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Health insurance (918,-666)
You searched for:
Keywords: Health insurance
Total judgments found: 70
1, 2, 3, 4 | next >
Judgment 4699
136th Session, 2023
European Organisation for the Safety of Air Navigation
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainant contests the decisions that found that his injuries had consolidated without permanent invalidity.
Considerations 5 & 8
Extract:
[T]he Tribunal fails to see how the fact that the doctor was appointed by the insurance company on the basis of a list previously approved by Eurocontrol should create a conflict of interest, since, if the Organisation were to appoint the doctor itself, the same issue would still arise given that it would then be its own financial interests that would be directly at stake.
[...]
The assertion that the Sickness Fund Supervisor was subject to a conflict of interests simply through being the “manager” of the fund is based on a mere premise, devoid of any prima facie evidence, and there is nothing in the documents submitted by the parties to suggest that such was the case here. Furthermore, if such an assertion were to be followed, it would lead to the conclusion that it was not permissible for any international organisation to create a sickness and invalidity insurance fund for the benefit of its officials, or, at the very least, that an organisation had to appoint a third party body to manage any fund it created, which is untenable.
Keywords:
conflict of interest; health insurance;
Judgment 4577
135th Session, 2023
World Tourism Organization
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: Follow-up judgment for the determination of material damages and consequential orders.
Consideration 6
Extract:
In relation to health insurance, the complainant has continued to contribute to the after-service health insurance Scheme and make payments to UNWTO’s health insurance provider. In total she will have, by September 2025, paid approximately 15,000 euros in this respect. The complainant requests that she be reimbursed these amounts because the amounts claimed for future loss of salary were net amounts. That is to say, as the Tribunal understands the argument, if she had succeeded in claiming the full amount of future salary lost it would not have included contributions made as just discussed. The contributions should be provided for separately by a specific award of damages. But the complainant derives a benefit from making these payments. They do not constitute a compensable loss. Accordingly, this claim is rejected.
Keywords:
health insurance; material damages; medical insurance;
Judgment 4576
135th Session, 2023
World Tourism Organization
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: Follow-up judgment for the determination of material damages and consequential orders.
Consideration 6
Extract:
[A]ny financial loss associated with the deprivation of membership of a particular health fund would include a loss occasioned by the non-payment of claims for medical expenses incurred and otherwise recoverable from that fund. [T]he complainant does not establish that he could be enrolled in that health fund in the absence of actually serving, as a matter of fact, the qualifying period.
Keywords:
health insurance; material damages; medical insurance;
Judgment 4514
134th Session, 2022
European Organisation for the Safety of Air Navigation
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainant challenges Eurocontrol’s decision to put an end, with retroactive effect, to the top-up sickness insurance cover received by his wife and, consequently, to recover the sums unduly paid by Eurocontrol under that cover.
Judgment keywords
Keywords:
complaint allowed; dependant; health insurance; recovery of overpayment;
Judgment 4473
133rd Session, 2022
European Organisation for the Safety of Air Navigation
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainant contests the decision not to recognise his son’s condition as a “serious illness” within the meaning of the provisions governing reimbursement of medical expenses.
Judgment keywords
Keywords:
complaint dismissed; dependent child; health insurance; illness; insurance benefits; motivation; motivation of final decision;
Judgment 4246
129th Session, 2020
World Intellectual Property Organization
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainant challenges the non-recognition of her illnesses as occupational illnesses.
Consideration 4
Extract:
Throughout the procedure, WIPO considered that the decision concerning the receivability of the request came within the insurer’s sole competence. In so doing, WIPO overlooked the fact that although the insurer is not an organ of the Organization, WIPO is liable for the insurer’s acts (see Judgment 3506, consideration 19). In view of its duty of care towards its staff members, WIPO was obliged to check whether the insurer’s calculation of the time limit was correct. If this had appeared not to be the case, it would have been obliged to contest it, using the dispute resolution procedure[.]
