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Insurance (401, 402, 403, 404, 405, 406, 407, 408, 409, 410, 411, 415, 416, 417, 418, 419, 422, 678, 667,-666)

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Keywords: Insurance
Total judgments found: 45

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  • Judgment 3780


    123rd Session, 2017
    European Patent Organisation
    Extracts: EN, FR
    Full Judgment Text: EN, FR
    Summary: The complaint deals with the complainant’s daughter’s affiliation to a Dutch health insurance scheme.

    Judgment keywords

    Keywords:

    complaint dismissed; insurance;



  • Judgment 3762


    123rd Session, 2017
    United Nations Educational, Scientific and Cultural Organization
    Extracts: EN, FR
    Full Judgment Text: EN, FR
    Summary: The complainants challenge a circular that implements amendments to the Rules of the Medical Benefits Fund.

    Judgment keywords

    Keywords:

    complaint allowed; decision quashed; insurance;



  • Judgment 3736


    123rd Session, 2017
    International Telecommunication Union
    Extracts: EN, FR
    Full Judgment Text: EN, FR
    Summary: The complainants challenge the ITU’s decision to change its medical insurance scheme and to increase their premiums under this insurance scheme.

    Judgment keywords

    Keywords:

    complaint allowed; consultation; decision quashed; insurance;



  • Judgment 3628


    121st Session, 2016
    European Patent Organisation
    Extracts: EN, FR
    Full Judgment Text: EN, FR
    Summary: The complainant challenges a decision of the Administrative Council relating to employees’ contribution to sickness insurance.

    Judgment keywords

    Keywords:

    complaint dismissed; contributions; insurance; summary procedure;



  • Judgment 3627


    121st Session, 2016
    International Telecommunication Union
    Extracts: EN, FR
    Full Judgment Text: EN, FR
    Summary: The complainant challenges the calculation of her health insurance contributions, as well as the amount of her disability pension.

    Judgment keywords

    Keywords:

    complaint dismissed; contributions; disability benefit; insurance; summary procedure;



  • Judgment 3507


    120th Session, 2015
    Global Fund to Fight AIDS, Tuberculosis and Malaria
    Extracts: EN, FR
    Full Judgment Text: EN, FR
    Summary: The complainant requests the payment of various sums in consequence of the decision to grant her a permanent disability benefit.

    Consideration 16

    Extract:

    "The Fund is [...] liable to provide compensation for this injury, without this obligation being restricted in any way by the terms of the organisation’s insurance policy (see, in this connection, Judgment 2533, under 26)."

    Reference(s)

    ILOAT Judgment(s): 2533

    Keywords:

    insurance;



  • Judgment 3506


    120th Session, 2015
    Global Fund to Fight AIDS, Tuberculosis and Malaria
    Extracts: EN, FR
    Full Judgment Text: EN, FR
    Summary: The complainant challenges the refusal of some of her requests for the defrayal of medical expenses.

    Consideration 19

    Extract:

    "[A]s the organisation is liable for the acts of its insurer […], the Fund itself must be ordered to reimburse the disputed expenses, which it may then seek to recover from the insurance company."

    Keywords:

    insurance;

    Consideration 9

    Extract:

    "The Global Fund then submits that the Tribunal is not competent to hear this dispute, as it is a dispute between the complainant and the insurance companies and, in its opinion, does not concern the organisation itself. The Fund is, however, greatly mistaken as to the nature of this dispute and the duties incumbent upon it in this case.
    International civil servants’ social protection forms an integral part of their terms of employment, which are the responsibility of the organisation for which they work. For this reason, despite the defendant organisation’s insistence to the contrary, where an organisation entrusts the responsibility for providing social protection to a private insurance company, as is the case here, the organisation has a duty to ensure that the insurer correctly processes the claims submitted by insured persons. In this situation, the organisation is in fact liable for the acts of its insurer (see, for example, Judgments 2063, under 8, or 3031, under 14, 18 and 19).
    In the instant case, the matter raised by the complainant is not in dispute between her and the insurance company, but between her and the Fund itself, and it concerns precisely the latter’s compliance with its duty to ensure the proper examination of a claim for the reimbursement of medical expenses. This matter does fall within the Tribunal’s competence (see, for example, in addition to the aforementioned Judgments 2063 and 3031, Judgments 2249 and 3030)."

    Reference(s)

    ILOAT Judgment(s): 2063, 2249, 3030, 3031

    Keywords:

    insurance;



  • Judgment 3218


    115th Session, 2013
    European Organisation for the Safety of Air Navigation
    Extracts: EN, FR
    Full Judgment Text: EN, FR
    Summary: The complainant challenges his registration with the new office in charge of the sickness insurance scheme.

    Judgment keywords

    Keywords:

    insurance; insurance benefit;



  • Judgment 3158


    114th Session, 2013
    European Patent Organisation
    Extracts: EN, FR
    Full Judgment Text: EN, FR
    Summary: The complainant successfully challenges the lawfulness of the decision not to reimburse the pharmaceutical products prescribed by his doctor.

