61978CJ0182_EN
Parties
Subject of the case
Grounds
Decision on costs
Operative part
Parties
IN CASE 182/78,
REFERENCE TO THE COURT UNDER ARTICLE 177 OF THE EEC TREATY BY THE CENTRALE RAAD VAN BEROEP ( COURT OF LAST INSTANCE IN SOCIAL SECURITY MATTERS ) FOR A PRELIMINARY RULING IN THE ACTION PENDING BEFORE THAT COURT BETWEEN
BESTUUR VAN HET ALGEMEEN ZIEKENFONDS ( MANAGERS OF THE GENERAL SICKNESS FUND ) DRENTHE-PLATTELAND, ZWOLLE,
AND
MRS G . PIERIK, WAPENVELD,
Subject of the case
ON THE INTERPRETATION OF THE PROVISIONS OF REGULATION NO 1408/71 OF THE COUNCIL RELATING TO THE RIGHT OF ' ' PENSIONERS ' '
TO RECEIVE TREATMENT APPROPRIATE TO THEIR STATE OF HEALTH IN THE TERRITORY OF A MEMBER STATE OTHER THAN THE ONE IN WHICH THEY RESIDE,
Grounds
1BY AN ORDER OF 18 JULY 1978 SENT TO THE COURT WITH A COVERING LETTER OF 8 SEPTEMBER 1978 FROM THE ACTING PRESIDENT OF THE CENTRALE RAAD VAN BEROEP AND RECEIVED AT THE REGISTRY ON 11 SEPTEMBER 1978, THE CENTRALE RAAD SUBMITTED CERTAIN QUESTIONS TO THE COURT FOR A PRELIMINARY RULING UNDER ARTICLE 177 OF THE EEC TREATY ON THE INTERPRETATION OF REGULATION NO 1408/71 OF THE COUNCIL OF 14 JUNE 1971 ON THE APPLICATION OF SOCIAL SECURITY SCHEMES TO EMPLOYED PERSONS AND THEIR FAMILIES MOVING WITHIN THE COMMUNITY ( OFFICIAL JOURNAL, ENGLISH SPECIAL EDITION 1971 ( II ), P . 416 ). THESE QUESTIONS WERE SUBMITTED IN A CASE IN CONNEXION WITH WHICH THE SAME NATIONAL COURT HAD REFERRED CERTAIN QUESTIONS TO THE COURT ON THE INTERPRETATION OF THE AFORESAID REGULATION BY A LETTER FROM ITS PRESIDENT LODGED AT THE REGISTRY ON 30 SEPTEMBER 1977 .
2THE COURT ANSWERED THOSE QUESTIONS IN ITS JUDGMENT OF 16 MARCH 1978 ( CASE 117/77 ( 1978 ) ECR 825 ), BUT THE NATIONAL COURT FOUND THAT IT COULD NOT REGARD ALL THE ISSUES IN THE MAIN ACTION AS BEING SETTLED BY THAT JUDGMENT . THUS CONTINUING THE PROCEEDINGS IN THE MAIN ACTION, THE SAID COURT HELD INTER ALIA THAT, IN SO FAR AS REGULATION NO 1408/71 WAS CONCERNED, THE DECISION IN THE CASE WAS STILL DEPENDENT UPON THE ANSWER TO THE FOLLOWING QUESTIONS :
' ' ( A ) IS THE CONCEPT OF WORKER IN ARTICLE 22 OF REGULATION NO 1408/71 MORE RESTRICTED THAN THE CONCEPT OF WORKER WITHIN THE MEANING OF ARTICLE 1 ( A ) OF THE REGULATION INASMUCH AS ARTICLE 22 RELATES SOLELY TO ACTIVE WORKERS, SO THAT, WITH REGARD TO PERSONS WHO ARE NOT, OR ARE NO LONGER, AT WORK AND ARE ENTITLED TO A BENEFIT ON THE GROUNDS OF INVALIDITY, DUE BY VIRTUE OF THE LEGISLATION OF A MEMBER STATE, AND WHO BY VIRTUE OF THE LEGISLATION OF THAT MEMBER STATE TO WHICH THE REGULATION IS APPLICABLE IN THE MATTER OF MEDICAL TREATMENT AND SPECIAL SICKNESS EXPENSES ARE ENTITLED TO BENEFITS IN KIND, ONLY THE PROVISIONS OF ARTICLE 31 ARE APPLICABLE?