Keywords:
duty of care; health insurance;
Judgment 4195
128th Session, 2019
European Patent Organisation
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainants challenge the decision to modify the conditions governing sickness insurance for employees’ spouses.
Judgment keywords
Keywords:
acquired right; complaint dismissed; health insurance;
Consideration 9
Extract:
[T]he Tribunal considers that the conditions under which health insurance for employees’ spouses is provided do not give rise to an acquired right. The Organisation is entitled to adjust the contribution rate if there are compelling reasons (including budgetary reasons), within reasonable limits. The Tribunal is satisfied in this case that the increased contribution rate resulting from the additional contribution for spouses is reasonable, justified and modest.
Keywords:
acquired right; budgetary reasons; health insurance;
Judgment 4028
126th Session, 2018
International Telecommunication Union
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainants challenge Service Order No.14/10 changing the health insurance scheme at the ITU, as well as individual decisions implementing that service order.
Consideration 13
Extract:
[A]s the complainants point out, the burden of the new measures is borne by the insured persons alone. It must however be remembered that, despite a fall in its income resulting from a zero growth budget and the drop in contributions from some member States, the ITU continues to fund 50 per cent of the scheme for staff members and two thirds of it for retirees. As the defendant organisation explains, the new measures which have been put in place seek to maintain the financial equilibrium of the new insurance plan in order to ensure its continuity and stability while respecting the principles of solidarity and mutualisation of risks.
In Judgment 1241, under 19, the Tribunal considered that “the change the complainants object[ed] to [was] part of wider reforms the [organisation] made to put the [health insurance] scheme on a sounder financial footing over the long term” and that the organisation in question was “right to pursue that aim by all suitable means at its disposal, [including by] measures to ensure that, in keeping with the notion of mutual aid, everyone bears a fair share of costs”.
This consideration applies mutatis mutandis to the present complaints.
Reference(s)
ILOAT Judgment(s): 1241
Keywords:
budgetary reasons; health insurance; medical expenses;
Judgment 3791
123rd Session, 2017
European Patent Organisation
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainant impugns the implied rejection of her internal appeal against the EPO’s refusal to recognise her medical condition as an occupational disease and to reimburse her for the relevant medical expenses which she incurred.
Judgment keywords
Keywords:
complaint dismissed; health insurance; illness; medical expenses; service-incurred;
Judgment 3790
123rd Session, 2017
European Patent Organisation
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainant requests the reimbursement of medical expenses under Article 22 of the EPO’s collective medical insurance contract.
Judgment keywords
Keywords:
complaint dismissed; health insurance; medical expenses;
Judgment 3780
123rd Session, 2017
European Patent Organisation
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complaint deals with the complainant’s daughter’s affiliation to a Dutch health insurance scheme.
Judgment keywords
Keywords:
complaint dismissed; health insurance; insurance;
Judgment 3762
123rd Session, 2017
United Nations Educational, Scientific and Cultural Organization
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainants challenge a circular that implements amendments to the Rules of the Medical Benefits Fund.
Judgment keywords
Keywords:
complaint allowed; decision quashed; health insurance; insurance;
Judgment 3736
123rd Session, 2017
International Telecommunication Union
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainants challenge the ITU’s decision to change its medical insurance scheme and to increase their premiums under this insurance scheme.
Judgment keywords
Keywords:
complaint allowed; consultation; decision quashed; health insurance; insurance;
Judgment 3650
122nd Session, 2016
International Atomic Energy Agency
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainant contests the refusal to pay her interest on reimbursement of medical costs.
Consideration 6
Extract:
Plainly enough, [...] the right to payment of medical expenses arising under Article 16 is conditioned by the consideration of any claim for payment by the organisation of whether the medical expenses incurred were reasonably incurred, which would include the consideration of any evidence furnished supporting a conclusion that they were reasonably incurred. Thus the right to payment of medical expenses cannot be said to be a right to an immediate payment of the claimed amount. Accordingly there is no room for the implication of a right to interest either from the time the medical expense was actually paid by the staff member or from the time the staff member lodged a claim for reimbursement.
