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Insurance benefit (412, 413,-666)

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Keywords: Insurance benefit
Total judgments found: 57

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  • Judgment 4028


    126th Session, 2018
    International Telecommunication Union
    Extracts: EN, FR
    Full Judgment Text: EN, FR
    Summary: The complainants challenge Service Order No.14/10 changing the health insurance scheme at the ITU, as well as individual decisions implementing that service order.

    Consideration 13

    Extract:

    [A]s the complainants point out, the burden of the new measures is borne by the insured persons alone. It must however be remembered that, despite a fall in its income resulting from a zero growth budget and the drop in contributions from some member States, the ITU continues to fund 50 per cent of the scheme for staff members and two thirds of it for retirees. As the defendant organisation explains, the new measures which have been put in place seek to maintain the financial equilibrium of the new insurance plan in order to ensure its continuity and stability while respecting the principles of solidarity and mutualisation of risks.
    In Judgment 1241, under 19, the Tribunal considered that “the change the complainants object[ed] to [was] part of wider reforms the [organisation] made to put the [health insurance] scheme on a sounder financial footing over the long term” and that the organisation in question was “right to pursue that aim by all suitable means at its disposal, [including by] measures to ensure that, in keeping with the notion of mutual aid, everyone bears a fair share of costs”.
    This consideration applies mutatis mutandis to the present complaints.

    Reference(s)

    ILOAT Judgment(s): 1241

    Keywords:

    budgetary reasons; insurance benefit;



  • Judgment 3967


    125th Session, 2018
    European Patent Organisation
    Extracts: EN, FR
    Full Judgment Text: EN, FR
    Summary: The complainant considers that he was a victim of harassment, or at least of straining, by his director who issued a warning letter regarding his performance and set new productivity targets which he was to achieve in 2004.

    Consideration 8

    Extract:

    [T]he warning letter provided for in Section A(6) of Circular No. 246 is not an act that could be challenged before the Tribunal as it is merely a step in the process that culminates in a staff report (see Judgments 3806, consideration 6, 3697, consideration 5, 3629, consideration 3, 3512, consideration 3, and 3433, consideration 9).

    Reference(s)

    ILOAT Judgment(s): 3433, 3512, 3629, 3697, 3806

    Keywords:

    decision; insurance benefit; step in the procedure;



  • 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.

    Judgment keywords

    Keywords:

    complaint allowed; decision quashed; insurance benefit; joinder; service-incurred;



  • Judgment 3497


    120th Session, 2015
    European Organisation for the Safety of Air Navigation
    Extracts: EN, FR
    Full Judgment Text: EN, FR
    Summary: The complainant contests the refusal of her request that her mother’s condition be recognized as a serious illness.

    Judgment keywords

    Keywords:

    case sent back to organisation; complaint allowed; decision quashed; illness; insurance benefit; medical opinion;



  • Judgment 3491


    120th Session, 2015
    International Atomic Energy Agency
    Extracts: EN, FR
    Full Judgment Text: EN, FR
    Summary: The complainant, who suffered service-incurred injuries and engaged in swimming therapy, impugns the decision to only partially reimburse the cost of her gym membership.

    Judgment keywords

    Keywords:

    complaint allowed; decision quashed; insurance benefit; joinder; service-incurred; sick leave;



  • Judgment 3361


    118th Session, 2014
    European Organisation for the Safety of Air Navigation
    Extracts: EN, FR
    Full Judgment Text: EN, FR
    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:

    insurance benefit;



  • Judgment 3354


    118th Session, 2014
    European Patent Organisation
    Extracts: EN, FR
    Full Judgment Text: EN, FR
    Summary: The Tribunal set aside the decision dismissing the complainant’s request for the reimbursement of pharmaceutical costs on the ground that the case should have been referred to the Medical Committee.

    Judgment keywords

    Keywords:

    insurance benefit;



  • Judgment 3268


    116th Session, 2014
    European Patent Organisation
    Extracts: EN, FR
    Full Judgment Text: EN, FR
    Summary: The complainant successfully impugns the establishment of a staff report containing negative comments.