( B)DOES THE OBLIGATION REFERRED TO IN THE SECOND SUBPARAGRAPH OF ARTICLE 22 ( 2 ) OF REGULATION NO 1408/71 TO GRANT THE AUTHORIZATION REQUIRED UNDER ARTICLE 22 ( 1 ) ( C ) EXTEND SO FAR THAT THE SAID AUTHORIZATION CANNOT BE REFUSED BY THE COMPETENT INSTITUTION ON THE BASIS OF THE FACT THAT THE TREATMENT IN QUESTION IS DELIBERATELY NOT INCLUDED IN THE SCHEME OF BENEFITS IN KIND UNDER THE SICKNESS AND MATERNITY LEGISLATION ADMINISTERED BY THAT INSTITUTION, FOR EXAMPLE ON MEDICAL, MEDICAL-ETHICAL OR FINANCIAL GROUNDS OR BECAUSE THE VALUE OF THE TREATMENT IN QUESTION IN THE MEMBER STATE IN WHICH THE COMPETENT INSTITUTION HAS ITS SEAT IS IN GENERAL NOT REGARDED AS POSITIVE OR BECAUSE THE TREATMENT IS NOT REGARDED AS FALLING WITHIN THE FIELD OF HEALTH TREATMENT AND FURTHERMORE IS DELIBERATELY NOT PROVIDED BY VIRTUE OF ANY OTHER LEGISLATION OF THAT MEMBER STATE TO WHICH THE REGULATION IS APPLICABLE?
( C)DO THE WORDS ' BENEFITS IN KIND PROVIDED ON BEHALF OF THE COMPETENT INSTITUTION BY THE INSTITUTION OF THE PLACE OF STAY OR RESIDENCE '
IN ARTICLE 22 ( 1 ) ( C ) ( I ) RELATE DIRECTLY TO THE CASE IN WHICH THE INSTITUTION OF THE MEMBER STATE TO WHICH THE PERSON CONCERNED WISHES TO GO IN ORDER TO UNDERGO TREATMENT IS COMPETENT TO PROVIDE THAT TREATMENT AS A BENEFIT IN KIND BUT IS NORMALLY NOT OBLIGED TO MAKE USE OF SUCH COMPETENCE, OR MUST THE COMPETENT INSTITUTION IN SUCH A SITUATION, BEFORE PROVIDING THE AUTHORIZATION REQUESTED, INQUIRE WHETHER THE INSTITUTION OF THE MEMBER STATE TO WHICH THE PERSON CONCERNED WISHES TO GO IN ORDER TO UNDERGO THE TREATMENT WOULD PROVIDE SUCH TREATMENT AS A BENEFIT IN KIND FOR THE PERSON CONCERNED IF HE WERE INSURED IN PURSUANCE OF THE LEGISLATION ADMINISTERED BY THAT INSTITUTION?
' '
3IN THE FIRST QUESTION THE NATIONAL COURT SEEKS ESSENTIALLY TO ASCERTAIN WHETHER THE PROVISIONS OF ARTICLE 22 OF REGULATION NO 1408/71, GOVERNING THE RIGHT OF A ' ' WORKER ' '
TO BENEFITS IN KIND, ALSO COVER A PENSIONER ' ' WHO IS NOT, OR IS NO LONGER, AT WORK ' '
AND WHO ASKS THE COMPETENT INSTITUTION FOR AUTHORIZATION TO GO TO A MEMBER STATE OTHER THAN THE ONE WHERE HE RESIDES TO RECEIVE THERE THE TREATMENT APPROPRIATE TO HIS STATE OF HEALTH .
