2024.07.04

2023 (Gyo-Hi) 108

Minshu Vol. 78, No. 3

(Civil Case)Judgment concerning an action to seek the revocation of a decision to pay insurance proceeds pertaining to industrial injury which was made with regard to a business prescribed in Article 12, paragraph (3) of the Act on Collection, etc. of Insurance Premiums of Labor Insurance (prior to the amendment by Act No. 14 of 2020), and the business operator's standing to file such action

Case seeking the revocation of a decision to pay medical treatment compensation benefits (a decision to change the decision not to pay) and the revocation of a decision to make compensation payment for loss of salary during a temporary absence from work

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

Tokyo High Court, Judgment of November 29, 2022

A business operator of a business prescribed in Article 12, paragraph (3) of the Act on Collection, etc. of Insurance Premiums of Labor Insurance (prior to the amendment by Act No. 14 of 2020) does not have standing to file an action to seek the revocation of a decision to pay insurance proceeds pertaining to industrial injury which was made under the Industrial Accident Compensation Insurance Act (prior to the amendment by Act No. 14 of 2020) regarding that business.

Article 9, paragraph (1) of the Administrative Case Litigation Act; Article 12, paragraph (3) of the Act on the Collection, etc. of Insurance Premiums of Labor Insurance (prior to the amendment by Act No. 14 of 2020); Article 15, paragraphs (1) and (3) and Article 19, paragraphs (1), (3), and (4) of the Act on the Collection, etc. of Insurance Premiums of Labor Insurance; Article 7, paragraph (1), item (i) of the Industrial Accident Compensation Insurance Act (prior to the amendment by Act No. 14 of 2020); and Article 12-8, paragraphs (1) and (2) of the Industrial Accident Compensation Insurance Act

The judgment in prior instance is quashed.

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

The costs for the appeal to the court of second instance and the costs for the final appeal shall be borne by the appellee of final appeal.

Concerning the reasons for a petition for acceptance of final appeal stated by the counsel for final appeal, HARUNA Shigeru, et al., and the reasons for a petition for acceptance of final appeal stated by the counsel for supporting intervention in final appeal, SHIMASAKI Chikara, NISHIKAWA Osamu, and YAMAOKA Yohei

1. The administrative agency concerned made decisions to pay medical treatment compensation benefits and make compensation payment for loss of salary during a temporary absence from work to the supporting intervenor in the final appeal, who engaged in duties as an employee of the appellee, under the Industrial Accident Compensation Insurance Act (prior to the amendment by Act No. 14 of 2020; hereinafter referred to as the "Industrial Accident Insurance Act"), on the grounds that the supporting intervenor in the final appeal was afflicted with a disease due to their duties (these decisions are hereinafter referred to as the "Dispositions").

This is a case in which the appellee filed an action against the appellant to seek the revocation of the Dispositions. The appellee argues that it has standing to file an action to seek the revocation of the Dispositions because, according to the provisions of Article 12, paragraph (3) of the Act on the Collection, etc. of Insurance Premiums of Labor Insurance (prior to the amendment by Act No. 14 of 2020; hereinafter referred to as the "Premiums Collection Act"), there is likelihood that the amount of labor insurance premiums (meaning the labor insurance premiums prescribed in Article 10, paragraph (2) of the Premiums Collection Act; the same applies hereinafter) that is payable by the appellee would be increased.

2. The outline of the system for collection, etc. of labor insurance premiums is as follows.

(1) The government collects labor insurance premiums from business operators for the purpose of covering the costs required for the businesses of industrial accident compensation insurance under the Industrial Accident Insurance Act (hereinafter referred to as "industrial accident insurance") and employment insurance under the Employment Insurance Act (Article 30 of the Industrial Accident Insurance Act, Article 68, paragraph (1) of the Employment Insurance Act, and Article 2, paragraph (1), and Article 10, paragraph (1) of the Premiums Collection Act).

(2) Each insurance year, a business operator must first declare and pay the amount of labor insurance premiums prescribed in the items of Article 15, paragraph (1) of the Premiums Collection Act as an estimated amount, and then, after the end of the insurance year, it must declare the amount of labor insurance premiums prescribed in the items of Article 19, paragraph (1) of the same Act as a final amount and pay any shortfall if the estimated amount already paid is in short of the final amount thus declared. If the government finds any error in the entries in the written declarations regarding these declarations, the government is to decide the amount of labor insurance premiums and give notice thereof to the business operator (Articles 15 and 19 of the same Act; the disposition to decide the estimated amount pursuant to the provisions of Article 15, paragraph (3) of the same Act and the disposition to decide the final amount pursuant to the provisions of Article 19, paragraph (4) of the same Act are jointly referred to as a "disposition to determine premiums").

