JUDGMENT OF THE COURT OF FIRST INSTANCE (Fourth Chamber)

21 April 2004

Case T-313/01

R

v

Commission of the European Communities

(Officials – Social security – Refusal of prior authorisation of a surgical procedure – Refusal on the ground of the exclusively cosmetic nature attributed by the administration to the operation – Infringement of the provisions of the Community rules)

Full text in Greek II - 0000

Application:         for, first, annulment of the refusal of prior authorisation of a surgical procedure and, second, reimbursement of the costs of the operation at issue.

Held:         The decision of 22 May 2001 rejecting the application for prior authorisation submitted by the applicant is annulled. The Commission is ordered to reimburse the applicant 85% of the cost of the surgical procedure as set out by the applicant’s surgeon in his prescription of 16 May 2001. The parties are ordered to determine by agreement the amount to be reimbursed to the applicant for the costs of the operation undergone according to the terms of the prescription and inform the Court of the agreed amount within a period of three months from the delivery of this judgment. In the absence of agreement, the parties are ordered to submit to the Court, within a period of three months from the delivery of this judgment, the figures they propose in respect of the amount to be reimbursed. The costs, including those incurred for the purposes of the expert medical report, are reserved.

Summary

1.     Officials – Social security – Sickness insurance – Medical expenses – Treatment requiring prior authorisation – Grounds for refusing reimbursement of costs incurred – No application for prior authorisation, or application not submitted properly

(Rules on sickness insurance, Art. 11(1)(c))

2.     Officials – Social security – Sickness insurance – Decision rejecting a request for prior authorisation for a surgical procedure – Refusal on the ground of the exclusively cosmetic nature attributed to the operation – Incorrect appraisal by the competent authority

(Rules on sickness insurance, Annex I, Section II(5))

3.     Officials – Actions – Subject-matter – Unlimited jurisdiction – Application for reimbursement of medical expenses under the Joint Sickness Insurance Scheme – Admissibility

(Staff Regulations, Art. 91(1))

4.     Officials – Actions – Prior administrative complaint – Requirement that subject-matter and grounds be the same – Application for reimbursement of medical expenses relating to a treatment adjoined to an action against the refusal to grant prior authorisation for that treatment – Admissibility

(Staff Regulations, Arts 90 and 91)