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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 992


    68th Session, 1990
    European Organisation for the Safety of Air Navigation
    Extracts: EN, FR
    Full Judgment Text: EN, FR

    Summary

    Extract:

    The complainant's application for permission to take a cure prescribed by his doctor was rejected. The Agency's medical officer reported to the health fund that the doctor had given no clear evidence of the need for the prescribed treatment. In keeping with Article 20 of Rule No. 10 concerning sickness and accident insurance, expenses relating to a cure shall be refunded provided that the cure "is recognised as strictly necessary by the medical officer". The Tribunal sees nothing improper in the medical officer's assessment nor in the administration's ensuing denial of permission.

    Keywords:

    cure; insurance benefit; medical consultant; medical opinion; refund; refusal;



  • Judgment 971


    66th Session, 1989
    World Health Organization
    Extracts: EN, FR
    Full Judgment Text: EN, FR

    Consideration 8

    Extract:

    "The complainant claims payment under Annex C. But only the WHO, not the complainant, is entitled to payment under this annex, which concerns its insurance policy. The policy is exclusively a matter between the WHO and its insurers. In application of its administrative practice, as reflected in paragraph 365 of Manual II.7, the organization does hand the difference over to the staff member if the sum it has actually received from the insurers more than covers its liability to him."

    Reference(s)

    Organization rules reference: WHO MANUAL PROVISION II.7

    Keywords:

    amount; complainant; difference; insurance; insurance benefit; organisation; payment; practice;



  • Judgment 944


    65th Session, 1988
    European Patent Organisation
    Extracts: EN, FR
    Full Judgment Text: EN, FR

    Consideration 4

    Extract:

    The complainant and her husband are both officials of the EPO. There are no rules concerning the refund of medical expenses which cover such contingencies. The Tribunal holds that "no other provision of the Service Regulations may be applied, even by analogy, if intended to fit an essentially different set of circumstances."

    Keywords:

    analogy; applicable law; enforcement; insurance benefit; marital status; no provision; other; provision; staff regulations and rules;

    Consideration 7

    Extract:

    The complainant and her husband are employees of the EPO. In view of the fact that between them they pay a double premium, she is seeking the refund at 100 per cent of their medical expenses, and not 80 per cent as stipulated in the insurance policy. In keeping with the organisation's view, the Tribunal holds that under the material rules of the organisation, "each staff member pays contributions that depend on the amount of salary, yet is entitled to the same benefits, whatever the degree of individual risk or family situation may be. Status as an official will always prevail over status as the member of an official's family, and the right to refund derives solely from the former, not from any marital connection there may be with another official."

    Keywords:

    consequence; contributions; family relationship; insurance benefit; official; rate; right; same;



  • Judgment 941


    65th Session, 1988
    European Organisation for the Safety of Air Navigation
    Extracts: EN, FR
    Full Judgment Text: EN, FR

    Consideration 9

    Extract:

    "As the texts stand vaccinations are not ordinarily covered by the [sickness insurance] scheme [...] that the policy of other European organisations is more liberal is an example Eurocontrol may wish but is not bound to follow."

    Keywords:

    applicable law; insurance; insurance benefit; law of european communities; rule of another organisation;



  • Judgment 925


    65th Session, 1988
    European Organisation for the Safety of Air Navigation
    Extracts: EN, FR
    Full Judgment Text: EN, FR

    Consideration 11

    Extract:

    "The scheme member has a duty to support a claim with documents that are clear enough for the administration to be able to tell what the treatment was and to apply the right rate of refund."

    Keywords:

    burden of proof; disclosure of evidence; evidence; illness; insurance; insurance benefit; rate; request by a party;



  • Judgment 924


    65th Session, 1988
    European Organisation for the Safety of Air Navigation
    Extracts: EN, FR
    Full Judgment Text: EN, FR

    Considerations 18 and 19

    Extract:

    The Eurocontrol Health Insurance Scheme in Luxembourg denied the complainant reimbursement of medical expenses incurred in Belgium by his wife who is entitled to so-called "supplementary coverage". The Tribunal holds that "since it has a duty to provide supplementary coverage the organisation was bound, under its own rules, to refund the full cost of Mrs. Boland's treatment in Belgium. The implied final decision must therefore be set aside and the case sent back to Eurocontrol for a new decision on the refund of the costs incurred by Mrs. Boland, with due regard to the freedom of choice guaranteed in Rule No. 10."

