Keywords
Summary

Keywords

1 Officials - Social security - Insurance against accident and occupational disease - Determination of the occupational origin of the illness - Respective powers of the Medical Committee and the appointing authority

(Staff Regulations, Art. 73; Rules on insurance against the risk of accident and of occupational disease, Arts 19 and 23)

2 Officials - Social security - Insurance against accident and occupational disease - Medical opinion - Judicial review - Limits

(Staff Regulations, Art. 73; Rules on insurance against the risk of accident and of occupational disease, Art. 23)

3 Officials - Social security - Insurance against accident and occupational disease - Occupational disease - Meaning - Determination of the occupational origin of the illness

(Staff Regulations, Art. 73(2); Rules on insurance against the risk of accident and of occupational disease, Art. 3(2))

4 Officials - Social security - Insurance against accident and occupational disease - Rate of permanent invalidity arising from an occupational disease - Detailed rules for calculating the invalidity lump sum - Role played by the performance of the official's duties in the emergence of the illness to be taken into account

(Staff Regulations, Art. 73; Rules on insurance against the risk of accident and of occupational disease, Arts 3 and 12)

5 Officials - Actions - Prior administrative complaint - Requirement that subject-matter and grounds be the same - Pleas in law and arguments not appearing in the complaint, but closely linked to it - Admissible

(Staff Regulations, Arts 90 and 91)

Summary

6 The purpose of Articles 19 and 23 of the Rules on the insurance of officials of the European Communities against the risk of accident and of occupational disease is to confer upon medical experts the task of definitively appraising all medical questions arising from the operation of the insurance scheme.

The Medical Committee is entrusted with a broad task, consisting in supplying the appointing authority with all the medical assessments necessary for adopting its decision concerning the recognition of the occupational origin of the official's disease and the determination of the degree of his permanent invalidity.

For the sake of efficiency, however, it is desirable for the appointing authority to indicate by a clear and precise set of instructions, when referring a matter to the Medical Committee, the points on which it wishes to obtain definitive medical assessments. Moreover, when it receives a report from the Medical Committee, the appointing authority may, by issuing further instructions, define its questions more closely or raise new ones in order to obtain all the assessments desired. In those cases, the Medical Committee is under a duty to reply clearly and precisely to the appointing authority's questions. However, those instructions cannot have the effect of preventing the Medical Committee from communicating to the appointing authority further medical findings capable of elucidating its decision.

7 Medical opinions properly so-called, which have been made by the Medical Committee established pursuant to Article 23 of the Rules on the insurance of officials of the European Communities against the risk of accident and of occupational disease, must be regarded as definitive provided the conditions in which they are given were not irregular, the Court's power of review being confined to questions concerning the constitution and proper functioning of such committees and the formal propriety of the opinions they deliver.

Within those limits, the Court of First Instance has jurisdiction to examine whether the opinion contains a statement of reasons enabling the reader to assess the considerations on which its conclusions were based and whether it establishes an intelligible link between the medical findings which it contains and the conclusions which the Medical Committee draws.

8 An official's illness constitutes an occupational disease within the meaning of Article 3(2) of the Rules on the insurance of officials of the European Communities against the risk of accident and of occupational disease if it was caused solely, essentially, preponderantly or predominantly by the performance of his duties.

However, that provision would be deprived of its effectiveness if recognition of the occupational origin of an official's illness were to be limited to that hypothesis alone. Where an official's illness has several causes, it is for the Medical Committee to determine whether the performance of duties with the Communities - whatever assessment might be made of that factor's significance in relation to the non-occupational factors - bears a direct relation to the official's illness, as, for example, where it is a factor triggering that illness.

9 If Article 73(2) of the Staff Regulations, Article 12 of the Rules on the insurance of officials of the European Communities against the risk of accident and of occupational disease and the invalidity scale are not to be deprived of their effectiveness, they must allow the varying range of medical conditions covered by Article 3(2) of those rules to be reflected in the indemnity paid to officials. Moreover, Article 3(1) of the rules demonstrates that the concept of `occupational disease' is based on the existence of a link between the pathological state of the official and the performance of his duties with the Communities. It is only `to the extent to which' that link exists that the illness may be regarded as an occupational disease.

Where the Medical Committee finds that a number of causes, occupational and non-occupational, have each directly contributed to the emergence of an official's illness, the appointing authority is under a duty to take that medical finding into account in calculating the amount of the lump sum provided for by Article 73(2) of the Staff Regulations.

Where, on the basis of the various examinations it has carried out or its experience in the area concerned, the Medical Committee considers that it is able to evaluate or quantify, in one form or another, how significant a role performance of the duties played in the emergence of the official's illness, and its conclusions give such a clear and precise evaluation, the appointing authority is entitled to reflect it in its calculation of the lump sum provided for by Article 73(2) of the Staff Regulations.

10 The rule of harmony between complaint and action requires that, for a plea before the Community judicature to be admissible, it must have already been raised in the pre-litigation procedure, enabling the appointing authority to know in sufficient detail the criticisms made by the person concerned of the contested decision.

However, whilst claims for relief before the Community judicature may contain only heads of claim that are based on the same matters as those raised in the complaint, those heads of claim may nevertheless be further developed before the Community judicature by the presentation of pleas in law and arguments which, whilst not necessarily appearing in the complaint, are closely linked to it.

Since, moreover, the pre-litigation procedure is informal in character and those concerned are generally acting without the assistance of a lawyer at that stage, the administration must not interpret the complaints restrictively but should, on the contrary, consider them with an open mind.