JUDGMENT OF THE EUROPEAN UNION CIVIL SERVICE TRIBUNAL

(First Chamber)

5 June 2012

Case F‑14/11

AW

v

European Commission

(Civil service — Officials — Social security — Serious illness — Payment of costs of dental prostheses — Reimbursement ceiling — Plea of illegality — Legitimate expectations)

Application: brought under Article 270 TFEU, applicable to the EAEC Treaty pursuant to Article 106a thereof, in which AW requests the Tribunal, first, to annul the Commission’s decisions applying a reimbursement ceiling to the costs of dental prostheses incurred for his daughter, and, second, to order the Commission to pay him compensation.

Held: AW’s action is dismissed. Each party is to bear its own costs.

Summary

Officials — Social security — Sickness insurance — Medical expenses — Serious illness — Reimbursement ceilings — Lawfulness — Conditions

(Staff Regulations, Art. 72(1))

The rate of 100% referred to in Article 72(1) of the Staff Regulations establishes only the maximum reimbursable rate in the event of serious illness in particular, and does not imply any obligation to reimburse members and persons covered by their insurance to the extent of 100% in all cases. Furthermore, since the resources of the Joint Sickness Insurance Scheme of the institutions of the European Union are limited to the contributions of members and of the institutions and the Scheme’s financial equilibrium requires that there must be a correlation between expenditure and contributions, the institutions are entitled, in the absence of reimbursement ceilings laid down by the Staff Regulations, to set such ceilings in the implementing provisions for Article 72(1), without, however, exceeding the limits to which their power is subject by virtue of the principle of social insurance cover underlying that provision of the Staff Regulations. That principle in no way implies that an insured person is entitled to reimbursement of a predetermined proportion of medical expenses which he has incurred, regardless of the price charged by the supplier of the medical services in question.

(see paras 49, 51)

See:

12 July 1991, T‑110/89 Pincherle v Commission, para. 25; 25 February 1992, T‑41/90 Barassi v Commission, para. 33; 26 October 1993, T‑6/92 and T‑52/92 Reinarz v Commission, para. 74