61989A0033

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1. Officials ° Actions ° Act adversely affecting an official ° Definition ° Information provided by a claims office regarding a claim for reimbursement of medical expenses ° Exclusion

(Staff Regulations, Art. 90(2))

2. Officials ° Actions ° Prior complaint through official channels ° Time-limits ° Complaint submitted within the time-limit to a non-competent department on the basis of information provided by that department ° Excusable error ° Effects ° Prolongation of the time-limit for initiating proceedings

(Staff Regulations, Arts 90 and 91)

3. Officials ° Social security ° Sickness insurance ° Medical expenses ° Definition ° Expenses in relation to an educational therapy programme ° Programme devised and carried out in an educational institution by persons with no medical or paramedical training ° Exclusion

(Staff Regulations, Art. 72(1))

4. Officials ° Social security ° Sickness insurance ° Claims offices ° Processing of claims for reimbursement ° Procedure

(Staff Regulations, Art. 72; Sickness insurance rules, Art. 20)

5. Procedure ° Originating application ° Formal requirements ° Brief statement of grounds on which application is based

(Statute of the Court of Justice of the EEC, Art. 19; Rules of Procedure of the Court of Justice, Art. 38(1))

6. Officials ° Social security ° Sickness insurance ° Medical expenses ° Reimbursement ° Conditions ° Appraisal of each claim in the light of its own merits in fact and in law

(Staff Regulations, Art. 72(1))

7. Community law ° Principles ° Protection of legitimate expectations ° Conditions

8. Officials ° Duty of the administration to have regard to the interests of officials ° Scope ° Limits

1. The only acts which may be regarded as adversely affecting an individual within the meaning of Article 90(2) of the Staff Regulations are acts issuing from the appointing authority which are capable of directly affecting a specific legal situation. The mere manifestation of an intention to adopt a specific decision in the future is not capable of creating corresponding rights or obligations on the part of the person concerned.

Information provided by a claims office regarding an application for the reimbursement of medical expenses which reveals that a decision is to be taken subsequently does not constitute an act adversely affecting an official within the meaning of that provision.

2. A failure to comply with time-limits laid down in Article 90(2) of the Staff Regulations does not prevent a prior complaint through official channels or an application against the rejection of that complaint from being admissible where the applicant has been in excusable error.

The concept of excusable error, in the context of time-limits for initiating proceedings, which are a matter of public policy and not subject to the discretion either of the court or of the parties, must be strictly construed and can concern only exceptional circumstances in which, in particular, the conduct of the institution concerned has been, either alone or to a decisive extent, such as to give rise to pardonable confusion in the mind of a party acting in good faith and exercising all the diligence required of a normally experienced person. In such an event, the administration may not rely on its own failure to observe the principles of legal certainty and the protection of legitimate expectations out of which the error arose.

It constitutes an excusable error, of such a kind as to prolong the time-limit for initiating proceedings, where a complaint is lodged within the time-limit laid down in the Staff Regulations with a non-competent department on the basis of incorrect information provided by that department, which merely returned the complaint to the official concerned without forwarding it to the department actually competent, which therefore received it out of time.

3. The fees for special courses of educational therapy in the context of a programme of specialist teaching in an educational institution, which was neither devised nor carried out by persons legally authorized to practise a medical or paramedical profession or by a duly recognized medical or paramedical institution, cannot be treated as medical expenses eligible for reimbursement under Article 72(1) of the Staff Regulations.

4. The purpose of Article 20 of the Insurance Rules is to allow the practical, efficient settlement of claims for reimbursement under the Joint Sickness Insurance Scheme. The distribution of claims among the different claims offices is on a strictly geographical basis and does not mean that the different offices have different powers or tasks. Therefore, the fact that a claim for reimbursement submitted to one office is sent to another office so that the claim can be processed without interruption cannot affect the legality of the decision adopted in response to that claim.

5. The application initiating proceedings must contain a brief statement of the grounds on which it is based. This means that the application must specify the nature of the grounds on which it is based, so that a mere abstract statement does not alone satisfy the requirements of the Statute of the Court of Justice or the Rules of Procedure.

A ground which has not been briefly set out in the application cannot, in the light of the prohibition on producing fresh issues in the course of the proceedings, be specified in the reply.

6. The appointing authority must, for every claim for reimbursement of medical expenses, determine whether the conditions for reimbursement laid down in Article 72(1) of the Staff Regulations are satisfied by reference to the matters of fact and of law disclosed by the person concerned, without being bound by a previous decision adopted on the basis of different or less complete evidence.

Accordingly, the fact that the administration agreed to meet, under the Joint Sickness Insurance Scheme, certain expenses incurred by an official cannot confer on the official concerned the right to future reimbursement of similar expenses unless the administration has given him specific assurances.

7. The right to rely on the principle of the protection of legitimate expectations extends to any individual who is in a situation in which it appears that the conduct of the Community administration has led him to entertain reasonable expectations. However, an official may not plead a breach of the principle of the protection of legitimate expectations unless the administration has given him specific assurances.

8. The duty of the administration to have regard for the interests of its officials reflects the balance of the reciprocal rights and obligations established by the Staff Regulations in the relationship between a public authority and civil servants. That duty implies in particular that when the appointing authority takes a decision concerning the situation of an official, it should take into consideration all the factors which may affect its decision and that when doing so it should take into account not only the interests of the service but also those of the official concerned. However, the protection of the rights and interests of officials must always be subject to compliance with the legal rules in force.