Keywords

Summary



Keywords

1. Officials ° Social security ° Insurance against accidents and occupational diseases ° Dispute about the performance of the collective insurance agreement concluded between the European Communities and the insurers ° Judicial proceedings excluded as regards medical disputes ° Legal disputes ° Pleas

(Staff Regulations, Art. 73; Agreement for collective insurance against accidents and occupational diseases, Art. 5)

2. Officials ° Social security ° Insurance against accidents and occupational diseases ° Obligations of the institution vis-à-vis its officials ° Effect on the insurers' obligations

(Staff Regulations, Art. 73; Agreement for collective insurance against accidents and occupational diseases, Art. 1)

3. Officials ° Social security ° Insurance against accidents and occupational diseases ° Decision likely to give rise to the award of one of the benefits underwritten ° Obligation to notify the draft decision to the insurers before notifying the interested party ° Scope ° Decision adopted after consulting a medical committee ° Excluded

(Staff Regulations, Art. 73; Rules on the Insurance of Officials against the Risk of Accident and of Occupational Disease, Arts 19 and 21; Agreement for collective insurance against accidents and occupational diseases, Art. 3)

4. Officials ° Social security ° Insurance against accidents and occupational diseases ° Medical appraisal ° Judicial review ° Scope ° Dispute on the performance of the collective insurance agreement concluded between the European Communities and the insurers

(Staff Regulations, Art. 73; Agreement for collective insurance against accidents and occupational diseases, Art. 5)

5. Officials ° Social security ° Insurance against accidents and occupational diseases ° Medical appraisal ° Discretion of the medical committee

(Staff Regulations, Art. 73; Rules on the Insurance of Officials against the Risk of Accident and of Occupational Disease, Art. 23)

6. Officials ° Social security ° Allowance for accidents and occupational diseases ° Invalidity pension ° Determination of the rate of invalidity under the invalidity procedure ° Taken into account in the course of the procedure for the grant of the allowance ° Permissibility

(Staff Regulations, Arts 73 and 78; Rules on the Insurance of Officials against the Risk of Accident and of Occupational Disease, Art. 25)

7. Officials ° Social security ° Allowance for accidents and occupational diseases ° Allowance for total permanent invalidity ° Allowance for injury or permanent disfigurement ° Overlapping ° Permissibility

(Staff Regulations, Art. 73(2); Rules on the Insurance of Officials against the Risk of Accident and of Occupational Disease, Arts 12 and 14 and annex)

Summary

1. Since, under the system set up by Article 5 of the Agreement for collective insurance against accidents and occupational diseases concluded between the European Communities and the insurers, the latter renounced recourse to judicial proceedings only in the case of medical disputes, they may still contest the obligation to make reimbursement by raising pleas other than ones of a medical nature even where the appointing authority' s decision relating to the determination of the pecuniary rights of the victim or those entitled under him is consistent with the opinion given by the medical committee and the insurer' s expert was a doctor member of that committee.

2. The stipulations of the Agreement for collective insurance against accidents and occupational diseases concluded between the European Communities and the insurers can have no effect on an institution' s obligations vis-à-vis its officials as laid down by Article 73 of the Staff Regulations and the Rules on the Insurance of Officials against the Risk of Accident and of Occupational Disease. Under that Agreement, the insurers undertook to cover the pecuniary consequences of the obligations under the Staff Regulations only on the terms set out in the Agreement. The possibility of such terms limiting an institution' s ability to obtain reimbursement from the insurers of sums which are due from it by virtue of its obligations under the Staff Regulations is therefore not precluded.

However, the obligations of the insurers may not be substituted for the obligations under the Staff Regulations, thus depriving officials of the particular guarantees secured for them by the Staff Regulations.

The Agreement, which refers to the Communities' obligations under the Staff Regulations as far as the financial risks which the insurers have undertaken to underwrite are concerned, must be interpreted in the light of Article 73 of the Staff Regulations and the Rules, which lay down those obligations, in so far as the stipulations of the Agreement do not exclude such an interpretation.

3. The obligation contained in Article 3(3) of the Agreement for collective insurance against accidents and occupational diseases of 28 January 1977 to notify to the insurers draft decisions likely to give rise to one of the benefits underwritten (medical expenses ° invalidity ° death) before notifying the persons concerned does not apply to decisions adopted following consultation of a medical committee.

4. Judicial review of the regularity of opinions given by a medical committee may not extend to medical appraisals properly so called, which must be considered definitive provided that the conditions in which they are made are regular. In contrast, the regularity of the constitution and functioning of such committees and the regularity of the opinions which they issue are amenable to judicial review. From that point of view, the Court has jurisdiction to examine whether the medical committee' s opinion contains reasons enabling the reader to assess the considerations on which the conclusions which it contains were based and whether it has established a comprehensible link between the medical findings which it contains and the conclusions reached.

It follows that complaints raised by the insurers about the regularity of an opinion issued by a medical committee may be examined in a dispute brought before the Court pursuant to Article 5 of the Agreement for collective insurance against accidents and occupational diseases.

5. Since the task of the medical committee consulted pursuant to Article 23 of the Rules on the Insurance of Officials against the Risk of Accident and of Occupational Disease consists in considering medical questions entirely objectively and independently, it must be allowed complete freedom of appraisal, which means that it is for the committee to decide to what extent account should be taken of medical reports previously drawn up.

6. Under the terms of Article 25 of the Rules on the Insurance of Officials against the Risk of Accident and of Occupational Disease, recognition of total or partial permanent invalidity pursuant to Article 73 of the Staff Regulations and to the Rules is in no way to prejudice application of Article 78 of the Staff Regulations and vice versa. The independence of those two procedures does not preclude the medical committee from taking account, in the context of the procedure provided for by Article 73, of the conclusions arrived at in the procedure provided for in Article 78.

7. Under the system established by Article 73(2)(b) of the Staff Regulations, Articles 12 and 14 of the Rules on the Insurance of Officials against the Risk of Accident and of Occupational Disease and the annex thereto, it is possible for there to be overlapping of the allowance for total permanent invalidity and the allowance for injury or permanent disfigurement which, although not affecting the victim' s capacity for work, constitutes a physical defect and has an adverse effect on his social relations.