Keywords:
health insurance; interest on damages; medical expenses;
Judgment 3638
122nd Session, 2016
United Nations Educational, Scientific and Cultural Organization
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainant impugns UNESCO’s implied rejection of his claim for reimbursement at the rate of 100 per cent of medical expenses related to a service-incurred injury.
Judgment keywords
Keywords:
complaint dismissed; health insurance; medical expenses;
Judgment 3628
121st Session, 2016
European Patent Organisation
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainant challenges a decision of the Administrative Council relating to employees’ contribution to sickness insurance.
Judgment keywords
Keywords:
complaint dismissed; contribution rate; contributions; health insurance; insurance; summary procedure;
Judgment 3627
121st Session, 2016
International Telecommunication Union
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainant challenges the calculation of her health insurance contributions, as well as the amount of her disability pension.
Judgment keywords
Keywords:
complaint dismissed; contribution rate; contributions; disability benefit; health insurance; insurance; summary procedure;
Judgment 3507
120th Session, 2015
Global Fund to Fight AIDS, Tuberculosis and Malaria
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainant requests the payment of various sums in consequence of the decision to grant her a permanent disability benefit.
Consideration 16
Extract:
"The Fund is [...] liable to provide compensation for this injury, without this obligation being restricted in any way by the terms of the organisation’s insurance policy (see, in this connection, Judgment 2533, under 26)."
Reference(s)
ILOAT Judgment(s): 2533
Keywords:
health insurance; insurance;
Judgment 3506
120th Session, 2015
Global Fund to Fight AIDS, Tuberculosis and Malaria
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainant challenges the refusal of some of her requests for the defrayal of medical expenses.
Judgment keywords
Keywords:
complaint allowed; decision quashed; health insurance; joinder; medical expenses; service-incurred;
Consideration 19
Extract:
"[A]s the organisation is liable for the acts of its insurer […], the Fund itself must be ordered to reimburse the disputed expenses, which it may then seek to recover from the insurance company."
Keywords:
health insurance; insurance; medical expenses;
Consideration 9
Extract:
"The Global Fund [...] submits that the Tribunal is not competent to hear this dispute, as it is a dispute between the complainant and the insurance companies and, in its opinion, does not concern the organisation itself. The Fund is, however, greatly mistaken as to the nature of this dispute and the duties incumbent upon it in this case.
International civil servants’ social protection forms an integral part of their terms of employment, which are the responsibility of the organisation for which they work. For this reason, despite the defendant organisation’s insistence to the contrary, where an organisation entrusts the responsibility for providing social protection to a private insurance company, as is the case here, the organisation has a duty to ensure that the insurer correctly processes the claims submitted by insured persons. In this situation, the organisation is in fact liable for the acts of its insurer (see, for example, Judgments 2063, under 8, or 3031, under 14, 18 and 19).
In the instant case, the matter raised by the complainant is not in dispute between her and the insurance company, but between her and the Fund itself, and it concerns precisely the latter’s compliance with its duty to ensure the proper examination of a claim for the reimbursement of medical expenses. This matter does fall within the Tribunal’s competence (see, for example, in addition to the aforementioned Judgments 2063 and 3031, Judgments 2249 and 3030)."
Reference(s)
ILOAT Judgment(s): 2063, 2249, 3030, 3031
Keywords:
health insurance; insurance; medical expenses;
Judgment 3497
120th Session, 2015
European Organisation for the Safety of Air Navigation
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainant contests the refusal of her request that her mother’s condition be recognized as a serious illness.
Judgment keywords
Keywords:
case sent back to organisation; complaint allowed; decision quashed; health insurance; illness; medical expenses; medical opinion;
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