Open Decision Ledger · Civil obligations & remedies
Health insurance subrogation against a liability insurer and deduction of insurance money
Supreme Court, Apr. 9, 2026, 2025Da210218 (judgment)
Case name: 구상금
Official text on the National Law Information Center
Question
Where the National Health Insurance Corporation has paid insurance benefits to a tort victim and subrogates to the victim's damages claim, may money the tortfeasor's liability insurer paid the victim after those benefits be deducted from the corporation's recourse claim, and how is the deductible amount fixed when the part unrelated to the benefits cannot be identified?
Holding
Money paid as damages after the benefits is not deducted as such, and the corporation may subrogate only to that part of the victim's whole damages claim which arises from the same cause as the health insurance benefits. Where liability insurance is capped and the insurer's payment to the victim is not in a complementary relation to the benefits, that payment is deducted from the sum the insurer owes the corporation, and if the insurer says the payment covered loss of that kind the court must examine whether that loss occurred and how much it came to. If the evidence does not allow the unrelated part to be identified, the most reasonable method is to deduct the share of the liability insurance money that the loss unrelated to the benefits bears in the victim's total loss.
Summary of the holding, verbatim
국민건강보험공단이 불법행위로 인한 피해자에게 보험급여를 한 후 피해자의 가해자 또는 그 보험자에 대한 손해배상채권을 대위하는 경우, 피해자의 과실 등을 고려하여 산정된 손해배상채권의 범위 내에서 보험급여액 중 가해자의 책임비율에 해당하는 금액에 관하여 피해자의 가해자 또는 그 보험자에 대한 손해배상채권을 대위할 수 있고, 여기에서 국민건강보험공단의 보험급여 이후 가해자 또는 그 보험자가 손해배상 명목으로 피해자에게 지급한 돈을 공제할 수는 없다.
Unofficial English translation
Where the National Health Insurance Service, after paying insurance benefits to a victim of a tort, subrogates the victim's claim for damages against the tortfeasor or the tortfeasor's insurer, the National Health Insurance Service may, within the scope of the claim for damages calculated in consideration of the victim's negligence, etc., subrogate the victim's claim for damages against the tortfeasor or the tortfeasor's insurer with respect to the portion of the insurance benefit amount corresponding to the tortfeasor's share of liability, and money paid by the tortfeasor or the tortfeasor's insurer to the victim in the name of damages after the National Health Insurance Service's payment of insurance benefits cannot be deducted therefrom.
Disposition
Dismissed Stated in the decision
상고를 기각한다. 상고비용은 피고가 부담한다.
Unofficial English translation
The appeal is dismissed. The costs of the appeal shall be borne by the defendant.
Form of the test
Elements stated Stated in the decision
다만 국민건강보험공단이 피해자를 대위하여 얻는 손해배상채권은 피해자의 전체 손해배상채권 중 건강보험 보험급여와 동일한 사유에 의한 손해배상채권, 즉 보험급여와 손해배상이 상호보완적 관계에 있어 보험급여의 실시로 가해자에 대한 손해배상채권이 전보되어 소멸될 수 있는 경우에 한정되므로
Unofficial English translation
However, the claim for damages obtained by the National Health Insurance Service by subrogating the victim is limited, among the victim's entire claim for damages, to a claim for damages arising from the same grounds as the National Health Insurance benefits, that is, to cases where the insurance benefits and the damages stand in a mutually complementary relationship, so that the claim for damages against the tortfeasor may be compensated and extinguished by the provision of the insurance benefits, and therefore
Factors
- 피해자의 과실 등을 고려하여 산정된 손해배상채권의 범위 내에서
- 건강보험 보험급여와 동일한 사유에 의한 손해배상채권, 즉 보험급여와 손해배상이 상호보완적 관계에 있어 보험급여의 실시로 가해자에 대한 손해배상채권이 전보되어 소멸될 수 있는 경우에 한정되므로
- 그 보험자가 피해자에게 책임보험금으로 지급한 돈이 건강보험 보험급여와 상호보완적 관계에 있지 않다면
- 국민건강보험공단의 구상금에서 공제할 금액은 책임보험금 중 ‘피해자의 전체 손해액에서 보험급여와 상호보완적 관계에 있지 않은 손해가 차지하는 비율’로 산정하는 것이 가장 합리적이다
Unofficial English translation
• within the scope of the claim for damages calculated in consideration of the victim's negligence, etc.
