Judgment No. 924
1. THE TRIBUNAL SETS ASIDE THE IMPLIED DECISION BY THE EUROCONTROL SICKNESS INSURANCE SCHEME TO REFUSE TO ENTERTAIN THE CLAIM TO REFUND OF THE EXPENSES INCURRED BY THE COMPLAINANT'S WIFE FOR TREATMENT IN BELGIUM AND TO REFUND THEM ACCORDING TO THE ORGANISATION'S RULES.
2. THE CASE IS SENT BACK TO EUROCONTROL FOR A NEW DECISION.
3. EUROCONTROL SHALL PAY THE COMPLAINANT 100,000 LUXEMBOURG FRANCS IN COSTS.
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."
complaint allowed; decision quashed; case sent back to organisation; dependant; insurance; freedom to choose practitioner; insurance benefit; supplementary coverage