Insurance (401, 402, 403, 404, 405, 406, 407, 408, 409, 410, 411, 415, 416, 417, 418, 419, 422, 678, 667,-666)

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Keywords: Insurance
Total judgments found: 47

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• Judgment 1880

  
  87th Session, 1999
  European Organisation for the Safety of Air Navigation
  Extracts: EN, FR
  Full Judgment Text: EN, FR

  Consideration 8

  Extract:

  "According to precedent [...] (see Judgments 1094 [...] and 1095 [...]), coverage at the rate of 100 per cent does not mean that in all circumstances an insured person is entitled to full repayment of expenses incurred. [T]o allow the [sickness] fund not to reimburse the part of the expenses deemed to be excessive is in keeping with the purpose of sickness insurance and it is a means of ensuring sound financing and comparable coverage for the beneficiaries, and as such falls within the authority delegated to the Director General. The reimbursement of expenses can be restricted by setting maximum limits or ceilings for certain types of expenditure or by reckoning limits for each case on the basis of costs incurred."

  Reference(s)

  Organization rules reference: ARTICLE 72 OF EUROCONTROL STAFF REGULATIONS
  ILOAT Judgment(s): 1094, 1095
  

  Keywords:

  case law; health insurance; illness; insurance; limits; maximum limit; medical expenses; purpose;
  

  
  
  

• Judgment 1848

  
  87th Session, 1999
  European Patent Organisation
  Extracts: EN, FR
  Full Judgment Text: EN, FR

  Consideration 12

  Extract:

  The complainant questions the right of the insurance company to which she is affiliated to contact her physicians directly to seek information. "The law is clear that [the insurance company] is entitled to any information which identifies the nature of the alleged illness and allows it to determine whether the prescribed treatment is appropriate and necessary [...] Of course the complainant is entitled to require that such information only be made available to [the insurance company's] medical adviser and be treated by the latter in confidence but she is not entitled to withhold from them any right of access whatsoever to the required medical information. Her unwillingness to allow such access goes against her duty to deal in good faith with her insurers."

  Reference(s)

  ILOAT Judgment(s): 1288
  

  Keywords:

  conduct; confidential evidence; elements; good faith; health insurance; illness; insurance; medical consultant; medical records; refusal; safeguard; staff member's duties;
  

  
  
  

• Judgment 1797

  
  86th Session, 1999
  World Health Organization
  Extracts: EN, FR
  Full Judgment Text: EN, FR

  Considerations 12-13

  Extract:

  "The Organization pleads that it is under no duty to pay contributions for [the complainant] to the Pension Fund or to the staff health insurance plan and would have had such duty only if he had been reinstated [...]. The Tribunal ruled on a similar issue in Judgment 1338 [...], in which it held that its award [...] of damages equivalent to 'the amount of the salary, allowances and other entitlements [the complainant] would have received' had not required reinstatement in the Pension Fund or health insurance."

  Reference(s)

  ILOAT Judgment(s): 1338
  

  Keywords:

  allowance; application for execution; case law; contribution rate; contributions; enforcement; health insurance; insurance; judgment of the tribunal; organisation's duties; reinstatement; salary; social benefits; unjspf;
  

  
  
  

• Judgment 1536

  
  81st Session, 1996
  United Nations Educational, Scientific and Cultural Organization
  Extracts: EN, FR
  Full Judgment Text: EN, FR

  Consideration 16

  Extract:

  The complainant seeks admission to the health insurance fund two years after his retirement even though the time limit for such claims is three months. "The answer to the complainant's plea of breach of equality is that the admission of the other retired official as an associate participant was a wrong decision. It should not be followed, and the board of management was right to refuse to follow it. Equality of treatment means equality in the observance of the law, not in the breach of it."

  Keywords:

  definition; equal treatment; general principle; health insurance; illness; insurance; retirement; time limit;
  

  
  
  

• Judgment 1519

  
  81st Session, 1996
  United Nations Educational, Scientific and Cultural Organization
  Extracts: EN, FR
  Full Judgment Text: EN, FR

  Consideration 12

  Extract:

  The International Civil Service Commission was not "bound to recommend that [the organization] fall in line with the practice of outside employers [...] In respect of compulsory insurance premiums and the refund of expenses incurred [the organization's] scheme of staff health insurance and the [national] social security system [...] are not closely comparable; indeed they are quite different. [...] The Commission abided by the applicable methodology - for all its flaws on that count - and [the organization] made no mistake of fact or of law."

