Judgment No. 3361
Decision
1. The decision of 12 October 2011 is set aside insofar as it confirms the refusal of the prior authorisation required for the maxillofacial surgical operation.
2. The case is referred back to Eurocontrol for further action as stated in consideration 15 of the judgment.
3. Eurocontrol shall pay the complainant compensation of 4,000 euros for moral injury.
4. It shall also pay her 3,000 euros in costs.
5. All other claims are dismissed.
Summary
The complainant successfully impugns the decision rejecting her request seeking payment of the costs of an orthodontic treatment and a surgical operation.
Judgment keywords
Keywords
complaint allowed; case sent back to organisation; medical expenses; health insurance
Consideration 11
Extract:
"It is true that the General Provisions require the application for prior authorisation to be made before the treatment or services begin, but they do not require authorisation to be given before that time. It was therefore open to the complainant to run the risk of having to bear the cost of the operation herself if the refusal of prior authorisation was later confirmed."
Keywords
refund
Consideration 14
Extract:
"The right to an internal appeal is a safeguard enjoyed by international civil servants. The ultimate decision-maker cannot therefore depart from the conclusions and recommendations of the internal appeal body without giving adequate reasons for her or his decision (see Judgments 2699, under 24, 2833, under 4, and 3208, under 11)."
Reference(s)
Jugement(s) TAOIT: 2699, 2833, 3208
Keywords
internal appeal
Consideration 8
Extract:
The Tribunal [...] cannot substitute its own views for the medical opinions on which the impugned decision was based. This is especially true in cases such as the present one, where specialists regarded by both parties as being highly qualified have given different opinions on the advisability of a treatment and a surgical operation.
The Tribunal is, however, fully competent to assess whether the procedure that has been followed was correctly carried out,
especially as regards respect for the adversarial principle or the right to be heard, and to examine whether the reports used as the
basis for an administrative decision contain any substantive error or inconsistency, overlook essential facts or draw erroneous conclusions from the evidence (see Judgments 620, under 4, 1284, under 4, and 2361, under 9).
Reference(s)
Jugement(s) TAOIT: 620, 1284, 2361
Keywords
medical opinion
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