건강보험공단의 구상권 행사범위 제한이 피해자 및 민영보험회사 등 이해관계자에 미치는 영향에 관한 연구 = A Study on Implications on Interested Parties Including Private Insurers and the Insured as a Result of the Reduced Scope of Indemnity for the National Health Insurance Service

다국어 초록 (Multilingual Abstract)

While the commercial law, as well as the laws related to public insurance schemes, explicitly stipulates the insurer's right of subrogation or indemnity, they are silent on how to define the scope of such right. And this has led to numerous disputes between insurers and the insured (or the injured). When it comes to the court's interpretation on the scope of subrogation under the law for the government-run health insurance scheme, the Supreme Court's En Banc Ruling on March 18, 2021 made a shift from the long-standing method of "making a deduction after applying the comparative negligence approach" to another method of "applying the comparative negligence approach after making a deduction." The former puts the right of the insurer before that of the insured, and the latter aims for a proportional balance between the two parties. This study reviewed the purpose of the insurer's subrogation, the effectiveness of insurance under different academic theories, and the Supreme Court's past rulings, and based on this review, concludes that the Supreme Court's March 2021 En Banc ruling to reduce the scope of subrogation for the National Health Insurance Service (NHIS) has many justifications and makes a valid sense. The study goes further to assess this ruling's other repercussions on private insurers, the insured, and the injured under liability insurance or private health insurance contracts. In terms of the liability insurance contract, this study suggests that the injured should be more compensated as much as the scope of indemnity for the NHIS is reduced. In a case where the right of indemnity for the NHIS competes with the injured's right to make a direct claim against an insurer, the latter should prevail over the former. The study further suggests that a subrogation clause be added into the standard terms and conditions for the private health insurance contract to address the subsequent side effects from the Supreme Court's March 2021 En Banc ruling, such as double compensation to the insured or exemption from liability for a third party.

참고문헌 (Reference)

1 이준교, "타인을 위한 보험계약이 포함된 화재보험 중복보험의 보험금 분담방식 개선" 6141 : 2020

2 장덕조 ; 남하균, "책임보험에서의 중복보험과 공동불법행위의 구상권" 한국금융법학회 15 (15): 111-139, 2018

3 정동윤, "주석상법(보험Ⅰ)" 한국사법행정학회 2015

4 노태헌, "인신사고로 인한 손해배상과 보험자의 구상권 - 국민건강보험공단의 구상권을 중심으로 -" 대한의료법학회 16 (16): 87-130, 2015

5 최윤희, "산업재해보상보험법상의 구상권 행사법리" 법학연구소 (30) : 301-319, 2015

6 신혜림, "산업재해보상보험급여와 손해배상의 조정 및 업무상 재해로 인한 손해배상청구에서의 과실상계에 관한 논의" 5 (5): 2016

7 양승규, "보험자대위에 관한 연구" 삼영사 1975

8 한기정, "보험법" 박영사 2018

9 장덕조, "보험법" 법문사 2020

10 양승규, "보험법" 삼지원 2005

11 박세민, "보험법" 박영사 2017

12 김은경, "보험계약법" 보험연수원 2016

13 장재용, "국민건강보험법에 따른 보험급여를 받은 피해자가 가해자를 상대로 구할 수 있는 치료비 손해배상채권액의 범위" 사법발전재단 1 (1): 907-946, 2021

14 김준래, "국민건강보험법상 제3자 행위로 인한 보험급여와 손해배상 조정 제도 등에관한 연구" 고려대 2020

15 김연희, "국민건강보험법상 구상권에 관한 연구" 성균관대 2015

16 황중연, "국민건강보험공단의 제3자에 대한 구상권의 범위" 서울동부지법 2013

17 박성원, "국민건강보험공단의 구상권에 대한 절대적 우위를 인정한 대법원2019. 4. 23. 선고 2015다231504 판결에 대한 비판" (사)한국보험법학회 14 (14): 107-130, 2020

18 서봉석, "구상권과 3자관계의 권리조정" 한국민사법학회 (42) : 459-492, 2008

19 서현덕, "공동불법행위자를 피보험자로 하는 책임보험자의 구상권 내용과 행사범위 - 대법원 2015. 7. 23. 선고 2014다42202 판결을 중심으로 -" (사)한국보험법학회 10 (10): 269-294, 2016