ILO is a specialized agency of the United Nations
ILO-en-strap
Site Map | Contact français
> Home > Triblex: case-law database > By thesaurus keyword > insurance

Judgment No. 2047

Decision

1. THE EPO IS ORDERED TO PROVIDE THE COMPLAINANT WITH ACCESS TO ANY MEDICAL REPORTS IN VAN BREDA'S FILE.
2. THE COMPLAINT BEING ALLOWED IN PART THE COMPLAINANT IS ENTITLED TO COSTS INCURRED BEFORE THE TRIBUNAL IN THE AMOUNT OF 500 EUROS.
3. THE ORGANISATION'S COUNTERCLAIM IS DISMISSED.
4. ALL OTHER CLAIMS ARE DISMISSED.

Consideration 11

Extract:

"The complainant adopts the position taken by the Appeals Committee to the effect that the [organisation] was obligated to appoint its own medical officer for the purposes of dealing with her claim and was not entitled to rely on the medical adviser appointed by [the insurance company] Van Breda for that purpose. For the Tribunal to so hold would amount to a denial of the organisation's right to appoint the medical officer of its choice. The fact that it selects and relies on the same medical adviser as the one appointed by the insurer, whom it has engaged to carry out its obligations to provide health coverage to its staff, is not in the least surprising. Such appointment cannot have any adverse effect upon the complainant who retains the right given by Article 90 [of the Service Regulations] to have any contested issue relating to medical matters determined by the Invalidity Committee."

Reference(s)

Organization rules reference: ARTICLE 90 OF THE SERVICE REGULATIONS

Keywords

complaint allowed; complaint allowed in part; organisation's duties; insurance; medical board; medical consultant; medical opinion; invalidity

Consideration 13

Extract:

"With regard to the complainant's claim to be provided with copies of any medical reports relied upon by [the insurance brokers] Van Breda, it is trite law that a staff member's right to see medical reports may not ordinarily be challenged. As such, the complainant should be provided with copies of medical reports contained in Van Breda's file relating to this matter. Whether or not the [organisation] has these documents in their possession is irrelevant. As the policy holder, it has the right to give instructions that the complainant be given access to these documents and must ensure that she is provided with the information as soon as reasonably possible. [...] It is of no avail that some or all of the reports in question may have been given by the complainant's own doctors: she is entitled to know from Van Breda exactly what medical information about her it has received and from whom."

Keywords

complaint allowed; complaint allowed in part; organisation's duties; duty to inform; insurance; medical opinion; medical records; right



 
Last updated: 15.08.2014 ^ top