2022.07.14

2021 (Ju) 1473

Minshu Vol. 76, No. 5

Judgment concerning the case where the total of the amount of the claim held by the injured party under Article 16, paragraph (1) of the Automobile Compensation Act and the amount of the abovementioned claim transferred to the State pursuant to Article 12-4, paragraph (1) of the Industrial Accident Insurance Act exceeds the amount of insurance coverage of automobile liability insurance, and the validity of the payment made in such case by an insurance company of automobile liability insurance to the State in response to the exercise of the abovementioned claim by the State

Case seeking insurance proceeds

Judgment of the First Petty Bench, quashed and decided by the Supreme Court

Osaka High Court, Judgment of June 3, 2021

Even if the total of the amount of the claim held by the injured party under Article 16, paragraph (1) of the Automobile Compensation Act and the amount of the abovementioned claim transferred to the State pursuant to Article 12-4, paragraph (1) of the Industrial Accident Insurance Act exceeds the amount of insurance coverage of automobile liability insurance, the payment of damages made to the State by an insurance company of automobile liability insurance in response to the exercise of the abovementioned claim by the State up to the limit of the abovementioned amount of insurance coverage constitutes valid performance of an obligation.

Article 16, paragraph (1) of the Act on Securing Compensation for Automobile Accidents (Automobile Compensation Act), Article 12-4, paragraph (1) of the Industrial Accident Compensation Insurance Act (Industrial Accident Insurance Act), Article 473 of the Civil Code

Act on Securing Compensation for Automobile Accidents
(Filing a Claim with the Insurer for Damages)
Article 16(1)　If a person in possession becomes liable to compensate for damage as under Article 3, the injured party may file a claim with insurer for the insurer to pay the injured party damages of up to the amount of insurance coverage, pursuant to Cabinet Order.

Industrial Accident Compensation Insurance Act
Article 12-4(1)　When the government has paid insurance proceeds in cases where an accident which is the cause of payment of insurance proceeds is caused by an act of a third party, the government acquires the right to claim compensation for damages held by the person who has received the insurance proceeds against the third party, at a maximum of the payment amount thereof.

Civil Code
(Performance)
Article 473　If the obligor performs an obligation to the obligee, the claim is extinguished.

1. The judgment in prior instance is quashed, and the judgment in first instance is revoked.

2. The appeal to the court of second instance filed by the appellee is dismissed.

3. The total court costs shall be borne by the appellee.

Concerning the reasons for a petition for acceptance of final appeal stated by the counsel for final appeal, INO Naoyuki (except for the reasons excluded)

1. In this case, the appellee, who was injured in a traffic accident, based on the claim under the provisions of Article 16, paragraph (1) of the Act on Securing Compensation for Automobile Accidents (hereinafter referred to as the "Automobile Compensation Act") (hereinafter referred to as the "direct claim"), demands the appellant, an insurance company of the automobile liability insurance which covers the vehicle that injured the appellee as the insured automobile, pay 1,039,212 yen, an amount that remains after deducting the amount already paid by the appellant to the appellee from the amount of damages up to the amount of insurance coverage (1,200,000 yen). As the appellee received insurance proceeds under the Industrial Accident Compensation Insurance Act (hereinafter referred to as the "Industrial Accident Insurance Act") (hereinafter referred to as "industrial accident insurance proceeds") for the injuries that the appellee suffered in the abovementioned accident, the appellant's direct claim has been transferred to the State, and in response to the exercise of the direct claim thus transferred, the appellant paid 1,039,212 yen to the State (hereinafter referred to as the "Payment"). Accordingly, whether the Payment constitutes valid performance of an obligation is disputed in this case.

2. The outline of facts lawfully determined by the court of prior instance is as follows.

(1) On January 5, 2016, while the motorized bicycle driven by the appellee was stopping on the car lane to take a right turn at an intersection, it collided with a vehicle that crossed a center line from the opposite lane due to the negligence of its driver, including a failure to look ahead carefully (hereinafter this traffic accident is referred to as the "Accident"), and the appellee suffered injuries including left tibiofibular open fracture (hereinafter referred to as the "Injuries").

(2) At the time of the Accident, there was a contract of automobile liability insurance that had been concluded for the abovementioned vehicle, for which the appellant was the insurance company.

(3) The government recognized the Accident as an occupational accident caused by an act of a third party, and paid medical treatment compensation benefits and compensation payment for loss of salary during a temporary absence from work to the appellee as industrial accident insurance proceeds in relation to the Injuries. The total value of this payment is 8,642,146 yen.

