Judgment No. 1180
Decision
THE COMPLAINT IS DISMISSED.
Considerations 2-3
Extract:
The complainant received treatment in a clinic. He had an operation and on that account spent five days in the clinic's department of surgery. The organisation agreed to refund the costs of his operation and the five-day hospital stay which it entailed. However it refused to regard the remainder of his stay in the clinic as "hospitalisation" and treated it as "a cure at a watering place". The material issue is whether that decision was lawful. "The Tribunal is satisfied that the Director General was right to decide that the complainant's stay at the clinic did not warrant the refund of his costs at the 'hospitalisation' rate [...] and that to regard but five days of that stay as 'a cure at a watering place' rather than hospitalisation for medical treatment was in line with the material rules."
Keywords
illness; cure; refund; medical expenses; health insurance
Consideration 4
Extract:
"The complainant argues that the Agency ought to have consulted an independent doctor. But there was no requirement in the Rules that it refer the complainant's case to outside doctors; indeed the Director General was right to rely on Eurocontrol's own medical officer, who was authorised to assess the position both by his own lights and in view of the opinion expressed by the complainant's own doctor. The complainant has not adduced any evidence to suggest that the Agency's medical officer made an improper assessment either of the state of the complainant's health or of the nature of the treatment he received [...] There is therefore no reason for the Tribunal to seek further expert advice".
Keywords
expert inquiry; illness; medical consultant; medical opinion
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