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Health insurance (918,-666)
You searched for:
Keywords: Health insurance
Total judgments found: 74
1, 2, 3, 4 | next >
Judgment 5082
140th Session, 2025
European Patent Organisation
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainant challenges the increase in employees’ contribution rate to the healthcare insurance scheme.
Consideration 7
Extract:
Regarding the nature of the amendment, the Tribunal’s case law has drawn a distinction between the right to receive a benefit, such as healthcare and pension, which is a key condition of employment, and the obligation to contribute financially to that benefit, which is ancillary and may change in rate or amount. In Judgment 4028, consideration 13, the Tribunal found that “the change to another health insurance scheme does not affect the staff’s actual right to membership of a social security scheme but concerns solely the terms and conditions for giving effect to this right”. By analogy, there is no vested right for the employees to a particular method of funding insurance benefits. Moreover, in Judgment 4195, consideration 9, concerning the EPO’s decision to increase sickness insurance contributions for employees’ spouses, the Tribunal found that the EPO was entitled to adjust the contribution rates within reasonable limits if there are compelling reasons, including budgetary reasons. The abolition of the ceiling in the present case only involves a potential increase in employees’ contributions, a part of the terms and conditions regarding the complainant’s right to health insurance and does not affect the complainant’s fundamental rights and the entitlement to health insurance.
Reference(s)
ILOAT Judgment(s): 4028, 4195
Keywords:
acquired right; health insurance;
Judgment keywords
Keywords:
acquired right; complaint dismissed; health insurance;
Consideration 4
Extract:
The complainant’s reliance on his acquired rights is misplaced. The abolition of the 2.4 per cent ceiling was part of a broader reform transforming the EPO’s health insurance from a pay-as-you-go scheme to a funded scheme, due to financial reasons.
Keywords:
acquired right; financial considerations; health insurance;
Judgment 5079
140th Session, 2025
European Patent Organisation
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainant contests Administrative Council decision CA/D 7/10, by which the EPO amended Article 83 of the Service Regulations for permanent employees of the European Patent Office, abolishing the ceiling of 2.4 per cent of the basic salary on employees’ healthcare insurance contributions.
Judgment keywords
Keywords:
acquired right; amendment to the rules; complaint dismissed; contribution rate; contributions; health insurance; staff regulations and rules;
Consideration 13
Extract:
In conclusion, the abolition of the 2.4 per cent ceiling on employee contributions has not altered a fundamental and essential term of employment affecting the complainant’s acquired rights. It has not resulted in any adverse effect on the balance of contractual obligations either. It follows that the complainant’s plea alleging a violation of his acquired rights is unfounded.
Keywords:
acquired right; amendment to the rules; contribution rate; contributions; health insurance;
Judgment 5076
140th Session, 2025
European Patent Organisation
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainant challenges the method for making payments into the healthcare insurance fund.
Judgment keywords
Keywords:
complaint dismissed; health insurance; medical insurance;
Judgment 4932
139th Session, 2025
International Telecommunication Union
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainant, a former staff member of ITU, challenges its alleged refusal to take steps to ensure that the organization’s insurers would cover his daughter’s medical expenses and his own non-medical expenses, as well as the lack of response to his requests for clarifications related to his health care contributions.
Considerations 4 and 6
Extract:
It is appropriate to recall the Tribunal’s case law on the role of international organizations with regard to disputes between staff members and insurance companies chosen by the organizations within the framework of collective insurance plans. In a case where an international organization submitted that a dispute between the staff member and the insurance company did not concern the organization itself, the Tribunal held that international civil servants’ social protection forms an integral part of their terms of employment, which are the responsibility of the organization for which they work. For this reason, where an organization entrusts the responsibility for providing social protection to a private insurance company, as was the case when ITU implemented the CMIP, the organization has a duty to ensure that the insurer correctly processes the claims submitted by the insured persons. In this situation, the organization is in fact liable for the acts of its insurer (see Judgment 3506, consideration 9; see also Judgments 3031, considerations 14, 18 and 19, and 2063, consideration 8). In such a case, the matter raised by the complainant is not a dispute between the complainant and the insurance company, but between the complainant and the organization itself, and it concerns precisely the latter’s compliance with its duty to ensure the proper examination of a claim for the reimbursement of medical expenses. This matter does fall within the Tribunal’s competence (see Judgments 3506, consideration 9, 3030 and 2249). When an organization is liable for the acts of its insurer, the organization itself must be ordered to reimburse the disputed expenses, which it may then seek to recover from the insurance company (see Judgment 3506, consideration 19).[…]
In light of the Tribunal’s case law quoted in consideration 4 […], the Tribunal notes that an organization must be held responsible for the acts of its private insurer within the framework of the collective insurance plan/fund/scheme, whilst it cannot be held responsible for additional services offered by the insurer to staff on an optional basis. These additional services stem from individual contracts and in this respect a dispute between a staff member (or a former staff member) and the insurance company is a private dispute which is outside the purview of the organization and of the Tribunal.
