Court Rules "Illegal to Reclaim Insurance Benefits from High School Student Delivery Worker Involved in Nighttime Traffic Accident"

Court: "Signal violation alone cannot be considered gross negligence"

The court ruled that the action taken by the National Health Insurance Service (NHIS) to recover insurance benefits paid for hospital treatment from a high school student who caused a traffic accident while working a night delivery part-time job was unlawful. The judgment stated that considering the individual's status and various circumstances such as driving on a rainy night, it is difficult to conclude that the accident was caused by the student's gross negligence.

According to the legal community on the 22nd, the Seoul Administrative Court, Administrative Division 6 (Chief Judge Lee Ju-young) recently ruled in favor of the plaintiff in a lawsuit filed by A's parents, acting as legal representatives, against the NHIS to cancel the notice of recovery of unjust enrichment.

In June 2022, A, a high school senior at the time, was riding a motorcycle and working a night delivery part-time job when he violated a traffic signal at an intersection in Anyang City, Gyeonggi Province, and collided with a vehicle coming from the opposite direction. A sustained injuries including fractures and received hospital treatment for five months. The NHIS paid the hospital 26.77 million KRW for medical benefits.

However, in March of the following year, the NHIS determined that the traffic accident was caused by A's gross negligence and that he fell under the category of insurance benefit restrictions under the National Health Insurance Act, notifying A that 26.77 million KRW would be collected as unjust enrichment.

In response, A's side argued, "At the time of the accident, the weather was rainy, which likely obstructed visibility, and as a student working a night part-time job, fatigue likely contributed significantly to the accident."

The court acknowledged that A violated the traffic signal causing the accident but held that the violation could not be immediately judged as intentional or gross negligence. The court stated, "Considering the surrounding circumstances and the driver's condition at the time, it is possible that A violated the signal due to momentary loss of concentration or misjudgment, making it difficult to conclude that the traffic accident was caused by A's gross negligence," and ruled the NHIS's action unlawful.

Furthermore, the court noted, "It was nighttime and raining at the time of the accident, and raindrops were likely on the helmet worn by the plaintiff, making it difficult to secure visibility," adding, "Given that the plaintiff attended school during the day and worked delivery at night, it cannot be ruled out that fatigue had significantly accumulated."

The court concluded, "Gross negligence refers to a state of markedly lacking caution almost equivalent to intent," and stated, "In the absence of circumstances recognizing that the plaintiff was intoxicated or speeding, it cannot be concluded that such a state existed solely because of a traffic signal violation."

This content was produced with the assistance of AI translation services.