    Considerations 9, 12 and 13

    Extract:

    "Assessment of an employee’s merit during a specified period involves a value judgement; for this reason, the Tribunal must recognise the discretionary authority of the bodies responsible for conducting such an assessment. Of course, it must ascertain whether the marks given to the employee have been worked out in full conformity with the rules, but it cannot substitute its own opinion for these bodies’ assessment of the qualities, performance and conduct of the person concerned. The Tribunal will therefore interfere in this field only if the decision was taken without authority, if it was based on an error of law or fact, a material fact was overlooked, or a plainly wrong conclusion was drawn from the facts, or if it was taken in breach of a rule of form or procedure, or if there was abuse of authority (see Judgments 2834, under 7, and 3006, under 7). This limitation on the Tribunal’s power of review naturally applies to both the mark given in a staff report and the comments accompanying that mark in the report."
    "The restraint which the Tribunal must exercise [...] does not mean that it can disregard the fact that the comment accompanying the complainant’s productivity rating considerably detracts from the marking “good” and that the countersigning officer’s comments underscore that effect. [...] It follows from the foregoing that the [...] disputed staff report must be set aside."

    Keywords:

    decision quashed; discretion; insurance benefit; performance evaluation; rating; supervisor;



  • 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.

    Judgment keywords

    Keywords:

    case sent back to organisation; complaint allowed; decision quashed; insurance benefit;

    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 3080


    112th Session, 2012
    World Health Organization
    Extracts: EN, FR
    Full Judgment Text: EN, FR

    Consideration 14

    Extract:

    "[A] passing reference to "husband" or "wife" in the Staff Rules is not sufficient to warrant interpreting all the relevant provisions thereof as denying same-sex spouses the entitlements concerned (see Judgment 2590 [...], under 6)."

    Reference(s)

    ILOAT Judgment(s): 2590

    Keywords:

    complaint allowed; complaint allowed in part; insurance benefit; interpretation; marital status; provision; same-sex marriage; social benefits; staff regulations and rules;

    Considerations 19 and 20

    Extract:

    "According to the Tribunal's case law, when an organisation is ordered to grant a financial benefit to a staff member who fulfilled the legal requirements for claiming it, but who failed to do so as soon as his/her entitlement arose, the benefit in question is due only as from the date of the initial claim by the person concerned, and not the date on which he/she became entitled to the benefit ([...] see Judgment 2550, under 6, or Judgment 2860, under 22). There would be no justification for ordering an organisation unexpectedly to pay potentially large, backdated, aggregated sums for benefits which had not been claimed by the staff member concerned when he or she should have done so. [...] [Moreover] it is true that the position would be different if the Organization itself were responsible for the fact that the [staff member] did not submit a claim [at that time]."

    Reference(s)

    ILOAT Judgment(s): 2550, 2860

    Keywords:

    amount; complaint allowed; complaint allowed in part; condition; date; delay; exception; insurance benefit; judgment of the tribunal; liability; marital status; non-retroactivity; organisation; payment; request by a party; staff member's duties;



  • 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 2870


    108th Session, 2010
    European Patent Organisation
    Extracts: EN, FR
    Full Judgment Text: EN, FR

    Considerations 6, 9 and 15

    Extract:

    The complaints raise the question whether Article 71 of the Office's Service Regulations - which provides for the payment of an education allowance to employees who are not nationals of the country in which they are serving and, in certain limited circumstances, to nationals of that country - offends the principle of equality. The complainants contend that, at least for the purposes of post-secondary education, Article 71 proceeds by reference to an irrelevant consideration - nationality - and, if it does not, the different treatment directed by that article is neither appropriate nor adapted to the difference involved.
    "[N]ationality is the primary distinction mandated by Article 71 [...]."
    "In principle, the nationality of the employee is properly to be regarded as a relevant difference warranting different treatment, including with respect to post-secondary education."
    "An international organisation such as the EPO, with a large workforce composed of many different nationalities, is entitled to proceed by reference to a rule applicable to all non nationals provided that the rule is appropriate and adapted to their general circumstances. And that is so even if its application in individual cases is less than perfect. Article 71 of the Service Regulations is appropriate and adapted to the general circumstances of the children of non-nationals."

    Reference(s)

    Organization rules reference: Article 71 of the Service Regulations
    ILOAT Judgment(s): 2313, 2638

    Keywords:

    difference; equal treatment; insurance benefit; nationality; staff regulations and rules;



  • Judgment 2782


    106th Session, 2009
    European Organisation for the Safety of Air Navigation
    Extracts: EN, FR
    Full Judgment Text: EN, FR

    Consideration 6

    Extract:

