Judgment — ECLI:EU:T:2002:271
Date: 2002-11-07
Based on: Merger Treaty (1965)
Subject matter: Staff regulations and employment conditions - EC
Concepts: Principle of the protection of legitimate expectations;Sickness insurance;Obligations of the administration
Procedure: Staff cases - unfounded

SUMMARY — CASE T-199/01 
Summary 
1. Community law - Principles - Protection of legitimate expectations -
Conditions 
2. Officials - Social security - Sickness insurance - Medical expenses -
Reimbursement - Refusal following previous reimbursements granted for identical 
treatments - Treatments considered inefficacious and unnecessary - Breach of the 
principle of the protection of legitimate expectations - None 
(Staff Regulations, Art. 72(1); Rules on Sickness Insurance, Annex I, section XV(3)) 
3. Officials - Social security - Sickness insurance - Medical expenses -
Reimbursement - Conditions - Appraisal of each claim in the light of its own 
merits in fact and in law 
(Staff Regulations, Art. 72(1)) 
4. Officials - Administration's duty to have regard for the interests of officials -
Scope — Limits 
1. The right to claim protection of legitimate expectations presupposes that three 
conditions are satisfied. First, specific, unconditional and consistent assurances 
originating from authorised and reliable sources must have been given to the person 
concerned by the Community administration. Second, those assurances must be such 
as to lead the person to whom they are addressed to entertain a legitimate 
expectation. Third, the assurances given must comply with the relevant rules. 
(see para. 38) 
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G v COMMISSION 
See: T-203/97 Forvass v Commission [1999] ECR-SC I-A-129 and II-705, para. 70. and 
the case-law cited 
2. Even if the approval of claims for reimbursement of medical expenses submitted 
in the past by a member of the Joint Sickness Insurance Scheme of the Community 
institutions (JSIS) constitutes a specific assurance as to the existence of a right to 
future reimbursement for identical treatments, it is obvious that, being contrary to 
the relevant regulations, those assurances cannot give rise to a legitimate 
expectation. 
For the purpose of safeguarding the financial equilibrium of the JSIS, the institutions 
have provided, in the first paragraph of section XV(3) of Annex I to the Rules on 
Sickness Insurance for Officials of the Communities, for the possibility of refusing 
reimbursement of expenses relating to treatments regarded as inefficacious or 
unnecessary. The fact that such a possibility is expressly provided for in the rules 
- which every official knows or is deemed to know - is sufficient in itself to 
preclude a person covered by the JSIS from relying on the existence, with respect 
to himself, of a legitimate expectation as to the automatic reimbursement of his 
medical expenses. Even though a member may reasonably take the view that his 
medical expenses will generally be reimbursed within the limits laid down in 
Article 72(1) of the Staff Regulations, he must nevertheless be aware of the fact that 
reimbursement may be refused by the office responsible for settling claims if, after 
consulting the medical officer, it considers that those expenses relate to an 
inefficacious or unnecessary treatment. Similarly, subsequent developments in 
scientific knowledge may establish that the medicinal preparation for which he has 
obtained reimbursement in the past is not efficacious in treating the pathology from 
which he suffers or that the medicinal preparation in question is efficacious only for 
a particular aspect of that pathology and/or under strict conditions. 
(see paras 41-42) 
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SUMMARY — CASE T-199/01 
See: T-12/94 Daffix v Commission [1997] ECR-SC I-A-453 and II-1197, para. 116 
3. The appointing authority must, for every claim for reimbursement submitted by 
a member of the Joint Sickness Insurance Scheme, determine whether the conditions 
for reimbursement laid down in Article 72(1) of the Staff Regulations are satisfied 
by reference to the matters of fact and of law disclosed by the person concerned, 
without being bound by a previous decision adopted on the basis of different or less 
complete evidence. 
(see para. 43) 
See: T-33/89 and T-74/89 Blackman v Parliament [1993] ECR II-249, para. 82 
4. The duty of the administration to have regard for the interests of its officials 
reflects the balance of the reciprocal rights and obligations established by the Staff 
Regulations in the relationship between a public authority and civil servants. That 
duty implies in particular that when the appointing authority takes a decision 
concerning the situation of an official, it should take into consideration all the 
factors which may affect its decision and that when doing so it should take into 
account not only the interests of the service but also those of the official concerned 
The duty to have regard for the interests of its officials cannot in any circumstances 
require the administration to act in contravention of the relevant provisions. 
However, that would be the case if, although convinced of the inefficacious or 
unnecessary nature of a treatment, the office responsible for settling claims of the 
Joint Sickness Insurance Scheme agreed to reimburse the relevant medical expenses. 
(see paras 67, 71) 
See: Blackman b Parliament, cited above, para. 96; Forvass v Commission, cited above, 
paras 52, 53 and 54 
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