There are cases where a medical accident victim exceeds the annual cap on their out-of-pocket expenses for health insurance while receiving treatment. The Supreme Court has issued its first ruling stating that the perpetrator of the medical accident is responsible for paying this amount to the Health Insurance Corporation.
The Supreme Court's Third Division (Chief Justice Eom Sang-pil) stated on the 27th that it had returned the case to the Suwon High Court, ordering a retrial of a lawsuit filed by the Health Insurance Corporation against the perpetrator of the medical accident, Doctor A, after partially ruling in favor of the Health Insurance Corporation.
In September 2018, Doctor A and two nursing assistants administered contaminated intravenous fluids (garlic injection) to Patient B. Patient B exhibited abnormal symptoms such as vomiting and received treatment, but the symptoms worsened, and they died from septic shock four days later.
In the same year, Patient B spent 6,308,770 won on hospital expenses, including costs associated with treating symptoms from the medical accident. This figure exceeded the out-of-pocket expense cap of 5,230,000 won by 1,078,770 won.
The excess amount was initially refunded to Patient B's family by the Health Insurance Corporation. In the meantime, Patient B's family received a settlement of 50 million won from Doctor A and agreed not to raise any civil or criminal objections in the future.
In this situation, a legal dispute arose between the Health Insurance Corporation and the perpetrator of the medical accident. The Health Insurance Corporation decided to exercise the damage compensation claim that the medical accident victim could assert against the perpetrator.
The first trial issued a partial ruling in favor of the Health Insurance Corporation. It stated that the medical accident perpetrator did not need to pay the excess amount exceeding Patient B's out-of-pocket expense cap (1,078,770 won). The court concluded that the damage compensation claim itself had been extinguished since Patient B's family reached a settlement with the perpetrator.
The second trial reached the same conclusion as the first. The court determined that "it is difficult to view the entire excess amount over Patient B's out-of-pocket expense cap as damages related to the medical accident."
However, the Supreme Court found the ruling of the second trial to be incorrect. The Supreme Court stated, "When treatment is provided to subscribers under the National Health Insurance Act, insurance benefits are paid, and the Health Insurance Corporation bears the costs, which also applies to expenses exceeding the out-of-pocket expense cap." It added, "If the Corporation had to pay the out-of-pocket expense cap excess due to a third party's actions (such as a medical accident), it can claim damages from the third party within the limit of that excess."
The Supreme Court further noted, "The Health Insurance Corporation gains the right to claim damages from the perpetrator for the portion of the hospital expenses borne by the Corporation that Patient B incurred due to this medical accident," stating that this includes the excess amount of 1,078,770 won related to out-of-pocket expenses from the medical accident.