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Medical expenses (678,-666)
You searched for:
Keywords: Medical expenses
Total judgments found: 50
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Judgment 4425
132nd Session, 2021
European Patent Organisation
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainant impugns the decision to reject her request for reimbursement of the cost of her spa cure as a type A cure undergone for “absolute medical necessity”.
Judgment keywords
Keywords:
complaint allowed; decision quashed; insurance; medical expenses;
Consideration 7
Extract:
[T]he Office had informed the complainant that her request for reimbursement of the cost of her spa cure could not be processed under Article 20, point 4.8(a), of the Collective Medical Insurance Contract, first, because of a change in the rules and, subsequently, rather, because of a stricter application of the reimbursement criteria for type A cures. This was wrong in law because, as the case law confirms, the principle of non-retroactivity requires that a new administrative practice (which must also include a decision to apply stricter criteria) must be clearly announced to staff prior to its application (see, for example, Judgment 3884, considerations 4 and 12, and the case law cited therein). There is no evidence that a decision to change the rules and/or to apply stricter criteria for reimbursement of the cost of type A cures was announced to EPO staff prior to determining that the complainant was not to be reimbursed for a type A cure.
Reference(s)
ILOAT Judgment(s): 3884
Keywords:
medical expenses; non-retroactivity; practice; refund;
Judgment 4401
132nd Session, 2021
European Organisation for the Safety of Air Navigation
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainant challenges the decision to dismiss her application for the reimbursement of medical expenses.
Consideration 7
Extract:
The question that must be decided in order to resolve this dispute is therefore whether Ms Q., as a holder of a degree in traditional Chinese medicine, was legally authorised to practise acupuncture at the date of the claim for reimbursement. This legally delicate question should have been referred by the Organisation to the Belgian authorities, who alone were in a position to provide the correct answer. As it did not do so, Eurocontrol could not lawfully refuse to effect the reimbursement at issue, since the file shows that acupuncture is widely practised in Belgium and it is clear from the evidence that the complainant had every reason to believe that the treatment carried out by Ms Q., who had been recommended by her doctor, was performed legally.
Accordingly, the impugned decision must be set aside, without there being any need to consider the complainant’s other pleas.
Keywords:
medical expenses;
Consideration 8
Extract:
[T]he complainant cannot seek, in these proceedings, reimbursement of the other sessions prescribed. The Tribunal cannot rule in the abstract and for the future on the reimbursement of sessions that were not covered by the impugned decision.
Keywords:
medical expenses;
Judgment keywords
Keywords:
complaint allowed; decision quashed; medical expenses;
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 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.
Judgment keywords
Keywords:
complaint dismissed; interest on damages; medical expenses;
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 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;
Judgment 3491
120th Session, 2015
International Atomic Energy Agency
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainant, who suffered service-incurred injuries and engaged in swimming therapy, impugns the decision to only partially reimburse the cost of her gym membership.
Judgment keywords
Keywords:
complaint allowed; decision quashed; health insurance; joinder; medical expenses; service-incurred; sick leave;
Judgment 3361
118th Session, 2014
European Organisation for the Safety of Air Navigation
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainant successfully impugns the decision rejecting her request seeking payment of the costs of an orthodontic treatment and a surgical operation.
Judgment keywords
Keywords:
case sent back to organisation; complaint allowed; health insurance; medical expenses;
Judgment 3354
118th Session, 2014
European Patent Organisation
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The Tribunal set aside the decision dismissing the complainant’s request for the reimbursement of pharmaceutical costs on the ground that the case should have been referred to the Medical Committee.
Judgment keywords
Keywords:
case sent back to organisation; complaint allowed; decision quashed; health insurance; medical expenses;
Judgment 3218
115th Session, 2013
European Organisation for the Safety of Air Navigation
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainant challenges his registration with the new office in charge of the sickness insurance scheme.
Judgment keywords
Keywords:
complaint dismissed; health insurance; insurance; medical expenses;
Judgment 3158
114th Session, 2013
European Patent Organisation
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainant successfully challenges the lawfulness of the decision not to reimburse the pharmaceutical products prescribed by his doctor.
Judgment keywords
Keywords:
case sent back to organisation; complaint allowed; decision quashed; health insurance; medical expenses;
Consideration 6
Extract:
"[T]he conditions listed in the explanatory note of 20 October 2000 involve an interpretation of both 'generally accepted medical treatment' and 'proven therapeutic effects', in order to determine what constitutes 'medicines' for the purpose of Article 20(b)(2) of the [Collective Insurance Contract]. The Tribunal considers that such an interpretation implies a medical opinion. Accordingly, the questions of whether the products prescribed for the use of the complainant are 'medicines' for the purpose of the insurance policy and whether the complainant is entitled to be reimbursed under the policy consistent with his rights under Article 83 of the Service Regulations, require a medical opinion. As a result, these questions have to be referred to the Medical Committee in accordance with Article 90(1), paragraph 2 [...]."
Reference(s)
Organization rules reference: Articles 83 and 90 of Service Regulations
Keywords:
advisory body; health insurance; interpretation; medical board; medical expenses; staff regulations and rules;
Consideration 5
Extract:
"[T]he consensus between the Office and the insurance broker contained in the explanatory note of 20 October 2000
[...] should not be considered as binding, since it merely establishes guidelines interpreting the term 'medicines' as contained in Article 20(b)(2) of the [Collective Insurance Contract]."