    Keywords:

    case sent back to organisation; complaint allowed; decision quashed; dependant; freedom to choose practitioner; insurance; insurance benefit; supplementary coverage;



  • Judgment 923


    65th Session, 1988
    European Organisation for the Safety of Air Navigation
    Extracts: EN, FR
    Full Judgment Text: EN, FR

    Consideration 12

    Extract:

    "In case of doubt it is for the staff member to show exactly what the treatment was if he is contending that the maximum limit does not apply."

    Keywords:

    burden of proof; disclosure of evidence; evidence; insurance benefit; maximum limit; request by a party;



  • Judgment 832


    62nd Session, 1987
    International Labour Organization
    Extracts: EN, FR
    Full Judgment Text: EN, FR

    Consideration 15

    Extract:

    "International civil servants quite understandably put stock in their retirement benefits and quite rightly want an income that, even if it will not sustain the same standard of living, will at least be comfortable. The decisions impugned do mar the outlook, in some cases seriously. But that is not enough to establish breach of an acquired right."

    Keywords:

    acquired right; amendment to the rules; amount; breach; grounds; insurance benefit; lack of evidence; official; retirement; same; separation from service;



  • Judgment 770


    59th Session, 1986
    World Health Organization
    Extracts: EN, FR
    Full Judgment Text: EN, FR

    Summary

    Extract:

    The complainant was injured in an aircraft accident while on an official mission. He sought compensation from the airline whose plane had caused the accident. The airline agreed to conclude a reasonable settlement. The complainant never disclosed the amount of the payment made to him. Under the circumstances, the Tribunal holds that it was proper for the organization to deny the complainant further benefits. Indeed, paragraph 32 of aAnnex E to the WHO Manual releases the compensation scheme from the obligation to make payments to a staff member who has obtained satisfaction through a third party.

    Reference(s)

    Organization rules reference: PARAGRAPH 32 OF ANNEX E TO THE WHO MANUAL

    Keywords:

    accumulation; illness; insurance; insurance benefit; organisation; professional accident; refusal; service-incurred;



  • Judgment 669


    56th Session, 1985
    European Patent Organisation
    Extracts: EN, FR
    Full Judgment Text: EN, FR

    Consideration 2

    Extract:

    "The general decision impugned* in this case puts no exact figure on the entitlement of the staff members concerned. That will be determined only when the administration comes to take individual decisions in pursuance of the general decision, viz. the Council's approval of the new text of [the] Article".
    (*) amending a provision in the Service Regulations on benefits payable in the event of invalidity.

    Keywords:

    amendment to the rules; competence of tribunal; general decision; individual decision; insurance benefit; invalidity; provision; receivability of the complaint; staff regulations and rules;



  • Judgment 550


    50th Session, 1983
    Pan American Health Organization
    Extracts: EN, FR
    Full Judgment Text: EN, FR

    Consideration 4

    Extract:

    Judgment No 450 "did not dispose of the question of the repayment of the medical expenses the [organisation] had agreed to bear, and [the judgment] does not have the authority of res judicata on this matter. In fact both the [Appeals] Board and the Director were required to take the matter up. The Director's refusal to consider the claim to repayment of medical expenses therefore suffers from a mistake of law and on this point the impugned decision must be set aside."

    Reference(s)

    ILOAT Judgment(s): 450

    Keywords:

    complaint allowed; complaint allowed in part; decision quashed; flaw; insurance benefit; internal appeal; receivability of the complaint; res judicata;

    Consideration 3

    Extract:

    "On 7 May 1981 the chief of personnel gave a final decision on the claims[*] submitted by that date, but not on any which might be submitted later. The complainant did later make further claims but did not seek a final decision on them."
    [*] concerning reimbursement of medical expenses

    Keywords:

    date; insurance benefit; internal remedies exhausted; receivability of the complaint; request by a party;



  • Judgment 540


    49th Session, 1982
    World Health Organization
    Extracts: EN, FR
    Full Judgment Text: EN, FR

    Considerations

    Extract:

    Staff Rules impose a duty on the organization to provide a staff member with clear and precise information on all charges of which he is accused. In particular the complainant should have been informed of the period during which the WHO alleges he submitted medical and education grant claims supported by forged or false documents. "It is not difficult to conceive of cases in which such an omission would constitute an irreparable flaw in the procedure laid down". In the particular circumstances of this case, the Tribunal did not find that there had been a breach of the Rules.

