보험금으로 청구할 수 있는지 여부(적극) [3] 교통사고로 부상한 피해자가 치료를 받던 도중 사망한 경우의 책임보험금에 관하여 규정하고 있는 자동차손해배상 보장법 시행령 제3조 제2항 제1호의 ‘제1항 제1호와 제2호에 따른 한도금액의 합산액 범위에서 피해자에게 발생한 손해액’의 의미 [4] 국민건강보험공단이 교통사고 피해자에게 보험급여를 한 다음 국민건강보험법 제58조 제1항에 따라 자동차손해배상 보장법 시행령 제3조 제1항 제2호 단서에 의한 책임보험금 청구권을 대위하는 경우, 대위의 범위(=공단부담금의 한도 내에서, 책임보험금 중 원래 가해자가 부담하여야 할 손해배상액 부분에 대해서는 공단부담금 중 가해자의 책임비율에 해당하는 금액 / 피해자 과실과 관계없이 위 단서 규정에 따라 증액된 나머지 부분에 대해서는 전액)
Unofficial English translation
[1] The meaning of "the amount of damage incurred by the victim," which is the amount that the liability insurer must pay under Article 3, paragraph (1), subparagraphs 1 and 2 of the Enforcement Decree of the Motor Vehicle Accident Damage Compensation Act [2] Whether the victim of a traffic accident may claim the amount corresponding to medical expenses under the proviso to Article 3, paragraph (1), subparagraph 2 of the Enforcement Decree of the Motor Vehicle Accident Damage Compensation Act as liability insurance proceeds, regardless of whether or to what degree the victim's own negligence contributed to the occurrence of the traffic accident (affirmative) [3] The meaning of "the amount of damage incurred by the victim within the aggregate of the limit amounts under paragraph (1), subparagraphs 1 and 2" in Article 3, paragraph (2), subparagraph 1 of the Enforcement Decree of the Motor Vehicle Accident Damage Compensation Act, which provides for liability insurance proceeds where a victim injured in a traffic accident dies while receiving treatment [4] Where, after providing insurance benefits to the victim of a traffic accident, the National Health Insurance Service subrogates, pursuant to Article 58, paragraph (1) of the National Health Insurance Act, the claim for liability insurance proceeds under the proviso to Article 3, paragraph (1), subparagraph 2 of the Enforcement Decree of the Motor Vehicle Accident Damage Compensation Act, the scope of subrogation (= within the limit of the amount borne by the Service, as for the portion of the liability insurance proceeds corresponding to the amount of damages originally to be borne by the tortfeasor, the amount corresponding to the tortfeasor's share of liability within the amount borne by the Service / as for the remaining portion increased pursuant to the above proviso, regardless of the victim's negligence, the entire amount)
Summary of the holding
The official text publishes no summary of the holding for this decision. The quotation and factors in this record are copied verbatim from the points at issue; the evidence for each axis is taken from the points at issue, the order and the reasons.
Order
원심판결 중 피고 패소 부분을 파기하고, 이 부분 사건을 수원지방법원에 환송한다.
Unofficial English translation
The judgment of the court below is reversed insofar as it ruled against the defendant, and this part of the case is remanded to the Suwon District Court.
Provisions referred to
[1] 자동차손해배상 보장법 시행령 제3조 제1항 제1호, 제2호 [2] 자동차손해배상 보장법 시행령 제3조 제1항 제2호 [3] 자동차손해배상 보장법 시행령 제3조 제1항 제1호, 제2호, 제2항 제1호 [4] 국민건강보험법 제58조 제1항, 자동차손해배상 보장법 시행령 제3조 제1항 제2호
Read 2026-10-25 · Cross-read 2026-10-25. All quotes matched against the official text. The Chinese-character placeholders the court used for anonymised parties are given in their Korean readings, and parenthetical Chinese-character glosses are omitted.
Every entry is published only after all quotes have been matched character by character against the official text, and audited by an independent second reading from a different model family across all eight axes. Both agreed axes and text-grounded interpretive divergences are recorded openly. The ledger is a research record, not an assessment of the court or advice on any matter.
Back to the ledger