JUDGMENT OF THE CIVIL SERVICE TRIBUNAL

(Third Chamber)

1 December 2010

Case F-89/09

Spyridon Gagalis

v

Council of the European Union

(Civil service — Social security — Occupational accident — Partial permanent invalidity — Decision to take responsibility for 75% of the costs of a thermal cure — Reimbursement for care under Article 72 of the Staff Regulations and additional reimbursement under Article 73 of the Staff Regulations — Exclusion of cover for subsistence expenses — Refusal of additional reimbursement — Interpretation of Article 73(3) of the Staff Regulations and of Article 9 of the Common rules on the insurance of officials against the risk of accident and occupational disease)

Application: brought under Articles 236 EC and 152 EA, by which Mr Gagalis seeks, first, annulment of the decision of the Director-General of the Directorate-General for Personnel and Administration of the Council, as the appointing authority of the Council, adopted on 9 December 2008, refusing to reimburse the applicant 75% of all the costs relating to a thermal cure pursuant to Article 73 of the Staff Regulations, and annulment of the decision of 15 July 2009 partially rejecting his complaint, and, second, an order that the Council pay an additional amount of EUR 1 551.38 with default interest.

Held: The action is dismissed. The applicant is ordered to pay all the costs.

Summary

1.      Officials — Social security — Insurance against the risk of accident and of occupational disease — Reimbursement of costs

(Staff Regulations, Arts 72 and 73(3); Rules on the Insurance of Officials of the European Communities against the Risk of Accident and of Occupational Disease, Art. 9)

2.      Officials — Decision adversely affecting an official — Obligation to state the reasons on which the decision is based — Scope

(Staff Regulations, Art. 25, second para.)

1.      In the case of the reimbursement of the cost of care arising from an accident and, in particular, a request for payment of the costs of a thermal cure including subsistence expenses, the wording of the second subparagraph of Article 73(3) of the Staff Regulations and of Article 9 of the Common rules on the insurance of officials against the risk of accident and of occupational disease reveals a link between those two provisions and Article 72 of the Staff Regulations. While the second subparagraph of Article 73(3) of the Staff Regulations provides that the reimbursement of the expenses incurred as a result of an accident is only made ‘where the amount paid to the official under Article 72 does not fully cover the expenditure incurred’, the third subparagraph of Article 9(1) of the above rules provides that the expenses arising from an accident are reimbursed ‘after the sickness insurance scheme provided for by Article 72 of the Staff Regulations has defrayed the part falling to that scheme under the conditions laid down therein’.

Accordingly, both Article 73(3) of the Staff Regulations and the third subparagraph of Article 9(1) of the Rules on the insurance of officials against the risk of accident and of occupational disease must be interpreted as meaning that they provide only for supplementary reimbursement of expenses incurred for benefits covered by Article 72 of the Staff Regulations, after reimbursement of the part of the costs to be borne by the sickness insurance scheme. The accident insurance scheme is supplementary and thus does not provide for any reimbursement of expenses incurred for benefits which are not covered by the sickness insurance scheme and thus do not give rise to any payment by the sickness insurance scheme.

(see paras 41-42)

2.      Under the second paragraph of Article 25 of the Staff Regulations any decision relating to a specific individual taken under the Staff Regulations and which adversely affects that person must state the grounds on which it is based. The requirement that a decision adversely affecting a person should state the reasons on which it is based is intended to provide the person concerned with sufficient details to allow him to ascertain whether or not the decision is well founded and make it possible for the decision to be the subject of judicial review. That obligation is intended, inter alia, to allow the person concerned to know the reasons for a decision taken concerning him so that he may seek the remedies necessary for the defence of his rights and interests.

An inadequate statement of grounds may be remedied by additional information provided even during the proceedings if, before his action was brought, the official concerned already had at his disposal information constituting the beginnings of a statement of grounds. Moreover, grounds stated for a decision are sufficient if the measure taken concerning the official was adopted in circumstances which are known to him and enable him to understand its scope.

(see paras 65, 67)

See:

T‑33/00 Martínez Páramo and Others v Commission [2003] ECR-SC I‑A‑105 and II‑541, para. 43 and case-law cited; T‑145/02 Petrich v Commission [2004] ECR-SC I‑A‑101 and II‑447, para. 54 and case-law cited; T‑132/03 Casini v Commission [2005] ECR-SC I‑A‑253 and II‑1169, para. 36 and case-law cited