JUDGMENT OF THE COURT OF FIRST INSTANCE (First Chamber)

30 May 1995

Case T-556/93

Monique Saby

v

Commission of the European Communities

‛Officials — Accident and occupational disease — Reopening of accident file and full reimbursement of medical expenses’

Full text in French II-375

Application for:

first, annulment of the Commission's decision dismissing the complaint lodged by the applicant seeking the reopening of her accident file and reimbursement in full of the medical and paramedical expenses arising from the treatment necessary for her recovery and rehabilitation, together with default interest, and, in the alternative, the setting up of a new Medical Committee to rule on the causal relationship between the treatment concerned and the accident justifying reimbursement in full of the relevant medical and paramedical expenses and the securing of the allowance under Article 73 of the Staff Regulations.

Decision:

Application dismissed.

Abstract of the Judgment

On 30 May 1983, the applicant informed the Commission that she had been a victim of an accident in her home and the authorities subsequently opened an accident file.

On 18 April 1990, the applicant requested the Commission to reopen her accident file on the basis of a medical certificate drawn up by her doctor.

On 1 October 1991, after the Commission's doctor had given a favourable opinion, the appointing authority notified the applicant of a draft decision under Article 21 of the Rules on the Insurance of Officials of the European Communities Against the Risk of Accident and of Occupational Disease (‘the Rules’) according to which the applicant's bodily health had been restored as completely as possible. The medical expenses incurred after the date of consolidation of the sequellae of her accident could therefore only be covered, save in exceptional circumstances, by the provisions relating to sickness cover. It also informed her that she could request consultation with the Medical Committee, failing which the draft decision would become definitive.

As part of the new job which she has held since 1 July 1991, the applicant is obliged to cany heavy objects, although several medical certificates note that doing so is contraindicated.

On 19 November 1991, the applicant requested that the matter come before the Medical Committee. The Committee delivered its medical report on 8 December 1992 and concluded that ‘it is not necessary to reopen the file because there are no new facts relating to the original injuries previously regarded as sequellae’ and that‘the applicant's current complaints are probably attributable to her conditions of work’.

On 5 February 1993, the appointing authority informed the applicant that the draft decision of 1 October 1991 had become definitive.

On 15 April 1993, the head of the Sickness and Accident Insurance unit informed the applicant that a claim she had made on 2 March 1993 concerning the reimbursement in full of the expenses incurred in recovering her health had been rejected pursuant to Article 10 of the Rules. He also drew attention to the possibility of lodging a request for recognition of an occupational disease.

On 3 May 1993, the applicant lodged a complaint against the decision of 5 February 1993.

On 1 June 1993, the head of the Sickness and Accident Insurance Unit informed the applicant that, following her complaint, his department had carried out an investigation with a view to obtaining evidence of the nature and occupational origin of her condition.

On 3 August 1993, the appointing authority dismissed the applicant's complaint in so far as it concerned the reopening of her accident file and her claim for reimbursement in full of the expenses incurred in recovering her health and confirmed that it had granted her request that the procedure for recognition of an occupational disease be opened.

Admissibility

New claims formulated for the first time in the reply are inadmissible. However, in this case, since the claims in the application relating to the annulment of the Commission's decision of 3 August 1993 were directed against the Commission's refusal to reopen the applicant's accident file, they also concern the reimbursement of the medical and paramedical expenses for the recovery of the applicant's health, in the context of that file, and the payment of default interest thereon (paragraph 28).

See: T-28/90 Asia Motor France and Others v Commission [1992] ECR II-2285, paras 43 and 44: T-87/91 Boessen v Economic and Social Committee [1993] BCR II-235, para. 36

It follows that the heads of claim in the reply which simply seek reimbursement of the expenses incurred solely in the context of the applicant's accident file and the payment of default interest thereon are not new claims and must be held to be admissible.

With regard to the claims seeking the establishment of a new Medical Committee, they are inadmissible since it is not for the Court to address instructions to institutions or to substitute itself for them (paragraph 30).

See: 2/87 Biedermann v Court of Auditors [1988] ECR 143, para. 6; T-19/90 Von Hoessle v Court of Auditors [1991] ECR II-615, para. 30

Substance

The first plea in law: the Medical Committee's conclusions were unlawful and the contested decision f ailed to take them into account

Medical appraisals properly so called prepared by the Medical Committee must be considered definitive provided that they are adopted in accordance with the correct procedure and review by the Court is confined to questions concerning the proper constitution and functioning of such committees and the lawfulness of their reports. The Court has jurisdiction to determine whether the report contains reasons enabling the reader to assess the considerations on which the conclusions were based and whether it has established a comprehensible link between the medical findings which it contains and the conclusions which it draws (paragraph 35).

See: 156/80 Morbelli v Commission [1981] ECR 1357, paras 18 and 20; 257/81 K. v Council [1983] ECR 1. para. 17; 265/83 Suss v Commission [1984] ECR 4029, paras 9 to 15; 277/84 Jänsch v Commission [ 1987] ECR 4923, para. 15; T-l54/89 Vidrányi v Commission [1990] ECR II-445, para. 8; T-122/89 F. v Commission [1990] ECR II-517, paras 14 to 16; C-185/90 P Commission v Gill [1991] ECR I-4779, para. 24; T-165/89 Plug v Commission [1992] ECR II-367; T-88/91 F. v Commission [1993] ECR II-13, para. 39; Biedermann v Court of Auditors, cited above, para. 8

There is a comprehensible link between the Medical Committee's medical findings with regard to the applicant's state of health and the conclusions it reached on that subject, the Medical Committee's conclusions were properly reached and must therefore be regarded as final and the disputed decision correctly interpreted the Medical Committee's conclusions without substituting its own appraisal for the Committee's medical appraisal (paragraphs 41 to 43).

See: T-1/92 Tallarico v Parliament [1993] ECR II-107, paras 65 and 66

The second plea: infringement of Article 10 of the Rules

Article 10 of the Rules cannot mean that an official who is an accident victim may at any time, even after consolidation of his injuries, request that his file be reopened, pursuant to Article 22 of the Rules, if injuries become apparent or pain occurs and his doctor establishes that there is a causal link between them and the accident. Such an interpretation disregards the fact that an accident or occupational disease may be established, in accordance with Article 19 of the Rules, only by decision of the appointing authority after notification to the party concerned or those entitled under him pursuant to Article 21 of the Rules of a draft decision, followed if relevant by the establishment at that party's request of a medical committee (paragraph 50).

The claim for default interest is ancillary to and depends on the outcome of the principal claim for reimbursement of the medical and paramedical expenses (paragraph 53).

See: 314/86 and 315/86 De Szy-Tarisse and Feyaerts v Commission [1988] ECR 6013, para. 37; T-8/90 Colmant v Commission [1992] ECR II-469, para. 46

Operative part:

The application is dismissed.