    Consideration 6

    Extract:

    "[T]he conditions listed in the explanatory note of 20 October 2000 involve an interpretation of both 'generally accepted medical treatment' and 'proven therapeutic effects', in order to determine what constitutes 'medicines' for the purpose of Article 20(b)(2) of the [Collective Insurance Contract]. The Tribunal considers that such an interpretation implies a medical opinion. Accordingly, the questions of whether the products prescribed for the use of the complainant are 'medicines' for the purpose of the insurance policy and whether the complainant is entitled to be reimbursed under the policy consistent with his rights under Article 83 of the Service Regulations, require a medical opinion. As a result, these questions have to be referred to the Medical Committee in accordance with Article 90(1), paragraph 2 [...]."

    Reference(s)

    Organization rules reference: Articles 83 and 90 of Service Regulations

    Keywords:

    advisory body; complaint allowed; complaint allowed in part; insurance; insurance benefit; interpretation; medical board; staff regulations and rules;

    Consideration 5

    Extract:

    "[T]he consensus between the Office and the insurance broker contained in the explanatory note of 20 October 2000
    [...] should not be considered as binding, since it merely establishes guidelines interpreting the term 'medicines' as contained in Article 20(b)(2) of the [Collective Insurance Contract]."

    Keywords:

    complaint allowed; complaint allowed in part; insurance; insurance benefit; interpretation;



  • Judgment 3019


    111th Session, 2011
    European Patent Organisation
    Extracts: EN, FR
    Full Judgment Text: EN, FR

    Consideration 7

    Extract:

    Automatic coverage of spouses under the Organisation's long-term health insurance / Obligation to file a waiver declaration.
    "The automatic coverage applied by the Implementing Rules cannot be deemed unreasonable. It is clear that under the system chosen by the Organisation some staff members may be slightly financially penalised if they fail to opt out of the scheme, as their automatic coverage will entail consequent deductions from their salaries. However, in evaluating the possible outcome resulting from automatic coverage and that resulting from a lack of coverage, the Organisation evidently considered that the outcome could be worse in the latter situation as staff members who neglected to enrol their spouses in the long-term care insurance scheme could suffer the severe financial consequences of not being insured when the need arose, and the Tribunal cannot regard the Organisation's choice as unreasonable."

    Keywords:

    deduction; insurance; insurance benefit; organisation; practice; salary; social benefits;



  • Judgment 2976


    110th Session, 2011
    European Patent Organisation
    Extracts: EN, FR
    Full Judgment Text: EN, FR

    Consideration 10

    Extract:

    "[I]n Judgment 2533 the Tribunal observed that compensation for injury properly included 'past and future adaptations to the complainant's house and car' and that those expenses were 'on no different footing than other necessary expenses incurred as a consequence of [...] service related injury'."

    Reference(s)

    ILOAT Judgment(s): 2533

    Keywords:

    compensation; definition; disability benefit; injury; insurance; insurance benefit; service-incurred;

    Consideration 11

    Extract:

    "The purpose of insurance is to indemnify, whether in whole or in part, and not simply to provide a social safety net."

    Keywords:

    compensation; insurance; insurance benefit; purpose;



  • Judgment 2533


    101st Session, 2006
    Organisation for the Prohibition of Chemical Weapons
    Extracts: EN, FR
    Full Judgment Text: EN, FR

    Consideration 26

    Extract:

    The complainant suffered a workplace injury at the Organization premises. The results of this seemingly minor accident were catastrophic and the complainant is now permanently and totally disabled and suffers from a rare illness, which has extended up both of the complainant's legs and requires him to use a wheelchair.

    "[G]iven the possibly progressive nature of [the illness], the condition may continue to deteriorate seriously. [...] the Tribunal asserts unequivocally that the defendant's obligation to pay the complainant reasonable compensation for the results of his workplace injury is a continuing one and is not affected or diminished by the terms of an insurance policy to which the complainant is not a party."

    Keywords:

    complaint allowed; complaint allowed in part; consequence; disability benefit; handicapped person; illness; insurance; insurance benefit; invalidity; maximum limit; organisation's duties; professional accident; provision; service-incurred;



  • Judgment 2290


    96th Session, 2004
    European Patent Organisation
    Extracts: EN, FR
    Full Judgment Text: EN, FR

    Consideration 3

    Extract:

    The Organisation contends that the internal appeal against a decision not to refund medical costs was not lodged in time. In doing so, it takes as the starting point of the time-limit the insurance representative's statement of account rejecting the request for refund. This "plea [...] is unfounded [...] This is because the insurance representative is not an organ of the Organisation, able to take decisions in the meaning of the Office's Service Regulations for Permanent Employees. Decisions concerning insurance benefits are taken by the Office, and more specifically by its President, in accordance with Article 83 of those Regulations."