    Keywords:

    duty to substantiate decision; education expenses; insurance benefit; misrepresentation; refund; request by a party; serious misconduct; termination of employment;



  • Judgment 479


    47th Session, 1982
    World Health Organization
    Extracts: EN, FR
    Full Judgment Text: EN, FR

    Consideration 13

    Extract:

    Under the rules reasonable medical expenses should be reimbursed. The complainant asks the Tribunal to declare that he is entitled to reimbursement of expenses as long as his condition requires. No formal declaration is required. "If the complainant presents his claims as they arise and they are within the rule, there is no reason to suppose that they will not be met."

    Keywords:

    insurance benefit; invalidity; period;

    Consideration 4

    Extract:

    "The fundamental principle of the scheme [...] is that it is not a contract of indemnity but a contract to pay a fixed or calculated sum in certain contingencies. This principle is not affected by the adaptation of the scheme to short-term or temporary employment nor by the fact that in the latter case the earnings are not actual but assumed from an actual amount"

    Keywords:

    amount; incapacity; insurance benefit; invalidity;



  • Judgment 264


    35th Session, 1975
    European Organisation for the Safety of Air Navigation
    Extracts: EN, FR
    Full Judgment Text: EN, FR

    Considerations

    Extract:

    The complainant is right in claiming from the organisation "reimbursement of the difference between the amount to which she is entitled in respect of her husband and the amount to which her husband is entitled as an employee" of the Railway Corporation. The material provision is applicable, according to the general principles of existing law, even in the absence of express provision, irrespective of the sex of the official. If the official is a woman her husband should benefit from the sickness insurance if he does not himself benefit in his own right from a more favourable or equally favourable scheme.

    Keywords:

    amount; complaint allowed; dependant; difference; illness; insurance; insurance benefit; right; supplementary coverage;



  • Judgment 250


    34th Session, 1975
    Universal Postal Union
    Extracts: EN, FR
    Full Judgment Text: EN, FR

    Considerations

    Extract:

    The illness which the complainant suffered during his appointment with the organisation left no mark on him and it did not prevent him from resuming normal work in his national administration nor from obtaining high-level responsibilities. Since the organisation met all expenses incurred by reason of his illness, the complainant suffered no other prejudice thereby and cannot properly claim compensation for disability from which he does not in fact suffer.

    Keywords:

    consequence; illness; insurance benefit; lack of injury;



  • Judgment 157


    24th Session, 1970
    International Labour Organization
    Extracts: EN, FR
    Full Judgment Text: EN, FR

    Consideration 1

    Extract:

    On return from a mission, the complainant was ill. The organisation extended his contract for as long as the sick leave to which he was entitled under his contract. With the expiry of that contract, there was no longer any legal connection between the official and the organisation, which "could no longer lawfully grant him further sick leave or continue to bear his medical expenses." The organisation was bound by no provision nor any general principle of law to grant the complainant monetary compensation.

    Keywords:

    contract; extension of contract; fixed-term; illness; insurance benefit; non-renewal of contract; organisation's duties; project personnel; service-incurred; sick leave;



  • Judgment 148


    23rd Session, 1970
    Food and Agriculture Organization of the United Nations
    Extracts: EN, FR
    Full Judgment Text: EN, FR

    Consideration 7

    Extract:

    Due to his total incapacity for work, the complainant seeks the reimbursement of medical and pharmaceutical expenses in perpetuity. He "is entitled to reimbursement of such expenses only for as long as his condition so requires."

    Keywords:

    condition; incapacity; insurance benefit; professional accident; service-incurred;

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