The complaint to the European Commission

1. The complainant is a retired EU civil servant who used to work for the Commission. The complainant had an accident in 2003 and was granted an invalidity allowance in 2005^[1]. A dispute followed regarding the complainant´s invalidity rate^[2] (the complainant went to Court twice regarding the matter).

2. In the course of the dispute, a medical committee was convened^[3]. The medical committee met several times during the period 2007 to 2015. The complainant had appointed one doctor to represent him on the medical committee^[4]. For this, the complainant wanted the Commission to reimburse him 15.128,42 EUR in doctor’s fees.

3. The complainant argued that the fees had to be reimbursed under the rules applicable until December 2005, which had no reimbursement limit for such fees. According to the complainant, even if the medical committee had started its work when new rules (see footnote 2) were in place, his claim for reimbursement should be treated under the old rules. This was because the EU Courts had held in 2012 that his invalidity rate should be calculated under the old rules, which were in place when the accident happened.

The European Commission’s response to the complainant

4. The Commission did not agree that the complainant’s request for reimbursement should be dealt with under the old rules. It stated, in summary, that the issue at stake was not the complainant’s invalidity rate (to which the old rules should apply), but the reimbursement of the fees of a medical committee member. The complainant’s request to set up a medical committee, as well as the work of the medical committee, were done under the new rules. In any case, the Commission could limit reimbursements to a reasonable amount also under the old rules, as it would be unreasonable to pay, without limit, for the discretionary fees of a doctor that it had not chosen.

5. Already in 2007, the Commission had informed the doctor appointed by the complainant that, on the basis of the applicable rules^[5], the maximum reimbursable fee had been established at 1000 EUR, plus transport and accommodation. The letter sent to the doctor explicitly mentioned that he would have to charge any exceeding amounts to the complainant, whom the doctor had to inform in advance. The doctor made one reimbursement claim of 2243 EUR to the Commission in June 2009 and he received 1243 EUR in accordance with the scale mentioned in the rules (see footnote 5).

6. In July 2012 and in April 2015, the medical committee was mandated with new tasks. The Commission thus informed its members that it would reimburse additional fees (a maximum of 750 EUR and 500 EUR respectively). The Commission is therefore willing to reimburse these amounts (plus transport and accommodation costs) if the complainant provides relevant supporting documents.

7. The complainant was not satisfied with the Commission’s response and therefore turned to the Ombudsman in April 2019, arguing that the Commission was not respecting the position of the Ombudsman as set out in a previous case^[6]. The Ombudsman had stated that “when dealing with the indemnity claims of the victims of accidents, the officials should be particularly helpful and courteous and avoid any remarks or allusions which might hurt or injure unnecessarily the complainants”. The complainant also argued that the Commission is confusing the interests of its insurance contractor with its own financial interests.

The European Ombudsman's findings

8. The Ombudsman has carefully considered the Commission’s reply to the complainant’s request and finds that the Commission has provided valid reasons for applying the new rules. It was thus lawful and reasonable for the Commission to limit the reimbursement of the doctor’s fees.

9. The statement by the Ombudsman referred to by the complainant concerns the behaviour of EU civil servants, not how to address the substance of indemnity claims.

10. Based on the above, the Ombudsman finds no maladministration in this case.^[7]

 

Tina Nilsson

Head of Inquiries - Unit 4

Strasbourg, 29/08/2019

 

[1] Members of the EU civil service who are not able to perform their duties for health reasons can be granted an invalidity allowance under the conditions established under the EU Staff Regulations (Article 73), see: https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX%3A01962R0031-20140501

[2] Article 11.3 of the Common Rules on the insurance of officials of the European Communities against the risk of accident and occupational disease (the Common Rules) provides that:

“ Where an insured party sustains partial permanent invalidity as a result of an accident or an occupational disease, he/she shall be paid a lump sum provided for in Article 73(2)(c) of the Staff Regulations and determined on the basis of the rates laid down in the [European disability rating scale given in Annex A]” See: http://www.europarl.europa.eu/tenders/2014/20140103/EN_Ref%203_Common%20rules_accident_EN.pdf

[3] As foreseen in article 20 of the Common Rules:  “Before taking a decision pursuant to Article 18, the appointing authority shall notify the insured party or those entitled under him/her of the draft decision and of the findings of the doctor(s) appointed by the institution. The insured party or those entitled under him/her may request that the full medical report be communicated to them or to a doctor chosen by them.   2. Within a period of 60 days the insured party or those entitled under him/her may request that the Medical Committee provided for in Article 22 deliver its opinion [...]”.

[4] Article 22 of the Common Rules foresees that: “The Medical Committee shall consist of three doctors: 

 – one appointed by the insured party or those entitled under him/her; 

 – one appointed by the appointing authority; 

 – one appointed by agreement between the first two doctors [...]”.

[5] Article 22.2 of the Common Rules: “The fees and expenses of the doctors making up the Medical Committee shall be set in accordance with a scale laid down by the Community institutions' Heads of Administration, depending on the complexity of the case assigned to the Medical Committee”.

[6] See Ombudsman decision in case 2782/2006/(MHZ)/RT: https://www.ombudsman.europa.eu/en/digest/en/12364

[7] This complaint has been dealt with under delegated case handling, in accordance with Article 11 of the Decision of the European Ombudsman adopting Implementing Provisions