4ARTICLE 1 ( A ) OF REGULATION NO 1408/71 DEFINES THE CONCEPT OF ' ' WORKER ' '
AS ANY PERSON WHO IS COMPULSORILY OR VOLUNTARILY INSURED UNDER ONE OF THE SOCIAL SECURITY SCHEMES REFERRED TO IN SUBPARAGRAPHS ( I ), ( II ) OR ( III ) OF THAT PROVISION . LAID DOWN ' ' FOR THE PURPOSE OF THIS REGULATION ' ', SUCH A DEFINITION HAS A GENERAL SCOPE, AND IN THE LIGHT OF THAT CONSIDERATION COVERS ANY PERSON WHO HAS THE CAPACITY OF A PERSON INSURED UNDER THE SOCIAL SECURITY LEGISLATION OF ONE OR MORE MEMBER STATES, WHETHER OR NOT HE PURSUES A PROFESSIONAL OR TRADE ACTIVITY . IT FOLLOWS THAT, EVEN IF THEY DO NOT PURSUE A PROFESSIONAL OR TRADE ACTIVITY, PENSIONERS ENTITLED TO DRAW PENSIONS UNDER THE LEGISLATION OF ONE OR MORE MEMBER STATES COME WITHIN THE PROVISIONS OF THE REGULATION CONCERNING ' ' WORKERS ' '
BY VIRTUE OF THEIR INSURANCE UNDER A SOCIAL SECURITY SCHEME, UNLESS THEY ARE SUBJECT TO SPECIAL PROVISIONS LAID DOWN REGARDING THEM .
5ARTICLES 27 TO 33 IN TITLE III, CHAPTER 1, SECTION 5 OF REGULATION NO 1408/71 LAY DOWN SPECIAL PROVISIONS CONCERNING ' ' PENSIONERS AND MEMBERS OF THEIR FAMILIES ' ' . BY VIRTUE OF ARTICLE 34, THESE PROVISIONS APPLY EXCLUSIVELY TO PENSIONERS WHO ARE ENTITLED TO BENEFITS IN KIND OTHERWISE THAN AS A RESULT OF PURSUING A PROFESSIONAL OR TRADE ACTIVITY, THUS COVERING INACTIVE PENSIONERS .
6HOWEVER, ARTICLE 31 OF THESE PROVISIONS GOVERNS THE ENTITLEMENT OF SUCH INSURED PERSONS TO BENEFITS IN KIND WHERE THOSE BENEFITS BECOME NECESSARY DURING A STAY IN A MEMBER STATE OTHER THAN THE ONE IN WHICH THEY RESIDE . ON THE OTHER HAND, THE ENTITLEMENT TO BENEFITS IN KIND OF AN INSURED PERSON WHO RESIDES IN ONE MEMBER STATE AND ASKS THE COMPETENT INSTITUTION FOR AUTHORIZATION TO GO TO THE TERRITORY OF ANOTHER MEMBER STATE TO RECEIVE THERE THE TREATMENT APPROPRIATE TO HIS CONDITION IS GOVERNED BY ARTICLE 22 ( 1 ) ( C ) IN THE SAME CHAPTER .
7BY THE REFERENCE TO A ' ' WORKER ' '
IN THE LATTER PROVISION, REGULATION NO 1408/71 DOES NOT PURPORT TO RESTRICT THE SCOPE OF THAT PROVISION TO ACTIVE WORKERS AS OPPOSED TO INACTIVE WORKERS, THE SAME REFERENCE BEING CONTAINED IN ARTICLES 25 AND 26 IN THE SAME CHAPTER, WHICH RESPECTIVELY CONCERN ' ' UNEMPLOYED PERSONS ' '
AND ' ' PENSION CLAIMANTS ' ' .