• it is limited to a claim for damages arising from the same grounds as the National Health Insurance benefits, that is, to cases where the insurance benefits and the damages stand in a mutually complementary relationship, so that the claim for damages against the tortfeasor may be compensated and extinguished by the provision of the insurance benefits, and therefore
• if the money paid by that insurer to the victim as liability insurance benefits is not in a mutually complementary relationship with the National Health Insurance benefits, then
• the amount to be deducted from the National Health Insurance Service's claim for reimbursement is most reasonably calculated as the portion of the liability insurance benefits corresponding to 'the ratio that the damages not in a mutually complementary relationship with the insurance benefits bear to the victim's total amount of damages'
Relation to precedent
Follows earlier decisions Stated in the decision
대법원 2022. 2. 10. 선고 2021다261117 판결(공2022상, 537)
Unofficial English translation
Supreme Court Decision 2021Da261117 decided February 10, 2022 (Gong 2022 Sang, 537)
Decisions referred to
대법원 2022. 2. 10. 선고 2021다261117 판결(공2022상, 537), 대법원 2024. 7. 11. 선고 2021다305437 판결(공2024하, 1245)
Burden of proof
Not addressed Not in the decision
Open question and revisit condition
When the insurer settles at the policy limit without an item breakdown, how far must the court press for evidence before it resorts to the proportional deduction?
A later decision that allows the proportional deduction only after specific enquiries, or that treats a settlement sum as wholly complementary, would require this entry to be read again. So would an amendment to Article 58(1) of the National Health Insurance Act or to Article 724(1) or (2) of the Commercial Act on the liability insurer's payment.
Cross-family AI independent reading & axis check
7 of 8 axes matched GPT-6 Astra (OpenAI, codex CLI) · 2026-10-24
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 “When the insurer settles at the policy limit without an item breakdown, how far must the court press for evidence before it resorts to the proportional deduction?” vs Independent “How should the deduction be calculated if the evidence cannot establish the victim's total losses or the amount of noncomplementary losses?”
The primary asks how much evidentiary inquiry must precede proportional deduction, while the independent asks how to calculate it when the losses needed for the ratio cannot be established.
국민건강보험공단이 불법행위로 인한 피해자에게 보험급여를 한 후 피해자의 가해자 또는 그 보험자에 대한 손해배상채권을 대위하는 경우, 피해자의 과실 등을 고려하여 산정된 손해배상채권의 범위 내에서 보험급여액 중 가해자의 책임비율에 해당하는 금액에 관하여 피해자의 가해자 또는 그 보험자에 대한 손해배상채권을 대위할 수 있고, 여기에서 국민건강보험공단의 보험급여 이후 가해자 또는 그 보험자가 손해배상 명목으로 피해자에게 지급한 돈을 공제할 수는 없다.Raw 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 decision does not name the court below or its case number. On the reasons' account, that court began from the view that non-covered treatment costs, future treatment costs, other costs, lost earnings and off-work damages, and consolation money within the victim's damages were not in a complementary relation to the health insurance benefits. It then worked out the range of the corporation's recourse by deducting, from the liability insurance money paid as settlement at the limit, the share that those items bore in the total loss. The insurer was the liability insurer of the operator of the goshiwon where the fire of 9 November 2018 injured six people, and had paid each victim a settlement equal to the limit on the policy, KRW 49 million to one of them.
Supreme Court standard: The Supreme Court held that this method of fixing the recourse was acceptable so long as the insurer, paying the settlements at the policy limit without disclosing the items, made the unrelated part hard to identify. Reading the reasons against the law and the record, it found no error in law under Article 58(1) of the National Health Insurance Act that affected the judgment. It dismissed the appeal on the unanimous opinion of the participating Justices and put the costs of the appeal on the defendant.
Distinguishing conditions
- A case in which the insurer discloses the items of the settlement it paid, so that the part unrelated to the health insurance benefits can be identified from the record and the proportional formula is not needed.
- Damages in the portion corresponding to the victim's own share of fault, since the subrogation runs only within damages calculated with the victim's fault taken into account and only as to the amount answering to the tortfeasor's liability ratio.
- Loss the benefits actually covered, that is, items arising from the same cause as the health insurance benefits, since the claim taken by subrogation is confined to such loss.
Record verification notes
List the victim's damage items one by one and mark each as complementary to the health insurance benefits or not, since the proportional formula applies only to the marked items. Then check whether the insurer disclosed the breakdown of the settlement it paid, and compare the result with the rules the Court took from Supreme Court Decision 2021Da305437 and Supreme Court Decision 2021Da261117.