(3) Among labor insurance premiums, the amount of general insurance premiums (Article 10, paragraph (2), item (i) of the Premiums Collection Act) is specified as an amount obtained by multiplying the total amount of wages by the insurance premium rate pertaining to the general insurance premiums. The insurance premium rate pertaining to the general insurance premiums is specified as the aggregate of the industrial accident insurance rate and the employment insurance rate in the case of a business in respect of which the insurance relations of industrial accident insurance and employment insurance have been established, or the industrial accident insurance rate in the case of a business in respect of which only the insurance relation of industrial accident insurance has been established (Article 11 and Article 12, paragraph (1), items (i) and (ii) of the same Act).

The industrial accident insurance rate is required to be of the value that allows the maintenance of a balanced finance pertaining to the industrial accident insurance business into the future, in light of the estimated amount of expenses to be required for the payment of insurance proceeds, etc. under the provisions of the Industrial Accident Insurance Act, and as specified by Cabinet Order, the rate is prescribed by the Minister of Health, Labour and Welfare by taking into consideration the injury rate pertaining to industrial injury, etc. during the past three years in respect of all businesses to which the Industrial Accident Insurance Act is applied and other circumstances (Article 12, paragraph (2) of the Premiums Collection Act; the industrial accident insurance rate to be specified under the provisions of the same paragraph is referred to as the "standard industrial accident insurance rate").

With regard to a business falling under any of the items of Article 12, paragraph (3) of the Premiums Collection Act during each insurance year of three consecutive insurance years and in respect of which three years or more have passed, since the establishment of the insurance relation of industrial accident insurance, as of March 31 of the last insurance year of the consecutive three insurance years (hereinafter referred to as a "specified business"), if the rate prescribed in the same paragraph (hereinafter referred to as the "expense to income ratio under the merit system") exceeds eighty-five one-hundredth (85/100), or is seventy-five one-hundredth (75/100) or less, the Minister of Health, Labour and Welfare may determine the rate calculated by increasing or decreasing the standard industrial accident insurance rate for the specified business by a prescribed method to be the industrial accident insurance rate for the insurance year two years following the insurance year in which the abovementioned date regarding the specified business is included (the same paragraph). The expense to income ratio under the merit system is calculated on the basis of factors including the amount of insurance proceeds pertaining to industrial injury under the provisions of the Industrial Accident Insurance Act as prescribed in the same paragraph (hereinafter referred to as "industrial accident insurance proceeds"), the payment of which has been made during such consecutive three insurance years (the same paragraph).

3. The court of prior instance determined as follows in summary and ruled that the appellee has standing to file an action to seek the revocation of the Dispositions made with regard to its specified business, and it revoked the judgment in first instance that denied the appellee's standing and dismissed its action, and remanded the case to the court of first instance.

If a decision to pay industrial accident insurance proceeds (hereinafter referred to as a "disposition to pay industrial accident insurance proceeds") has been made regarding a specified business, the expense to income ratio under the merit system would increase and therefore there is likelihood that the amount of labor insurance premiums that is payable by a business operator of the specified business would be increased. As such, a business operator of a specified business has standing to file an action to seek the revocation of the disposition to pay industrial accident insurance proceeds, as a person whose right or legally protected interest has been violated or is likely to be inevitably violated due to the disposition to pay industrial accident insurance proceeds, which has been made with regard to the specified business.

4. However, the abovementioned determination by the court of prior instance cannot be affirmed, for the following reasons.

(1) A "person who has legal interest" to seek the revocation of a disposition as referred to in Article 9, paragraph (1) of the Administrative Case Litigation Act is a person whose right or legally protected interest has been violated or is likely to be inevitably violated due to the disposition. In this case, the question is whether the amount of industrial accident insurance proceeds based on a disposition to pay industrial accident insurance proceeds, which has been made regarding a specified business, would necessarily affect subsequent decisions of the amount of labor insurance premiums that is payable by a business operator of the specified business.