8FOR THESE REASONS THE ANSWER TO THE FIRST QUESTION SHOULD THEREFORE BE THAT, IN THE CASE OF A PENSIONER WHO IS ENTITLED TO BENEFITS IN KIND UNDER THE LEGISLATION OF A MEMBER STATE AND WHO DOES NOT PURSUE A PROFESSIONAL OR TRADE ACTIVITY, THE RIGHT TO BE AUTHORIZED BY THE COMPETENT INSTITUTION TO GO TO ANOTHER MEMBER STATE TO RECEIVE THERE THE TREATMENT APPROPRIATE TO HIS CONDITION IS GOVERNED BY THE PROVISIONS OF ARTICLE 22 ( 1 ) ( C ) AND ( 2 ) OF REGULATION NO 1408/71 .
9AS TO THE SECOND QUESTION, IN ITS AFORESAID JUDGMENT OF 16 MARCH 1978 IN CASE 117/77 THE COURT HELD THAT, ' ' THE DUTY LAID DOWN IN THE SECOND SUBPARAGRAPH OF ARTICLE 22 ( 2 ) TO GRANT THE AUTHORIZATION REQUIRED UNDER ARTICLE 22 ( 1 ) ( C ) COVERS BOTH CASES WHERE THE TREATMENT PROVIDED IN ANOTHER MEMBER STATE IS MORE EFFECTIVE THAN THAT WHICH THE PERSON CONCERNED CAN RECEIVE IN THE MEMBER STATE WHERE HE RESIDES AND THOSE IN WHICH THE TREATMENT IN QUESTION CANNOT BE PROVIDED ON THE TERRITORY OF THE LATTER STATE ' ' .
10IN PARAGRAPH 15 OF THE DECISION IN THAT CASE IT WAS ALSO HELD THAT BENEFITS IN KIND FOR WHICH THE WORKER IS AUTHORIZED TO GO TO ANOTHER MEMBER STATE ' ' COVER ALL TREATMENT CALCULATED TO BE EFFECTIVE FOR THE SICKNESS OR DISEASE FROM WHICH THE PERSON CONCERNED SUFFERS ' ', AND IN PARAGRAPH 16 IT WAS HELD TO FOLLOW THAT, ' ' IN THOSE CIRCUMSTANCES IT IS OF LITTLE IMPORTANCE WHETHER THE BENEFIT IN KIND WHICH THE WORKER REQUIRES CAN BE PROVIDED ON THE TERRITORY OF THE MEMBER STATE WHERE HE RESIDES SINCE THE MERE FACT THAT THAT BENEFIT CORRESPONDS TO TREATMENT MORE APPROPRIATE TO THE STATE OF HEALTH OF THE PERSON CONCERNED IS DECISIVE FOR THE PURPOSE OF ISSUING THE AUTHORIZATION REFERRED TO IN THE ABOVE-MENTIONED PARAGRAPH ( 1 ) ( C ) ' ' . IN SETTING A LIMIT TO THE COMPETENT INSTITUTION ' S POWER OF DECISION IN THIS AREA, PARAGRAPH 17 OF THE SAID DECISION IMPLICITLY ACKNOWLEDGES THAT IT IS FOR THAT INSTITUTION OBJECTIVELY TO ASSESS THE MEDICAL GROUNDS FOR GRANTING OR REFUSING THE AUTHORIZATION REQUIRED UNDER ARTICLE 22 ( 1 ) ( C ), HAVING REGARD INTER ALIA TO THE STATE OF HEALTH OF THE PERSON CONCERNED, THE SERIOUSNESS OF HIS SICKNESS OR DISEASE AND THE EFFECTIVENESS OF THE TREATMENT IN QUESTION .
11WHEN THE COMPETENT INSTITUTION, HAVING MADE USE OF SUCH POWER, ACKNOWLEDGES THAT THE TREATMENT IN QUESTION CONSTITUTES AN EFFECTIVE TREATMENT OF THE SICKNESS OR DISEASE FROM WHICH THE PERSON CONCERNED SUFFERS, ITS POWER OF DECISION IS THUS BOUND BY THE OBLIGATION CLEARLY AND UNEQUIVOCALLY IMPOSED UPON IT BY THE SECOND SUBPARAGRAPH OF ARTICLE 22 ( 2 ) OF THE REGULATION NOT TO REFUSE IN THAT CASE THE AUTHORIZATION REQUIRED UNDER ARTICLE 22 ( 1 ) ( C ).