  Keywords:

  contributions; flemming principle; general service category; health insurance; icsc decision; inquiry; insurance; investigation; salary; social benefits; terms of appointment;
  

  
  
  

• Judgment 1389

  
  78th Session, 1995
  Universal Postal Union
  Extracts: EN, FR
  Full Judgment Text: EN, FR

  Consideration 27

  Extract:

  "The international organisation is under no duty to insure its expert against any adverse effects on him that the national postal department may draw from conclusions about the nature of an accident that has befallen him while on mission for the organisation. So any claim that the expert may make that goes beyond those limits should be made to the national department, which will deal with it according to its own rules. Nor indeed may the Union or the Tribunal intervene in the area of the department's competence."

  Keywords:

  applicable law; competence of tribunal; domestic law; insurance; organisation's duties; professional accident; project personnel;
  

  
  
  

• Judgment 1241

  
  74th Session, 1993
  World Health Organization
  Extracts: EN, FR
  Full Judgment Text: EN, FR

  Consideration 19

  Extract:

  The complainants object to the way of reckoning their premiums "the change the complainants object to is part of wider reforms the WHO made to put the scheme on a sounder financial footing over the long term. The Organization is right to pursue that aim by all suitable means at its disposal, and they include measures to ensure that, in keeping with the notion of mutual aid, everyone bears a fair share of costs."

  Keywords:

  amendment to the rules; budgetary reasons; contributions; illness; insurance; scale; social solidarity; written rule;
  

  Consideration 24

  Extract:

  The complainants object to the way of reckoning their premiums under the organization's health insurance scheme in accordance with an amendment to its rules. They allege breach of acquired rights. "The organization has not discriminated against them: far from it. Its purpose was to remove an unfair advantage the rules used to confer on them. Such corrective action may not be treated as breach of acquired rights even if the advantage was enjoyed for a long time."

  Keywords:

  acquired right; amendment to the rules; budgetary reasons; contributions; equal treatment; health insurance; illness; insurance; social solidarity; written rule;
  

  
  
  

• Judgment 1232

  
  74th Session, 1993
  United Nations Educational, Scientific and Cultural Organization
  Extracts: EN, FR
  Full Judgment Text: EN, FR

  Consideration 5

  Extract:

  The complainant, a civil servant of the organization who had been sentenced in his country of origin, was released from prison but was not allowed to leave the country. Under duress he wrote a letter applying for early retirement which was forwarded to the organization by his government. The organization accepted the request and rejected the complainant's internal appeal against that decision. The Tribunal quashes the decision. "The organization must reinstate [the complainant] and restore pension and sickness insurance entitlements for himself and his dependants. It shall pay him damages reckoned according to the amount of the salary and allowances he would have been entitled to".

  Keywords:

  allowance; consequence; health insurance; illness; insurance; judgment of the tribunal; pension entitlements; reckoning; reconstruction of career; salary;
  

  
  
  

• Judgment 1226

  
  74th Session, 1993
  Food and Agriculture Organization of the United Nations
  Extracts: EN, FR
  Full Judgment Text: EN, FR

  Considerations 3, 7 and 8

  Extract:

  The complainants challenge decisions by the Director-General confirming the abolition of free after-service medical cover. They allege breach of acquired rights and contend that the FAO's financial position did not warrant such measures. "The Tribunal will not compare the options open to the FAO in the area of financial policy since it might ignore the realities that the FAO has to take into account. All the Tribunal need do is acknowledge that it was because of the financial plight of the scheme and its own that the organization decided to do away with free coverage for pensioners. The change does cause the complainants detriment. [...] But that alone does not amount to breach of any acquired right. First, the effect of the change was to put all fao pensioners on a par. [...] Secondly, there were transitional measures to lighten the impact of the change [...]. Since the change was made by way of rules, and because of the reasons for it, the complainants have suffered no breach of any acquired right despite the injury to their interests."

  Keywords:

  acquired right; amendment to the rules; budgetary reasons; discretion; grounds; health insurance; insurance; judicial review; limits; medical expenses; organisation's interest; social benefits; staff regulations and rules;
  

  
  
  

• Judgment 1186

  
  73rd Session, 1992
  Food and Agriculture Organization of the United Nations
  Extracts: EN, FR
  Full Judgment Text: EN, FR

  Consideration 7

  Extract:

  The complainants object to the abolition of free after-service health insurance cover. They contend that as serving officials they contributed to a health scheme that covered both their own medical expenses and those of former officials. The FAO's answer is that they never contributed to a health scheme that was intended to cover the expenses incurred both by serving and by retired officials. "The complainants are mistaken: as to medical insurance coverage their position before retirement was distinct from their position after it and amendments in the terms of their coverage after they had left had no retroactive effect on their earlier coverage."

  Keywords:

  amendment to the rules; further submissions; health insurance; illness; insurance; medical expenses; non-retroactivity; separation from service;
  

  
  
  

• Judgment 1176

  
  73rd Session, 1992
  European Organisation for the Safety of Air Navigation
  Extracts: EN, FR
  Full Judgment Text: EN, FR

  Consideration 12

  Extract:

  "Treating a person as a dependent child of the staff member in accordance with [the material provisions] confers health insurance coverage ipso facto on that person. [...] Eurocontrol must consider the consequences its decision [to treat someone as a dependent child] will have for insurance coverage."

