Maximum limit (413,-666)

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Keywords: Maximum limit
Total judgments found: 5

• Judgment 2533

  
  101st Session, 2006
  Organisation for the Prohibition of Chemical Weapons
  Extracts: EN, FR
  Full Judgment Text: EN, FR

  Consideration 26

  Extract:

  The complainant suffered a workplace injury at the Organization premises. The results of this seemingly minor accident were catastrophic and the complainant is now permanently and totally disabled and suffers from a rare illness, which has extended up both of the complainant's legs and requires him to use a wheelchair.
  "[G]iven the possibly progressive nature of [the illness], the condition may continue to deteriorate seriously. [...] the Tribunal asserts unequivocally that the defendant's obligation to pay the complainant reasonable compensation for the results of his workplace injury is a continuing one and is not affected or diminished by the terms of an insurance policy to which the complainant is not a party."

  Keywords:

  consequence; disability benefit; handicapped person; health insurance; illness; insurance; invalidity; maximum limit; medical examination; organisation's duties; professional accident; provision; service-incurred;
  

  
  
  

• Judgment 1880

  
  87th Session, 1999
  European Organisation for the Safety of Air Navigation
  Extracts: EN, FR
  Full Judgment Text: EN, FR

  Consideration 8

  Extract:

  "According to precedent [...] (see Judgments 1094 [...] and 1095 [...]), coverage at the rate of 100 per cent does not mean that in all circumstances an insured person is entitled to full repayment of expenses incurred. [T]o allow the [sickness] fund not to reimburse the part of the expenses deemed to be excessive is in keeping with the purpose of sickness insurance and it is a means of ensuring sound financing and comparable coverage for the beneficiaries, and as such falls within the authority delegated to the Director General. The reimbursement of expenses can be restricted by setting maximum limits or ceilings for certain types of expenditure or by reckoning limits for each case on the basis of costs incurred."

  Reference(s)

  Organization rules reference: ARTICLE 72 OF EUROCONTROL STAFF REGULATIONS
  ILOAT Judgment(s): 1094, 1095
  

  Keywords:

  case law; health insurance; illness; insurance; limits; maximum limit; medical expenses; purpose;
  

  
  
  

• Judgment 1095

  
  70th Session, 1991
  European Organisation for the Safety of Air Navigation
  Extracts: EN, FR
  Full Judgment Text: EN, FR

  Summary

  Extract:

  The complainant's fees for difficult confinement were refunded at the 100 per cent rate up to a maximum limit reckoned by likening the treatment she received to a surgical operation. Though the Tribunal finds nothing wrong with setting maximum limits in general it holds that there was no valid limit at the material time on costs incurred for difficult confinements and that the complainant was entitled to the refund of her confinement expenses in full.

  Keywords:

  amount; analogy; flaw; health insurance; maximum limit; medical expenses; no provision; rate; reckoning; refund;
  

  
  
  

• Judgment 1094

  
  70th Session, 1991
  European Organisation for the Safety of Air Navigation
  Extracts: EN, FR
  Full Judgment Text: EN, FR

  Considerations 24-25

  Extract:

  Under Article 72 of the Staff Regulations governing officials and of the General Conditions of employment of the Agency the Director general is "empowered to do whatever is needed to make the [health] scheme workable and financially sound, provided that he abides by the provisions of the Staff Regulations, and the cost is shared between organisation and staff in line with the principle of solidarity. That is why it is a proper precaution to set maximum limits on the costs of some forms of treatment and to require prior permission in some cases." Setting the rate of refund at 100 per cent for certain forms of treatment, including confinement, does not bar maximum limits.

  Reference(s)

  Organization rules reference: ARTICLE 72 OF EUROCONTROL STAFF REGULATIONS
  
  

  Keywords:

  health insurance; illness; insurance; maximum limit; medical expenses; refund; social solidarity;
  

  
  
  

• Judgment 923

  
  65th Session, 1988
  European Organisation for the Safety of Air Navigation
  Extracts: EN, FR
  Full Judgment Text: EN, FR

  Consideration 12

  Extract:

  "In case of doubt it is for the staff member to show exactly what the treatment was if he is contending that the maximum limit does not apply."

  Keywords:

  burden of proof; disclosure of evidence; evidence; health insurance; maximum limit; medical expenses; request by a party;