Judgment;Judgment (extracts);Abstract — ECLI:EU:T:2021:367
Date: 2021-06-16
Language of the case: Italian
Court formation: Fourth Chamber
Based on: Merger Treaty (1965)
Subject matter: Staff regulations and employment conditions - EC
Procedure: Staff cases - unfounded;Staff cases - inadmissible;Action for damages - unfounded

Summary of the pleas relied upon – No clear identification of the document designed to modify the subject matter of the application – Inadmissibility (Rules of Procedure of the General Court, Art. 86(3)) (see paragraphs 70-73) 3. Officials – Social security – Insurance against the risk of accident and of occupational disease – Reimbursement of costs – Refusal decision – Applicability of the procedure relating to decisions recognising the occupational origin of the disease or accident – Exclusion (Rules on insurance against the risk of accident and of occupational disease, Arts 9(1), 18 and 23) (see paragraphs 106-110) 4. Officials – Social security – Insurance against the risk of accident and of occupational disease – Reimbursement of costs – Refusal decision – Use of the procedure for consulting another doctor – Appointment procedure – Obligation of the administration to find a solution in the event of disagreement between the insured party and the doctor appointed by the administration – Limits – Application by analogy of the rule for appointing the third doctor – Exclusion (Rules on insurance against the risk of accident and of occupational disease, Arts 22 and 23) (see paragraphs 111-128) 5. Officials – Social security – Insurance against the risk of accident and of occupational disease – Reimbursement of costs – Refusal decision – Use of the procedure for consulting another doctor – Obligation of the other doctor to issue a valid opinion – Scope (Rules on insurance against the risk of accident and of occupational disease, Arts 22 and 23) (see paragraphs 130-134) 6. Actions brought by officials – Subject matter – Decision based on several pillars of reasoning, each sufficient to justify the operative part – Annulment – Conditions (Staff Regulations, Arts 90 and 91) (see paragraph 136) Résumé The applicant, Arnaldo Lucaccioni, worked as an official at the European Commission from 1962. During his tenure at the Commission building, the Berlaymont, in Brussels (Belgium), he was exposed to asbestos dust and fibres. In 1991, the applicant retired and was granted an invalidity pension. Subsequently, the Commission recognised the occupational origin of the applicant’s disease (lung damage) in accordance with Article 73 of the Staff Regulations of Officials of the European Union (‘Staff Regulations’), and found that he had a 100% total permanent invalidity. In 2016, the applicant applied to the appointing authority for reimbursement of expenses related to dental treatment. In a draft decision, the appointing authority intended to dismiss that claim on the ground that the medical costs could not be reimbursed as part of the applicant’s occupational disease. The appointing authority relied, in that regard, on the findings contained in the reports of the specialist doctor consulted on its own initiative. Since he disagreed with the draft decision, the applicant asked that another doctor be consulted, pursuant to the first subparagraph of Article 23(1) of the Rules on insurance. (1) However, although several candidates were proposed by the doctor appointed by the appointing authority and by the doctor appointed by the applicant in order to agree on the appointment of ‘another doctor’, as required by the aforementioned article, those two doctors failed to reach an agreement. The director of the Commission’s Office for Administration and Payment of Individual Entitlements (PMO) called on the President of the Court of Justice of the European Union to appoint a doctor of his own motion, applying, by analogy, the second subparagraph of Article 22(1) of the aforementioned rules. That request did not lead to the appointment of a doctor by the President of the Court of Justice. Subsequently, the applicant asked the appointing authority to apply the whole of the procedure laid down in Article 22 of the Rules on insurance concerning consultation of a Medical Committee. As the appointing authority rejected that request, the applicant brought an action before the General Court for annulment of the decision refusing to refer the case to the Medical Committee. The General Court dismisses the action and for the first time interprets the procedure applicable for appointing ‘another doctor’ within the meaning of Article 23 of the Rules on insurance, in order to resolve a disagreement between the doctor appointed by the appointing authority and the doctor appointed by the insured party, both of whom have the task of appointing that ‘other doctor’. Assessment of the General Court The General Court points out, in the first place, that the Rules on insurance