    Reference(s)

    Organization rules reference: Article 83 of the Service Regulations for Permanent Employees of the European Patent Office

    Keywords:

    complaint; complaint allowed; complaint allowed in part; decision; executive head; illness; insurance; insurance benefit; internal appeal; receivability of the complaint; staff regulations and rules; start of time limit; time bar; time limit;



  • Judgment 2063


    91st Session, 2001
    European Patent Organisation
    Extracts: EN, FR
    Full Judgment Text: EN, FR

    Consideration 8

    Extract:

    "The Tribunal is fully competent to consider whether the Office is right in maintaining that [the insurance broker] Van Breda correctly exercised its authority in rejecting the request to meet the cost of transferring the complainant to a convalescent home."

    Keywords:

    competence of tribunal; complaint allowed; complaint allowed in part; discretion; insurance; judicial review; refund; refusal; request by a party;

    Consideration 8

    Extract:

    "The authority of the insurance brokers goes beyond a simple right to make an administrative check of the claims it receives [...]. [Insurers] have the right to check whether, under the insurance contract, they are liable for the costs of the care dispensed. But they must so exercise that authority as to provide the insured with a guarantee that their claims to coverage are examined with all due care."

    Keywords:

    complaint allowed; complaint allowed in part; condition; contract; discretion; duty of care; insurance; insurance benefit; refund; request by a party; safeguard;



  • Judgment 2047


    91st Session, 2001
    European Patent Organisation
    Extracts: EN, FR
    Full Judgment Text: EN, FR

    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; insurance; invalidity; medical board; medical consultant; medical opinion; organisation's duties;

    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; duty to inform; insurance; medical opinion; medical records; organisation's duties; right;



  • Judgment 1917


    88th Session, 2000
    European Southern Observatory
    Extracts: EN, FR
    Full Judgment Text: EN, FR

    Considerations 7 and 8

    Extract:

    The Tribunal noted that since 1974 the health insurance contract has always been concluded for periods of one year and has even been amended several times. It does not agree that the complainant has an absolute claim to a specific system of health insurance, therefore, there has been no impairment of an acquired right.

    Keywords:

    acquired right; amendment to the rules; insurance; staff member's interest;



  • Judgment 1904


    88th Session, 2000
    World Health Organization
    Extracts: EN, FR
    Full Judgment Text: EN, FR

    Summary

    Extract:

    When the Tribunal gives an organisation the choice to either reinstate a complainant or pay damages, and the organisation chooses to pay damages, it does not have to pay the contributions of the pension fund or the staff health insurance.

    Keywords:

    allowance; contributions; illness; insurance; judgment of the tribunal; material damages; pension; reconstruction of career; reinstatement; unjspf;



  • Judgment 1894


    88th Session, 2000
    European Patent Organisation
    Extracts: EN, FR
    Full Judgment Text: EN, FR

    Consideration 5

    Extract:

    "It is not for the complainant [...] to judge whether the information requested by [the insurance company] is necessary in order to enable it to assess her claims. That is a matter for the professional assessment of [the insurance company] and its medical adviser and the Tribunal would not interfere unless it was satisfied that the information was being sought for some abusive or improper purpose."

    Keywords:

    evidence; good faith; illness; insurance; insurance benefit; judicial review; limits; medical examination; staff member's duties; tribunal;



  • Judgment 1880


    87th Session, 1999
    European Organisation for the Safety of Air Navigation
    Extracts: EN, FR
    Full Judgment Text: EN, FR

    Consideration 8

    Extract:

    "According to precedent [...] (see Judgments 1094 [...] and 1095 [...]), coverage at the rate of 100 per cent does not mean that in all circumstances an insured person is entitled to full repayment of expenses incurred. [T]o allow the [sickness] fund not to reimburse the part of the expenses deemed to be excessive is in keeping with the purpose of sickness insurance and it is a means of ensuring sound financing and comparable coverage for the beneficiaries, and as such falls within the authority delegated to the Director General. The reimbursement of expenses can be restricted by setting maximum limits or ceilings for certain types of expenditure or by reckoning limits for each case on the basis of costs incurred."

    Reference(s)

    Organization rules reference: ARTICLE 72 OF EUROCONTROL STAFF REGULATIONS
    ILOAT Judgment(s): 1094, 1095

    Keywords:

    case law; illness; insurance; insurance benefit; limits; maximum limit; purpose;



  • Judgment 1848


    87th Session, 1999
    European Patent Organisation
    Extracts: EN, FR
    Full Judgment Text: EN, FR

    Consideration 12

    Extract:

    The complainant questions the right of the insurance company to which she is affiliated to contact her physicians directly to seek information. "The law is clear that [the insurance company] is entitled to any information which identifies the nature of the alleged illness and allows it to determine whether the prescribed treatment is appropriate and necessary [...] Of course the complainant is entitled to require that such information only be made available to [the insurance company's] medical adviser and be treated by the latter in confidence but she is not entitled to withhold from them any right of access whatsoever to the required medical information. Her unwillingness to allow such access goes against her duty to deal in good faith with her insurers."

    Reference(s)

    ILOAT Judgment(s): 1288

    Keywords:

    conduct; confidential evidence; elements; good faith; illness; insurance; medical consultant; medical records; refusal; safeguard; staff member's duties;

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Last updated: 02.07.2020 ^ top