  Keywords:

  dependant; dependent child; health insurance; illness; insurance; medical expenses; organisation's duties;
  

  Considerations 11 and 13

  Extract:

  Eurocontrol asked the complainant to supply proof that the dependant for whom he was seeking health insurance had no means of gaining cover for sickness under another public health scheme in keeping with Article 2(2) of Rule No. 10 of the Staff Regulations. "But since what is required is disproof - viz. proof that there is no coverage under this or that scheme - Eurocontrol may not consistently lay the burden on the insured member. If it did so, there would be a danger of making the rule unworkable. A fortiori it may not, after duly determining on all the material evidence at its disposal that someone may be treated as a dependent child, raise the question of possible coverage by another public scheme whenever the insured member happens to claim refund or to seek prior authorisation of expenditure."

  Reference(s)

  Organization rules reference: Article 2(2) of Rule no. 10 of the Staff Regulations
  
  

  Keywords:

  burden of proof; dependant; dependent child; evidence; health insurance; illness; insurance; medical expenses; organisation's duties;
  

  
  
  

• Judgment 1148

  
  72nd Session, 1992
  European Organisation for the Safety of Air Navigation
  Extracts: EN, FR
  Full Judgment Text: EN, FR

  Consideration 20

  Extract:

  The complainant objects to the Sickness Fund's refusal to refund the costs of a given item. "Eurocontrol has [...] discretion under Article 24, which empowers the fund to refuse refund of the costs of treatment which the medical officer deems to be 'non-functional, superfluous or unnecessary'. As was said in Judgment 1088, [article] 24 covers all sorts of 'treatments', however the term 'pharmaceutical product' in [article] 14 is to be construed."

  Reference(s)

  Organization rules reference: ARTICLES 14 AND 24 OF RULE 10
  ILOAT Judgment(s): 1088
  

  Keywords:

  definition; discretion; health insurance; insurance; limits; medical consultant; medical expenses; refund; refusal;
  

  
  
  

• Judgment 1110

  
  71st Session, 1991
  European Southern Observatory
  Extracts: EN, FR
  Full Judgment Text: EN, FR

  Summary

  Extract:

  In Judgment 996 the Tribunal set aside the decision to dismiss the complainant and ordered his reinstatement "with full arrears of salary and allowances". In execution of that judgment the ESO reinstated him as a member of its health insurance scheme as from the date of dismissal and deducted the corresponding premiums from his pay. The complainant's objections to the deductions are mistaken. The intention of Judgment 996 was, as far as possible, to put the complainant in the same position as if he had not been dismissed. The Tribunal is satisfied that in respect of health insurance the organisation has complied with the letter and the spirit of the judgment.

  Reference(s)

  ILOAT Judgment(s): 996
  

  Keywords:

  application for interpretation; consequence; contributions; deduction; health insurance; insurance; interpretation; judgment of the tribunal; medical expenses; payment; reinstatement; salary;
  

  
  
  

• Judgment 1094

  
  70th Session, 1991
  European Organisation for the Safety of Air Navigation
  Extracts: EN, FR
  Full Judgment Text: EN, FR

  Considerations 24-25

  Extract:

  Under Article 72 of the Staff Regulations governing officials and of the General Conditions of employment of the Agency the Director general is "empowered to do whatever is needed to make the [health] scheme workable and financially sound, provided that he abides by the provisions of the Staff Regulations, and the cost is shared between organisation and staff in line with the principle of solidarity. That is why it is a proper precaution to set maximum limits on the costs of some forms of treatment and to require prior permission in some cases." Setting the rate of refund at 100 per cent for certain forms of treatment, including confinement, does not bar maximum limits.

  Reference(s)

  Organization rules reference: ARTICLE 72 OF EUROCONTROL STAFF REGULATIONS
  
  

  Keywords:

  health insurance; illness; insurance; maximum limit; medical expenses; refund; social solidarity;
  

  
  
  

• Judgment 1070

  
  70th Session, 1991
  International Telecommunication Union
  Extracts: EN, FR
  Full Judgment Text: EN, FR

  Consideration 7, Summary

  Extract:

  The complainant submitted a claim for medical expenses incurred by his former wife which another insurance scheme had already met. He submits that he bore no responsibility for the error and acted in good faith. The Tribunal holds that as he knew that his former wife was covered under another health scheme he should have made sure that it had not previously refunded her expenses. The complainant's "conduct argues, to say the least, a degree of laxity quite inadmissible in an international civil servant in that he wilfully ran a substantial and unreasonable risk, the foreseeable outcome being the defrauding of the fund. He has only himself to blame for the consequences of his own oversight."