Reference(s)
ILOAT Judgment(s): 2063, 2249, 3030, 3031, 3506
Keywords:
competence; competence of tribunal; health insurance; insurance;
Judgment keywords
Keywords:
complaint dismissed; health insurance; insurance;
Judgment 4699
136th Session, 2023
European Organisation for the Safety of Air Navigation
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainant contests the decisions that found that his injuries had consolidated without permanent invalidity.
Considerations 5 & 8
Extract:
[T]he Tribunal fails to see how the fact that the doctor was appointed by the insurance company on the basis of a list previously approved by Eurocontrol should create a conflict of interest, since, if the Organisation were to appoint the doctor itself, the same issue would still arise given that it would then be its own financial interests that would be directly at stake.
[...]
The assertion that the Sickness Fund Supervisor was subject to a conflict of interests simply through being the “manager” of the fund is based on a mere premise, devoid of any prima facie evidence, and there is nothing in the documents submitted by the parties to suggest that such was the case here. Furthermore, if such an assertion were to be followed, it would lead to the conclusion that it was not permissible for any international organisation to create a sickness and invalidity insurance fund for the benefit of its officials, or, at the very least, that an organisation had to appoint a third party body to manage any fund it created, which is untenable.
Keywords:
conflict of interest; health insurance;
Judgment 4577
135th Session, 2023
World Tourism Organization
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: Follow-up judgment for the determination of material damages and consequential orders.
Consideration 6
Extract:
In relation to health insurance, the complainant has continued to contribute to the after-service health insurance Scheme and make payments to UNWTO’s health insurance provider. In total she will have, by September 2025, paid approximately 15,000 euros in this respect. The complainant requests that she be reimbursed these amounts because the amounts claimed for future loss of salary were net amounts. That is to say, as the Tribunal understands the argument, if she had succeeded in claiming the full amount of future salary lost it would not have included contributions made as just discussed. The contributions should be provided for separately by a specific award of damages. But the complainant derives a benefit from making these payments. They do not constitute a compensable loss. Accordingly, this claim is rejected.
Keywords:
health insurance; material damages; medical insurance;
Judgment 4576
135th Session, 2023
World Tourism Organization
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: Follow-up judgment for the determination of material damages and consequential orders.
Consideration 6
Extract:
[A]ny financial loss associated with the deprivation of membership of a particular health fund would include a loss occasioned by the non-payment of claims for medical expenses incurred and otherwise recoverable from that fund. [T]he complainant does not establish that he could be enrolled in that health fund in the absence of actually serving, as a matter of fact, the qualifying period.
Keywords:
health insurance; material damages; medical insurance;
Judgment 4514
134th Session, 2022
European Organisation for the Safety of Air Navigation
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainant challenges Eurocontrol’s decision to put an end, with retroactive effect, to the top-up sickness insurance cover received by his wife and, consequently, to recover the sums unduly paid by Eurocontrol under that cover.
Judgment keywords
Keywords:
complaint allowed; dependant; health insurance; recovery of overpayment;
Judgment 4473
133rd Session, 2022
European Organisation for the Safety of Air Navigation
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainant contests the decision not to recognise his son’s condition as a “serious illness” within the meaning of the provisions governing reimbursement of medical expenses.
Judgment keywords
Keywords:
complaint dismissed; dependent child; health insurance; illness; insurance benefits; motivation; motivation of final decision;
Judgment 4246
129th Session, 2020
World Intellectual Property Organization
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainant challenges the non-recognition of her illnesses as occupational illnesses.
Consideration 4
Extract:
Throughout the procedure, WIPO considered that the decision concerning the receivability of the request came within the insurer’s sole competence. In so doing, WIPO overlooked the fact that although the insurer is not an organ of the Organization, WIPO is liable for the insurer’s acts (see Judgment 3506, consideration 19). In view of its duty of care towards its staff members, WIPO was obliged to check whether the insurer’s calculation of the time limit was correct. If this had appeared not to be the case, it would have been obliged to contest it, using the dispute resolution procedure[.]
Keywords:
duty of care; health insurance;
Judgment 4195
128th Session, 2019
European Patent Organisation
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainants challenge the decision to modify the conditions governing sickness insurance for employees’ spouses.