(2) a. Under the Industrial Accident Insurance Act, a decision to pay or not to pay industrial accident insurance proceeds is to be made by means of an administrative disposition addressed to a worker suffering an industrial accident, etc. who claims payment of the insurance proceeds (see Article 12-8, paragraph (2)). This is based on the intention to provide effective relief for the rights and interests of a worker suffering an industrial accident, etc. by determining a number of legal relationships involved in the payment of industrial accident insurance proceeds at an early stage, while providing a special appeal system under which specialized organs handle administrative appeals (Article 38, paragraph (1)), in light of the purpose of industrial accident insurance, that is, to protect workers suffering industrial accidents, etc. in a prompt and fair manner (see Article 1). It cannot be construed that the Industrial Accident Insurance Act intends to further ensure that the legal relationship that will serve as the basis for deciding the amount of labor insurance premiums that is payable by a business operator of a specified business will also be determined at an early stage. If it is assumed that even such legal relationship is determined by a disposition to pay industrial accident insurance proceeds, it is considered that a business operator of the specified business should be given the opportunity to dispute that legal relationship, but this would undermine the purpose of the Industrial Accident Insurance Act, i.e. determining the legal relationships involved in the payment of industrial accident insurance proceeds at an early stage.

b. In addition, the Premiums Collection Act provides that the industrial accident insurance rate is required to be of the value that allows the maintenance of a balanced finance pertaining to the industrial accident insurance business into the future, while also providing that the industrial accident insurance rate for a specified business is to be calculated on the basis of the standard industrial accident insurance rate but may be increased or decreased by means of the expense to income ratio under the merit system according to the amount of industrial accident insurance proceeds to be paid for each specified business. This is based on the intention to ensure equity among business operators and promote business operators' efforts to prevent industrial accidents within the extent that a balanced finance can be maintained. It is contrary to such intention if the amount of industrial accident insurance proceeds that objectively does not satisfy the requirement for payment is used as the basis for deciding the amount of labor insurance premiums that is payable by a business operator of a specified business, and it is unlikely that the maintenance of the abovementioned balanced finance would be hindered even if the amount of labor insurance premiums is decided only on the basis of the amount of industrial accident insurance proceeds that objectively satisfies the requirement for payment. In light of the system for collection, etc. of labor insurance premiums mentioned in 2. above, it is sufficient if the amount of labor insurance premiums is decided at the time of a declaration or a disposition to determine premiums, and it is difficult to find it necessary to determine beforehand the legal relationship that will serve as the basis for deciding the amount of labor insurance premiums, by means of a disposition to pay industrial accident insurance proceeds.

c. For the reasons stated above, it is reasonable to construe that the amount of the portion of the industrial accident insurance proceeds paid with regard to a specified business that objectively does not satisfy the requirement for payment does not serve as the basis for deciding the amount of labor insurance premiums that is payable by a business operator of the specified business. As such, the amount of industrial accident insurance proceeds based on a disposition to pay industrial accident insurance proceeds, which has been made with regard to a specified business, would not necessarily affect subsequent decisions of the amount of labor insurance premiums, and therefore, a business operator of a specified business cannot be regarded as a person whose right or legally protected interest has been violated or is likely to be inevitably violated due to the disposition to pay industrial accident insurance proceeds, which has been made with regard to the specified business.

(3) Consequently, it should be said that a business operator of a specified business does not have standing to file an action to seek the revocation of the disposition to pay industrial accident insurance proceeds mentioned above.

Even if the above interpretation is adopted, a business operator of a specified business would be able to file an appeal against a disposition to determine premiums which has been addressed thereto or an action to seek the revocation of such disposition, and argue, as the grounds for illegality of the disposition to determine premiums itself, that the amount of labor insurance premiums has been increased because it is calculated on the basis of the amount of industrial accident insurance proceeds that objectively does not satisfy the requirement for payment, and thus, due process is guaranteed for the business operator.

5. The determination by the court of prior instance that is contrary to the above contains a violation of law or regulation that has clearly influenced the judgment. The counsel's arguments are well-grounded, and the judgment in prior instance should inevitably be quashed. According to the explanation given above, this action is unlawful, and the judgment in first instance that dismissed it is justifiable for the conclusion, and therefore, the appeal to the court of second instance filed by the appellee should be dismissed.

For the reasons stated above, the Court unanimously decides as set forth in the main text of the judgment.

Justice SAKAI Toru

Justice MIYAMA Takuya

Justice YASUNAMI Ryosuke

Justice OKA Masaaki

Justice MIYAGAWA Mitsuko