12IN FACT IT EMERGES FROM THE PROVISIONS AND THE ESSENTIAL AIMS OF ARTICLE 22 THAT IT WAS THE INTENTION OF THE REGULATION TO GIVE MEDICAL REQUIREMENTS A DECISIVE ROLE IN THE DECISION OF THE COMPETENT INSTITUTION TO GRANT OR REFUSE THE AFORESAID AUTHORIZATION BY PROVIDING GENERALLY AND UNRESERVEDLY IN THE SECOND SUBPARAGRAPH OF ARTICLE 22 ( 2 ) THAT AUTHORIZATION MAY NOT BE REFUSED ' ' WHERE THE TREATMENT IN QUESTION CANNOT BE PROVIDED FOR THE PERSON CONCERNED WITHIN THE TERRITORY OF THE MEMBER STATE IN WHICH HE RESIDES ' ' .
13THUS THE ANSWER TO THE SECOND QUESTION SHOULD BE THAT, WHEN THE COMPETENT INSTITUTION ACKNOWLEDGES THAT THE TREATMENT IN QUESTION CONSTITUTES A NECESSARY AND EFFECTIVE TREATMENT OF THE SICKNESS OR DISEASE FROM WHICH THE PERSON CONCERNED SUFFERS, THE CONDITIONS FOR THE APPLICATION OF THE SECOND SUBPARAGRAPH OF ARTICLE 22 ( 2 ) OF REGULATION NO 1408/71 ARE FULFILLED AND THE COMPETENT INSTITUTION MAY NOT IN THAT CASE REFUSE THE AUTHORIZATION REFERRED TO BY THAT PROVISION AND REQUIRED UNDER ARTICLE 22 ( 1 ) ( C ).
14FINALLY AS TO THE THIRD QUESTION, IT IS ESTABLISHED - AS THE COURT HELD IN ITS AFORESAID JUDGMENT OF 16 MARCH 1978 IN CASE 117/77 - THAT BY VIRTUE OF THE PROVISIONS OF ARTICLES 93 ( 1 ) AND 96 OF REGULATION NO 574/72 OF THE COUNCIL OF 21 MARCH 1972 FIXING THE PROCEDURE FOR IMPLEMENTING REGULATION NO 1408/71 ( OFFICIAL JOURNAL, ENGLISH SPECIAL EDITION 1972 ( I ), P . 159 ) THE AMOUNT OF BENEFITS PROVIDED UNDER ARTICLE 22 OF REGULATION NO 1408/71 ' ' SHALL BE REFUNDED BY THE COMPETENT INSTITUTION TO THE INSTITUTION WHICH PROVIDED THE SAID BENEFITS AS SHOWN IN THE ACCOUNTS OF THAT INSTITUTION ' ', AND MOREOVER THAT IT IS TO BE ' ' FULLY ' '
REFUNDED .
15IT FOLLOWS THAT, SINCE THE COSTS RELATING TO THE TREATMENT IN QUESTION ARE CHARGEABLE TO THE COMPETENT INSTITUTION WHICH GRANTED THE AUTHORIZATION, THE INSTITUTION OF THE MEMBER STATE TO WHICH THE PERSON CONCERNED GOES TO RECEIVE THE TREATMENT IS REQUIRED TO PROVIDE IT UPON PRESENTATION OF SUCH AN AUTHORIZATION EVEN IF, UNDER THE LEGISLATION WHICH IT ADMINISTERS, IT DOES NOT HAVE A DUTY BUT ONLY HAS A POWER TO GRANT IT .