  Keywords:

  complainant; fitness for international civil service; good faith; health insurance; insurance; medical expenses; misrepresentation; negligence; request by a party; serious misconduct; staff member's duties;
  

  Consideration 7, Summary

  Extract:

  Under Article 2.7(1) of the ILO/ITU Staff Health Insurance Fund Regulations claimants must supply a statement, together with supporting documents, listing any benefits received or to be received from another health scheme in respect of each claim made. The complainant submitted a claim for his ex-wife's medical bills, which had already been reimbursed by another health scheme. "In filing such a statement the complainant had a duty to make sure that the 'supporting documents' were genuine and he could not shirk it by shifting responsibility to his former wife and professing his own ignorance and good faith."

  Reference(s)

  Organization rules reference: ARTICLE 2.7(1) OF THE ILO/ITU STAFF HEALTH INSURANCE FUND REGULATIONS
  
  

  Keywords:

  accumulation; dependant; good faith; health insurance; insurance; liability; medical expenses; misrepresentation; request by a party;
  

  
  
  

• Judgment 1062

  
  70th Session, 1991
  European Patent Organisation
  Extracts: EN, FR
  Full Judgment Text: EN, FR

  Summary

  Extract:

  Article 38(3) of the EPO Service Regulations says that the General Advisory Committee, a joint body comprising staff and management representatives, shall be responsible for giving a "reasoned opinion" - except in cases of obvious urgency - on any proposal which concerns the whole or part of the staff. The aim of the provision is to encourage proper consultation between the two sides and that means giving the Committee enough information. At issue is the decision to raise from 1 January 1988 the staff's contributions to the organisation's collective insurance against the risks of death and invalidity. But the Committee did not have the information on which to base "a reasoned opinion" until its meeting of 24 and 25 November. The Tribunal will therefore quash the EPO's decision to increase his contributions for the period from 1 January to 25 November 1988.

  Reference(s)

  Organization rules reference: ARTICLE 38.3 OF THE EPO SERVICE REGULATIONS
  
  

  Keywords:

  advisory body; advisory opinion; consultation; contributions; increase; insurance; organisation's duties;
  

  
  
  

• Judgment 971

  
  66th Session, 1989
  World Health Organization
  Extracts: EN, FR
  Full Judgment Text: EN, FR

  Consideration 8

  Extract:

  "The complainant claims payment under Annex C. But only the WHO, not the complainant, is entitled to payment under this annex, which concerns its insurance policy. The policy is exclusively a matter between the WHO and its insurers. In application of its administrative practice, as reflected in paragraph 365 of Manual II.7, the organization does hand the difference over to the staff member if the sum it has actually received from the insurers more than covers its liability to him."

  Reference(s)

  Organization rules reference: WHO MANUAL PROVISION II.7
  
  

  Keywords:

  amount; complainant; difference; health insurance; insurance; organisation; payment; practice;
  

  
  
  

• Judgment 941

  
  65th Session, 1988
  European Organisation for the Safety of Air Navigation
  Extracts: EN, FR
  Full Judgment Text: EN, FR

  Consideration 9

  Extract:

  "As the texts stand vaccinations are not ordinarily covered by the [sickness insurance] scheme [...] that the policy of other European organisations is more liberal is an example Eurocontrol may wish but is not bound to follow."

  Keywords:

  applicable law; health insurance; insurance; law of european communities; medical expenses; rule of another organisation;
  

  
  
  

• Judgment 925

  
  65th Session, 1988
  European Organisation for the Safety of Air Navigation
  Extracts: EN, FR
  Full Judgment Text: EN, FR

  Consideration 11

  Extract:

  "The scheme member has a duty to support a claim with documents that are clear enough for the administration to be able to tell what the treatment was and to apply the right rate of refund."

  Keywords:

  burden of proof; disclosure of evidence; evidence; health insurance; illness; insurance; medical expenses; rate; request by a party;
  

  
  
  

• Judgment 924

  
  65th Session, 1988
  European Organisation for the Safety of Air Navigation
  Extracts: EN, FR
  Full Judgment Text: EN, FR

  Considerations 18-19

  Extract:

  The Eurocontrol Health Insurance Scheme in Luxembourg denied the complainant reimbursement of medical expenses incurred in Belgium by his wife who is entitled to so-called "supplementary coverage". The Tribunal holds that "since it has a duty to provide supplementary coverage the organisation was bound, under its own rules, to refund the full cost of Mrs. Boland's treatment in Belgium. The implied final decision must therefore be set aside and the case sent back to Eurocontrol for a new decision on the refund of the costs incurred by Mrs. Boland, with due regard to the freedom of choice guaranteed in Rule No. 10."

  Keywords:

  dependant; freedom to choose practitioner; health insurance; insurance; medical expenses; supplementary coverage;
  

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