The amount of damage suffered by the appellee due to the Injuries that is not covered even after receiving the abovementioned industrial accident insurance proceeds is 4,401,977 yen. The amount of insurance coverage of automobile liability insurance (hereinafter referred to as the "amount of automobile liability insurance coverage") regarding the damage due to the Injuries is 1,200,000 yen.

(4) On June 8, 2018, the appellee exercised the direct claim against the appellant for the damage mentioned above. Meanwhile, on June 14, 2018, the State also exercised against the appellant the direct claim that had been transferred to the State under Article 12-4, paragraph (1) of the Industrial Accident Insurance Act as a result of the government having paid the abovementioned industrial accident insurance proceeds.

In response, the appellant paid 160,788 yen to the appellee on July 20, 2018, and paid 1,039,212 yen to the State on July 27, 2018 (the Payment).

3. Based on the facts mentioned above, the court of prior instance determined as summarized below and dismissed the appellee's claim.

Where an injured party in a traffic accident exercises a direct claim for the damage that is not covered even after receiving industrial accident insurance proceeds (hereinafter referred to as “uncovered damage”), even if the direct claim transferred to the State pursuant to Article 12-4, paragraph (1) of the Industrial Accident Insurance Act is exercised and the total of the amounts of these direct claims exceeds the amount of automobile liability insurance coverage, the injured party is allowed to receive payment of damages from an insurance company of automobile liability insurance up to the limit of the amount of automobile liability insurance coverage, in priority to the State (see 2017 (Ju) 659 and 660, the judgment of the First Petty Bench of the Supreme Court of September 27, 2018, Minshu Vol. 72, No. 4, at 432). According to this, where the total of the amount of the direct claim held by the injured party and the amount of the direct claim transferred to the State pursuant to that paragraph exceeds the amount of automobile liability insurance coverage, if the insurance company of automobile liability insurance pays the State the damages that should have been paid to the injured party in priority to the State, such payment does not constitute valid performance of an obligation. In this respect, since the Payment was made with regard to the damages that should have been paid to the appellee in priority to the State, it does not constitute valid performance of an obligation.

4. However, the aforementioned determination of the court of prior instance cannot be upheld for the following reasons.

A direct claim arises in the same amount as a claim for compensation for damage under the provisions of Article 3 of the Automobile Compensation Act held by the injured party against the insured (the party at fault), and if industrial accident insurance proceeds are paid to the injured party, the direct claim is transferred to the State pursuant to Article 12-4, paragraph (1) of the Industrial Accident Insurance Act up to the limit of the value of the industrial accident insurance proceeds mentioned above, and the State acquires the direct claim up to the limit of such value. Where the injured party exercises the direct claim for the uncovered damage, even if the direct claim transferred to the State is exercised and the total of the amounts of these direct claims exceeds the amount of automobile liability insurance coverage, the injured party is allowed to receive payment of damages from the insurance company of automobile liability insurance up to the limit of the amount of automobile liability insurance coverage, in priority to the State (see the abovementioned judgment of the First Petty Bench of the Supreme Court of September 27, 2018). However, this only means that there is a relationship between the injured party and the State in which the former is relatively superior to the latter in receiving payment of damages based on the abovementioned direct claims, and it does not serve as the basis for denying the validity of the payment of damages made to the State by the insurance company of automobile liability insurance in response to the exercise of the direct claim by the State as performance of an obligation (this is different from the argument that the State, as a result of receiving such payment, assumes an obligation to return to the injured party, as unjust enrichment, the part of the amount of that payment which is equivalent to the amount of uncovered damage that should have been paid to the injured party in priority to the State).

Consequently, it is appropriate to consider that even if the total of the amount of the direct claim held by the injured party and the amount of the direct claim transferred to the State pursuant to Article 12-4, paragraph (1) of the Industrial Accident Insurance Act exceeds the amount of automobile liability insurance coverage, the payment of damages made to the State by the insurance company of automobile liability insurance in response to the exercise of the direct claim by the State up to the limit of the amount of automobile liability insurance coverage constitutes valid performance of an obligation.

According to the facts mentioned above, the Payment constitutes valid performance of an obligation.

5. The determination by the court of prior instance that differs from the above contains a violation of laws and regulations that has clearly influenced the judgment. The counsel's arguments are well-grounded as arguments to this effect, and the judgment in prior instance should inevitably be quashed. According to the explanation given above, the appellee's claim is groundless, and hence, the judgment in first instance should be revoked and that claim should be dismissed.

Accordingly, the Court unanimously decides as set forth in the main text of the judgment.

Justice YAMAGUCHI Atsushi

Justice MIYAMA Takuya

Justice YASUNAMI Ryosuke

Justice OKA Masaaki

Justice SAKAI Toru