clearly distinguish between two situations concerning the review of a draft decision to be adopted following consultation of the doctor appointed by the appointing authority. In the first situation, if the insured party so requests, the decision is adopted following consultation of the Medical Committee in accordance with Article 18, second indent, of the Rules on insurance. In the second situation, the insured party may request that ‘another doctor’ be consulted for his opinion, in cases other than those referred to in Article 18 of those rules. It follows from those provisions that decisions adopted in connection with a claim for reimbursement of costs, in accordance with Article 9(1) of the Rules on insurance, do not fall within the material scope of Article 18 of the Rules on insurance. That article relates to ‘decisions recognising the accidental cause of an occurrence, be it an occurrence attributed to occupational or non-occupational risks, and decisions linked thereto, recognising the occupational nature of the disease or assessing the degree of permanent invalidity’. Since those terms are clear, they cannot be interpreted as including decisions relating to claims for reimbursement of costs within the meaning of Article 9(1) of the Rules on insurance. Therefore, decisions adopted under Article 9(1) of the Rules on insurance concern situations which are different from those covered by Article 18 thereof and are governed by the procedure described in Article 23. Consequently, Article 22 of the Rules on insurance does not apply to decisions relating to a reimbursement of medical costs. In the second place, the General Court held that to accept that, failing agreement between the doctor appointed by the appointing authority and the doctor appointed by the insured party in respect of the appointment of the ‘other doctor’, it is necessary to use the procedure laid down by the second subparagraph of Article 22(1) of the Rules on insurance would risk altering the scope of the consultation procedure as initially envisaged by its drafters. Moreover, as is apparent from the preamble to the Rules on insurance, the institutions, not the General Court, are responsible for drawing up by agreement rules on insurance and, consequently, for laying down, if appropriate, such procedure or making an explicit reference to the second subparagraph of Article 22(1) of the Rules on insurance. Since the institutions have not expressly provided for the President of the Court of Justice to appoint the ‘other doctor’ of his own motion, or indicated their agreement to that application by analogy, it is not for the General Court to impose it by judicial decision. In that regard, the General Court cannot disregard the clear and precise wording of a provision which provides only for the possibility of appointing ‘another doctor’ chosen by mutual agreement by the doctor appointed by the appointing authority and the doctor appointed by the insured party. Consequently, the Commission cannot apply, by analogy to the situation in this case, the second subparagraph of Article 22(1) of the Rules on insurance. In the third place, the Court concludes that the Commission cannot invoke the duty to have regard for the welfare of officials to justify the application by analogy of the rule for appointing the third doctor laid down by the second subparagraph of Article 22(1) of the Rules on insurance, since the first subparagraph of Article 23(1) of those rules precludes such application and, moreover, is not incompatible with any general legal principle. In the fourth place, the Court holds that the investigation procedure and the review procedure, as governed by Article 23 of the Rules on insurance, provide adequate guarantees concerning respect for the applicant’s rights of defence in connection with the examination of his claim for reimbursement of costs, so he cannot demand the appointment of a Medical Committee to ensure respect for those rights. Finally, the Court concludes that, where there is disagreement between the doctor appointed by the appointing authority and the doctor appointed by the insured party, both of whom have the task of appointing ‘another doctor’, the appointing authority cannot apply by analogy the provisions of Article 22 of those rules. Accordingly, it can neither consult the Medical Committee, nor appoint the ‘other doctor’ by applying the procedure for the appointment of the third doctor by the President of the Court of Justice of his own motion, a procedure laid down by the second subparagraph of Article 22(1) of those rules, only for the purpose of constituting such a committee. 1 Common rules on the insurance of officials of the European Communities against the risk of accident and of occupational disease, adopted on 13 December 2005 by the EU institutions pursuant to Article 73 of the Staff Regulations of Officials of the European Union (‘Rules on insurance’).