Keywords:
health insurance; insurance; interpretation; medical expenses;
Judgment 3080
112th Session, 2012
World Health Organization
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Consideration 14
Extract:
"[A] passing reference to "husband" or "wife" in the Staff Rules is not sufficient to warrant interpreting all the relevant provisions thereof as denying same-sex spouses the entitlements concerned (see Judgment 2590 [...], under 6)."
Reference(s)
ILOAT Judgment(s): 2590
Keywords:
dependant; interpretation; marital status; medical expenses; provision; same-sex marriage; social benefits; staff regulations and rules;
Considerations 19-20
Extract:
"According to the Tribunal's case law, when an organisation is ordered to grant a financial benefit to a staff member who fulfilled the legal requirements for claiming it, but who failed to do so as soon as his/her entitlement arose, the benefit in question is due only as from the date of the initial claim by the person concerned, and not the date on which he/she became entitled to the benefit ([...] see Judgment 2550, under 6, or Judgment 2860, under 22). There would be no justification for ordering an organisation unexpectedly to pay potentially large, backdated, aggregated sums for benefits which had not been claimed by the staff member concerned when he or she should have done so. [...] [Moreover] it is true that the position would be different if the Organization itself were responsible for the fact that the [staff member] did not submit a claim [at that time]."
Reference(s)
ILOAT Judgment(s): 2550, 2860
Keywords:
amount; condition; date; delay; exception; judgment of the tribunal; liability; marital status; medical expenses; non-retroactivity; organisation; payment; request by a party; staff member's duties;
Judgment 3019
111th Session, 2011
European Patent Organisation
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Consideration 7
Extract:
Automatic coverage of spouses under the Organisation's long-term health insurance / Obligation to file a waiver declaration.
"The automatic coverage applied by the Implementing Rules cannot be deemed unreasonable. It is clear that under the system chosen by the Organisation some staff members may be slightly financially penalised if they fail to opt out of the scheme, as their automatic coverage will entail consequent deductions from their salaries. However, in evaluating the possible outcome resulting from automatic coverage and that resulting from a lack of coverage, the Organisation evidently considered that the outcome could be worse in the latter situation as staff members who neglected to enrol their spouses in the long-term care insurance scheme could suffer the severe financial consequences of not being insured when the need arose, and the Tribunal cannot regard the Organisation's choice as unreasonable."
Keywords:
deduction; dependant; health insurance; insurance; medical expenses; organisation; practice; salary; social benefits;
Judgment 2976
110th Session, 2011
European Patent Organisation
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Consideration 10
Extract:
"[I]n Judgment 2533 the Tribunal observed that compensation for injury properly included 'past and future adaptations to the complainant's house and car' and that those expenses were 'on no different footing than other necessary expenses incurred as a consequence of [...] service related injury'."
Reference(s)
ILOAT Judgment(s): 2533
Keywords:
compensation; definition; disability benefit; health insurance; injury; insurance; medical expenses; service-incurred;
Consideration 11
Extract:
"The purpose of insurance is to indemnify, whether in whole or in part, and not simply to provide a social safety net."
Keywords:
compensation; health insurance; insurance; medical expenses; purpose;
Judgment 2533
101st Session, 2006
Organisation for the Prohibition of Chemical Weapons
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Consideration 18
Extract:
The complainant suffered a workplace injury at the Organization premises. The results of this seemingly minor accident were catastrophic and the complainant is now permanently and totally disabled and suffers from a rare illness, which has extended up both of the complainant's legs and requires him to use a wheelchair.
"[T]he expenses of necessary adaptations to house and car are on no different footing than other necessary expenses incurred as a consequence of the complainant's service-related injury and must be reimbursed."
Keywords:
handicapped person; health insurance; invalidity; medical expenses; organisation's duties; professional accident; refund; service-incurred;
Judgment 2290
96th Session, 2004
European Patent Organisation
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Consideration 3
Extract:
The Organisation contends that the internal appeal against a decision not to refund medical costs was not lodged in time. In doing so, it takes as the starting point of the time-limit the insurance representative's statement of account rejecting the request for refund. This "plea [...] is unfounded [...] This is because the insurance representative is not an organ of the Organisation, able to take decisions in the meaning of the Office's Service Regulations for Permanent Employees. Decisions concerning insurance benefits are taken by the Office, and more specifically by its President, in accordance with Article 83 of those Regulations."
Reference(s)
Organization rules reference: Article 83 of the Service Regulations for Permanent Employees of the European Patent Office
Keywords:
complaint; decision; executive head; health insurance; illness; insurance; internal appeal; medical expenses; receivability of the complaint; staff regulations and rules; start of time limit; time bar; time limit;
Judgment 2083
92nd Session, 2002
International Labour Organization
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Considerations 8-9
Extract:
The complainant suffered from retinal detachments and a detachment of the vitreous. The organization recognised her eye condition as service incurred. In "September 1998 [...] the [organization] decide[d] to stop reimbursing the bills [she submitted] on [the] grounds [...] that curing her retinal detachments was no longer the object of the treatment. However, it did not show that the service-incurred injuries were not a "direct and principal" cause of the treatment [... ] The Tribunal takes the view that although, as the organization says, the decision to stop reimbursing the bills was at the discretion of the Director-General, it could not be taken without an independent expert medical opinion obtained through a process which provides all the safeguards of transparency and impartiality." The case is therefore sent back to the organization.
Keywords:
consequence; decision; discretion; due process; executive head; expert inquiry; grounds; illness; independence; lack of evidence; medical expenses; medical opinion; organisation; organisation's duties; procedure before the tribunal; professional accident; refund; refusal; safeguard; service-incurred;
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