Judgment keywords
Keywords:
acquired right; complaint dismissed; health insurance;
Consideration 9
Extract:
[T]he Tribunal considers that the conditions under which health insurance for employees’ spouses is provided do not give rise to an acquired right. The Organisation is entitled to adjust the contribution rate if there are compelling reasons (including budgetary reasons), within reasonable limits. The Tribunal is satisfied in this case that the increased contribution rate resulting from the additional contribution for spouses is reasonable, justified and modest.
Keywords:
acquired right; budgetary reasons; health insurance;
Judgment 4028
126th Session, 2018
International Telecommunication Union
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainants challenge Service Order No.14/10 changing the health insurance scheme at the ITU, as well as individual decisions implementing that service order.
Consideration 13
Extract:
[A]s the complainants point out, the burden of the new measures is borne by the insured persons alone. It must however be remembered that, despite a fall in its income resulting from a zero growth budget and the drop in contributions from some member States, the ITU continues to fund 50 per cent of the scheme for staff members and two thirds of it for retirees. As the defendant organisation explains, the new measures which have been put in place seek to maintain the financial equilibrium of the new insurance plan in order to ensure its continuity and stability while respecting the principles of solidarity and mutualisation of risks.
In Judgment 1241, under 19, the Tribunal considered that “the change the complainants object[ed] to [was] part of wider reforms the [organisation] made to put the [health insurance] scheme on a sounder financial footing over the long term” and that the organisation in question was “right to pursue that aim by all suitable means at its disposal, [including by] measures to ensure that, in keeping with the notion of mutual aid, everyone bears a fair share of costs”.
This consideration applies mutatis mutandis to the present complaints.
Reference(s)
ILOAT Judgment(s): 1241
Keywords:
budgetary reasons; health insurance; medical expenses;
Judgment 3791
123rd Session, 2017
European Patent Organisation
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainant impugns the implied rejection of her internal appeal against the EPO’s refusal to recognise her medical condition as an occupational disease and to reimburse her for the relevant medical expenses which she incurred.
Judgment keywords
Keywords:
complaint dismissed; health insurance; illness; medical expenses; service-incurred;
Judgment 3790
123rd Session, 2017
European Patent Organisation
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainant requests the reimbursement of medical expenses under Article 22 of the EPO’s collective medical insurance contract.
Judgment keywords
Keywords:
complaint dismissed; health insurance; medical expenses;
Judgment 3780
123rd Session, 2017
European Patent Organisation
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complaint deals with the complainant’s daughter’s affiliation to a Dutch health insurance scheme.
Judgment keywords
Keywords:
complaint dismissed; health insurance; insurance;
Judgment 3762
123rd Session, 2017
United Nations Educational, Scientific and Cultural Organization
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainants challenge a circular that implements amendments to the Rules of the Medical Benefits Fund.
Judgment keywords
Keywords:
complaint allowed; decision quashed; health insurance; insurance;
Judgment 3736
123rd Session, 2017
International Telecommunication Union
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainants challenge the ITU’s decision to change its medical insurance scheme and to increase their premiums under this insurance scheme.
Judgment keywords
Keywords:
complaint allowed; consultation; decision quashed; health insurance; insurance;
Judgment 3650
122nd Session, 2016
International Atomic Energy Agency
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainant contests the refusal to pay her interest on reimbursement of medical costs.
Consideration 6
Extract:
Plainly enough, [...] the right to payment of medical expenses arising under Article 16 is conditioned by the consideration of any claim for payment by the organisation of whether the medical expenses incurred were reasonably incurred, which would include the consideration of any evidence furnished supporting a conclusion that they were reasonably incurred. Thus the right to payment of medical expenses cannot be said to be a right to an immediate payment of the claimed amount. Accordingly there is no room for the implication of a right to interest either from the time the medical expense was actually paid by the staff member or from the time the staff member lodged a claim for reimbursement.
Keywords:
health insurance; interest on damages; medical expenses;
Judgment 3638
122nd Session, 2016
United Nations Educational, Scientific and Cultural Organization
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainant impugns UNESCO’s implied rejection of his claim for reimbursement at the rate of 100 per cent of medical expenses related to a service-incurred injury.
Judgment keywords
Keywords:
complaint dismissed; health insurance; medical expenses;
Judgment 3628
121st Session, 2016
European Patent Organisation
Extracts: EN,
FR
Full Judgment Text: EN,
FR
Summary: The complainant challenges a decision of the Administrative Council relating to employees’ contribution to sickness insurance.
Judgment keywords
Keywords:
complaint dismissed; contribution rate; contributions; health insurance; insurance; summary procedure;
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