From the official text
Points at issue
국민건강보험공단이 불법행위의 피해자에게 보험급여를 한 후 피해자의 가해자 또는 그 보험자에 대한 손해배상채권을 대위하는 경우, 대위의 범위 및 여기에서 국민건강보험공단의 보험급여 이후 가해자 또는 그 보험자가 손해배상 명목으로 피해자에게 지급한 돈을 공제할 수 있는지 여부(소극) / 국민건강보험공단이 피해자를 대위하여 얻는 손해배상채권의 범위(=건강보험 보험급여와 동일한 사유에 의한 손해배상채권) 및 책임보험과 관련하여 한도액이 있는 때에는 국민건강보험공단이 가해자의 보험자에게 손해배상채권을 대위 청구한 경우 보험자가 피해자에게 책임보험금으로 지급한 돈이 건강보험 보험급여와 상호보완적 관계에 있지 않다면 그 돈은 보험자가 국민건강보험공단에 지급할 책임보험금에서 공제되어야 하는지 여부(적극) / 이때 보험자가 피해자에게 지급한 책임보험금 중 어느 부분이 보험급여와 상호보완적 관계에 있지 않은지 특정하기 어려운 경우, 국민건강보험공단의 구상금에서 공제할 금액을 산정하는 방법
Unofficial English translation
Where the National Health Insurance Service, after paying insurance benefits to a victim of a tort, subrogates the victim's claim for damages against the tortfeasor or the tortfeasor's insurer, the scope of the subrogation and whether amounts paid by the tortfeasor or the tortfeasor's insurer to the victim in the name of damages after the National Health Insurance Service's payment of insurance benefits may be deducted therefrom (negative) / The scope of the claim for damages obtained by the National Health Insurance Service by subrogating the victim (= a claim for damages arising from the same grounds as the National Health Insurance benefits) and, where there is a limit under a liability insurance, where the National Health Insurance Service claims the subrogation of a claim for damages against the tortfeasor's insurer, whether money paid by the insurer to the victim as liability insurance benefits must, if it is not in a mutually complementary relationship with the National Health Insurance benefits, be deducted from the liability insurance benefits payable by the insurer to the National Health Insurance Service (affirmative) / In such case, where it is difficult to identify which portion of the liability insurance benefits paid by the insurer to the victim is not in a mutually complementary relationship with the insurance benefits, the method of calculating the amount to be deducted from the National Health Insurance Service's claim for reimbursement
Summary of the holding
국민건강보험공단이 불법행위로 인한 피해자에게 보험급여를 한 후 피해자의 가해자 또는 그 보험자에 대한 손해배상채권을 대위하는 경우, 피해자의 과실 등을 고려하여 산정된 손해배상채권의 범위 내에서 보험급여액 중 가해자의 책임비율에 해당하는 금액에 관하여 피해자의 가해자 또는 그 보험자에 대한 손해배상채권을 대위할 수 있고, 여기에서 국민건강보험공단의 보험급여 이후 가해자 또는 그 보험자가 손해배상 명목으로 피해자에게 지급한 돈을 공제할 수는 없다. 다만 국민건강보험공단이 피해자를 대위하여 얻는 손해배상채권은 피해자의 전체 손해배상채권 중 건강보험 보험급여와 동일한 사유에 의한 손해배상채권, 즉 보험급여와 손해배상이 상호보완적 관계에 있어 보험급여의 실시로 가해자에 대한 손해배상채권이 전보되어 소멸될 수 있는 경우에 한정되므로, 책임보험과 관련하여 그 한도액이 있는 때에는 국민건강보험공단이 가해자의 보험자에게 손해배상채권을 대위 청구한 경우 그 보험자가 피해자에게 책임보험금으로 지급한 돈이 건강보험 보험급여와 상호보완적 관계에 있지 않다면 이는 보험자가 국민건강보험공단에 지급할 책임보험금에서 공제되어야 한다. 따라서 보험자가 피해자에게 책임보험금으로 지급한 돈에 보험급여와 상호보완적 관계에 있지 않은 손해가 포함되어 있음을 주장한 경우에는 그 주장과 같은 손해의 발생 여부와 그 배상액의 범위를 심리·판단하여 이를 국민건강보험공단의 구상금에서 공제하여야 한다. 그런데 관련 증거를 살펴보더라도 지급된 책임보험금 중 어느 부분이 보험급여와 상호보완적 관계에 있지 않은지 특정하기 어렵다면, 국민건강보험공단의 구상금에서 공제할 금액은 책임보험금 중 ‘피해자의 전체 손해액에서 보험급여와 상호보완적 관계에 있지 않은 손해가 차지하는 비율’로 산정하는 것이 가장 합리적이다.
Order
상고를 기각한다. 상고비용은 피고가 부담한다.
Unofficial English translation
The appeal is dismissed. The costs of the appeal shall be borne by the defendant.
Provisions referred to
국민건강보험법 제58조 제1항, 상법 제719조, 제724조 제1항, 제2항
Read 2026-10-24 · Cross-read 2026-10-24. 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