Judgment No. 1176
1. THE IMPUGNED DECISIONS REFUSING THE COMPLAINANT HEALTH INSURANCE COVERAGE FOR HIS MOTHER-IN-LAW ARE SET ASIDE.
2. THE CASE IS SENT BACK TO EUROCONTROL SO THAT IT MAY DETERMINE, IN CO- OPERATION WITH THE COMPLAINANT, WHETHER HIS MOTHER-IN-LAW MAY OBTAIN COVERAGE UNDER A PUBLIC SCHEME WITHIN THE MEANING OF ARTICLE 2(2) OF RULE NO. 10 CONCERNING SICKNESS AND ACCIDENT INSURANCE.
3. EUROCONTROL SHALL PAY THE COMPLAINANT INTEREST ON THE SUMS DUE AT THE RATE OF 8 PER CENT A YEAR FROM 10 JANUARY 1991.
4. IT SHALL PAY HIM 50,000 BELGIAN FRANCS IN COSTS.
"The complainant has brought two similar complaints challenging [the same] decision. [...] He explains that since the time limit for answering his internal appeal ran out [...] he inferred rejection and filed a complaint. He then left on holiday and not until he got back - by which time his first complaint had already been filed - did he receive the letter of rejection. So it was only by way of precaution that he filed the second complaint, within the time limit, against that express decision. In the circumstances the two complaints are receivable and may be joined."
complaint; decision; express decision; implied decision; failure to answer claim; joinder; receivability of the complaint; time limit
"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."
organisation's duties; dependant; dependent child; insurance; illness; medical expenses; health insurance
Considerations 11 and 13
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."
Organization rules reference: Article 2(2) of Rule no. 10 of the Staff Regulations
evidence; burden of proof; organisation's duties; dependant; dependent child; insurance; illness; medical expenses; health insurance
The Tribunal will discount "a new material fact" which the organisation supplied "too late for the complainant to be able to comment".
new fact on which the party was unable to rely in the original proceedings; time limit; disclosure of evidence; adversarial proceedings; right to reply