16FOR THESE REASONS THE ANSWER TO THE THIRD QUESTION SHOULD BE THAT THE EXPRESSION ' ' BENEFITS IN KIND PROVIDED ON BEHALF OF THE COMPETENT INSTITUTION BY THE INSTITUTION OF THE PLACE OF STAY OR RESIDENCE ' '
IN ARTICLE 22 ( 1 ) ( C ) ( I ) OF REGULATION NO 1408/71 REFERS TO ANY BENEFIT WHICH THE INSTITUTION OF THE MEMBER STATE TO WHICH THE PERSON CONCERNED GOES AFTER OBTAINING THE AUTHORIZATION REFERRED TO IN ARTICLE 22 ( 1 ) ( C ) HAS THE POWER TO GRANT, EVEN IF IT IS NOT REQUIRED TO PROVIDE THEM UNDER THE LEGISLATION WHICH IT ADMINISTERS .
Decision on costs
COSTS
17THE COSTS INCURRED BY THE GOVERNMENTS OF THE KINGDOM OF BELGIUM, THE KINGDOM OF THE NETHERLANDS AND THE UNITED KINGDOM, AS WELL AS BY THE COMMISSION OF THE EUROPEAN COMMUNITIES, WHICH HAVE SUBMITTED OBSERVATIONS TO THE COURT, ARE NOT RECOVERABLE . AS THESE PROCEEDINGS ARE, IN SO FAR AS THE PARTIES TO THE MAIN ACTION ARE CONCERNED, IN THE NATURE OF A STEP IN THE ACTION PENDING BEFORE THE NATIONAL COURT, THE DECISION ON COSTS IS A MATTER FOR THAT COURT .
Operative part
ON THOSE GROUNDS,
THE COURT
IN ANSWER TO THE QUESTIONS SUBMITTED TO IT BY AN ORDER OF THE CENTRALE RAAD VAN BEROEP OF 18 JULY 1978, SENT TO THE COURT WITH A COVERING LETTER OF 8 SEPTEMBER 1978 BY THE ACTING PRESIDENT OF THAT COURT, HEREBY RULES :
1 . IN THE CASE OF A PENSIONER WHO IS ENTITLED TO BENEFITS IN KIND UNDER THE LEGISLATION OF A MEMBER STATE AND WHO DOES NOT PURSUE A PROFESSIONAL OR TRADE ACTIVITY, THE RIGHT TO BE AUTHORIZED BY THE COMPETENT INSTITUTION TO GO TO ANOTHER MEMBER STATE TO RECEIVE THERE THE TREATMENT APPROPRIATE TO HIS CONDITION IS GOVERNED BY THE PROVISIONS OF ARTICLE 22 ( 1 ) ( C ) AND ( 2 ) OF REGULATION NO 1408/71 .
2 . WHEN THE INSTITUTION ACKNOWLEDGES THAT THE TREATMENT IN QUESTION CONSTITUTES A NECESSARY AND EFFECTIVE TREATMENT OF THE SICKNESS OR DISEASE FROM WHICH THE PERSON CONCERNED SUFFERS THE CONDITIONS FOR THE APPLICATION OF THE SECOND SUBPARAGRAPH OF ARTICLE 22 ( 2 ) OF REGULATION NO 1408/71 ARE FULFILLED AND THE COMPETENT INSTITUTION MAY NOT IN THAT CASE REFUSE THE AUTHORIZATION REFERRED TO BY THAT PROVISION AND REQUIRED UNDER ARTICLE 22 ( 1 ) ( C ).
3 . THE EXPRESSION ' ' BENEFITS IN KIND PROVIDED ON BEHALF OF THE COMPETENT INSTITUTION BY THE INSTITUTION OF THE PLACE OF STAY OR RESIDENCE ' '
IN ARTICLE 22 ( 1 ) ( C ) ( I ) OF REGULATION NO 1408/71 REFERS TO ANY BENEFIT WHICH THE INSTITUTION OF THE MEMBER STATE TO WHICH THE PERSON CONCERNED GOES AFTER OBTAINING THE AUTHORIZATION REFERRED TO IN ARTICLE 22 ( 1 ) ( C ) HAS THE POWER TO GRANT, EVEN IF IT IS NOT REQUIRED TO PROVIDE THEM UNDER LEGISLATION WHICH IT ADMINISTERS .