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Freedom to choose practitioner (410,-666)

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Keywords: Freedom to choose practitioner
Total judgments found: 2

  • Judgment 1148


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

    Consideration 19

    Extract:

    The complainant objects to the Sickness Fund's refusal to refund the costs of a product which her doctor prescribed and which she bought in a pharmacy. The Tribunal holds that the fact "that a product has been bought in a pharmacy [is immaterial] since a pharmacy may sell many health items that are not products within the meaning of the rule. Likewise a doctor's prescription is no criterion since according to the rule it is a condition of refund over and above the objective effects of the product."

    Keywords:

    discretion; freedom to choose practitioner; insurance benefit;

    Consideration 18

    Extract:

    The complainant is challenging [the organisation's] Sickness Fund's refusal to refund the cost of an item classified as "phytotherapy". The Tribunal holds that "under Article 14 the administration may determine whether an item that a fund member wants to have refunded is a 'pharmaceutical product' within the meaning of the rule. [...] That is a matter of medical opinion and among the relevant criteria are the preventive or therapeutic efficacy of the product, scientific inquiry into the effects it has, and any risks involved in using it. So decisions by public health bodies are highly relevant, particularly for an international fund like [the organisation's] that covers more than one country and allows free choice of practitioner."

    Reference(s)

    Organization rules reference: ARTICLE 14 OF RULE 10

    Keywords:

    discretion; domestic law; freedom to choose practitioner; insurance benefit;



  • Judgment 924


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

    Considerations 18 and 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:

    case sent back to organisation; complaint allowed; decision quashed; dependant; freedom to choose practitioner; insurance; insurance benefit; supplementary coverage;


 
Last updated: 19.09.2019 ^ top