    In order to execute Judgment 2560 the Organisation paid salary arrears not only to the officials who had filed the complaints that led to that judgment, but also to all other members of staff and to all former members of staff in receipt of a retirement pension. However, interest on arrears was paid only to the members of staff who had filed a complaint with the Tribunal; the complainant was not among them. He is consequently challenging the decision not to pay him interest on arrears.
    "(a) In the absence of any particular rule requiring the Organisation to pay interest on arrears to a staff member where a benefit due to that person is paid belatedly, such interest is not in principle due until the creditor - i.e. the staff member to whom the benefit is owed - has served notice on the Organisation to pay. This apparently harsh solution is justified because no particular formalities are required for the service of such notice, it being sufficient for the creditor to request payment of the amount due. [...]
    (b) However, this rule does not apply where the debt is one which falls due on a fixed date. In such a case the due date is equivalent to the service of notice (dies interpellat pro homine). The debtor owes interest on arrears as from that date, without any need for the creditor to establish that he or she has requested payment of the due sum. The same applies where the debt falls due periodically at a fixed date, as in the case of a salary.
    The salary adjustment at issue forms an integral part of the salary. Moreover, the salary, plus increments, is due on precise dates at the end of every month. In the instant case the payment of the staff member's salary, including the adjustment thereto, did not depend on a request from that person. The claim for interest on arrears is therefore well founded."

    Reference(s)

    ILOAT Judgment(s): 2560

    Keywords:

    adjustment; amount; complainant; complaint allowed; complaint allowed in part; date; debt; delay; exception; execution of judgment; formal requirements; general principle; increase; insurance benefit; interest on damages; no provision; organisation's duties; payment; request by a party; retirement; salary;



  • Judgment 2751


    105th Session, 2008
    European Patent Organisation
    Extracts: EN, FR
    Full Judgment Text: EN, FR

    Consideration 9

    Extract:

    "The intention with which a statement is made is not necessarily determinative of the question whether a statement that is wholly irrelevant is also one that can serve no proper purpose." The complainant represented three colleagues whose complaints were considered by the Tribunal in Judgment 2514. In its replies the Organisation had stated that, by reason of the time he had spent providing legal assistance to staff members, the complainant's work as an examiner had been less satisfactory than it should have been. "That was defamatory. It was also inconsistent with the duty of the EPO to respect the complainant's dignity. In the context of the other comments that were within the limits of the privilege that attaches to proceedings before the Tribunal, it carried the threat of possible administrative consequences for the complainant's employment. Such a remark can serve no proper purpose. Accordingly, it was not privileged and the complainant is entitled to seek relief with respect to it."

    Reference(s)

    ILOAT Judgment(s): 2514

    Keywords:

    breach; compensation; complaint allowed; complaint allowed in part; consequence; counsel; iloat; insurance benefit; intention of parties; organisation; organisation's duties; privileges and immunities; procedure before the tribunal; purpose; request by a party; respect for dignity; right; security of tenure; staff representative;



  • 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;

    Consideration 18

    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.

    "[T]he expenses of necessary adaptations to house and car are on no different footing than other necessary expenses incurred as a consequence of the complainant's service-related injury and must be reimbursed."

    Keywords:

    complaint allowed; complaint allowed in part; handicapped person; insurance benefit; invalidity; organisation's duties; professional accident; refund; 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 2083


    92nd Session, 2002
    International Labour Organization
    Extracts: EN, FR
    Full Judgment Text: EN, FR

    Considerations 8 and 9

    Extract:

    The complainant suffered from retinal detachments and a detachment of the vitreous. The organization recognised her eye condition as service incurred. In "September 1998 [...] the [organization] decide[d] to stop reimbursing the bills [she submitted] on [the] grounds [...] that curing her retinal detachments was no longer the object of the treatment. However, it did not show that the service-incurred injuries were not a "direct and principal" cause of the treatment [... ] The Tribunal takes the view that although, as the organization says, the decision to stop reimbursing the bills was at the discretion of the Director-General, it could not be taken without an independent expert medical opinion obtained through a process which provides all the safeguards of transparency and impartiality." The case is therefore sent back to the organization.

    Keywords:

    case sent back to organisation; complaint allowed; consequence; decision; discretion; due process; executive head; expert inquiry; grounds; illness; independence; insurance benefit; lack of evidence; medical opinion; organisation; organisation's duties; procedure before the tribunal; professional accident; refund; refusal; safeguard; service-incurred;



  • Judgment 2063


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

    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;

    Consideration 8

    Extract:

    After the complainant underwent surgery, the insurance brokers refused to cover his convalescence in a home. "In order to assess any physical injury suffered by the complainant, it is necessary to ascertain the later consequences for his health of the refusal to meet the costs of his admission to a convalescent home, and the fact that he did not as a result stay in such a home. These are purely medical matters which [...] need to be referred to the Invalidity Committee".

    Keywords:

    claim; competence; complaint allowed; complaint allowed in part; consequence; illness; insurance benefit; medical board; receivability of the complaint; refund; refusal; request by a party;

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Last updated: 02.07.2020 ^ top