BIB.JUDGMENT
T-33/89T-74/8961989A00330006.0001252128635TJudgment of the Court of First Instance (Fourth Chamber)
16 March 1993(*)*
In Joined Cases T-33/89 and T-74/89,
David Blackman, a member of the temporary staff of the European Parliament, residing at Tervueren (Belgium), represented by Aloyse May, of the Luxembourg Bar, with an address for service at his Chambers, 31 Grand-Rue,
applicant,European Parliament, represented by Jorge Campinos, Jurisconsult, Manfred Peter, Head of Division, and Didier Petersheim, of the Legal Service, acting as Agents, assisted by Francis Herbert, of the Brussels Bar, with an address for service at the General Secretariat of the European Parliament, Kirchberg,
defendant,APPLICATION in Case T-33/89, for the annulment of the decision of the President of the Socialist Group of the European Parliament of 4 February 1988 rejecting the applicant's complaint against the decision refusing the applicant 100% reimbursement European Communities of the fees for special courses incurred for his daughter during the academic year 1986-1987 and, in Case T-74/89, the annulment of the decision of the European Parliament of 31 January 1989 rejecting the applicant's complaint against the refusal of his request for prior authorization concerning his daughter's participation in special courses during the academic year 1987-1988,
THE COURT OF FIRST INSTANCE OF THE EUROPEAN COMMUNITIES (Fourth Chamber),
composed of: R. Garcia-Valdecasas, President, R. Schintgen and C. P. Briët, Judges,
Registrar: M. Fierstra, Legal Secretary,
gives the following
Judgment
The facts
‘Concerning the special learning support programme, in particular one individual session per week of educational therapy, I spoke to our Medical Officer, who contacted the British School. His opinion, which in my view is reasonable, is that as the special programme consists partly of remedial courses and partly of special treatment, the sickness insurance fund should meet 50% of the fees’.
‘Since it is now clear from examining the file that the request for prior authorization concerns remedial classes in mathematics and that courses of this type do not form part of medical treatment, there are no grounds for conferring a right to reimbursement for such services. Services of this type provided in an educational institution by persons who are not medical or paramedical practitioners are excluded by the provisions for the interpretation of sickness insurance rules adopted by the heads of administration on 10 September 1987, which specify that “the treatments specified in the Annexes to these Rules must be administered by a person or persons legally authorized to exercise a medical or paramedical profession or by approved medical or paramedical establishments.”’
The procedure
Forms of order sought by the parties
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formally admit the action as having been brought within the prescribed time-limit;
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declare unlawful and annul the decision adopted by the President of the Socialist Group of the European Parliament on 4 February 1988 refusing the applicant 100% reimbursement by the Joint Scheme of the costs of special paramedical education for his daughter incurred between May 1986 and August 1987;
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declare that the applicant is entitled to 100% reimbursement, in accordance with Article 72 of the Staff Regulations, of the medical and paramedical expenses relating to the serious illness of his daughter, for special paramedical courses followed by her;
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declare that the defendant must reimburse the applicant for the balance of 50% not met during the period in question;
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order the defendant to pay the arrears owed on the basis of the new calculation;
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order the defendant to pay the costs.
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principally, dismiss the action as inadmissible;
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in the alternative, dismiss the action as unfounded;
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in either event, order the applicant to pay the costs.
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declare the action admissible;
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declare unlawful and annul the decision adopted by the appointing authority of the Parliament on 31 January 1989 expressly rejecting the applicant's complaint of 30 May 1988 and refusing to grant the prior authorization requested by the applicant on 18 October 1987 concerning the programme of educational therapy — remedial teaching to be followed by the applicant's daughter;
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declare that the applicant is entitled to 100% reimbursement of the medical and paramedical expenses incurred in 1987-1988 in respect of his daughter's serious illness, in accordance with Article 72(1) of the Staff Regulations;
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declare that the defendant must reimburse all expenditure incurred by the applicant for the programme of educational therapy — remedial teaching followed by his daughter in 1987-1988, with interest from the date on which reimbursement fell due to the date of actual payment;
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order that this case be joined with Case T-33/89;
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order the defendant to pay the costs.
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dismiss the action as devoid of purpose, after declaring that the contested decision falls within Article IX or, alternatively, Article XV of Annex I to the Insurance Rules, while the third and fourth heads of claim submitted in the action are covered by Article IV of Annex I;
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in the alternative, after declaring that those heads of claim did not form the subject-matter of a prior complaint, dismiss them as inadmissible pursuant to Article 91(2) of the Staff Regulations;
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in the further alternative, after declaring that the Court is not competent to take the place of the administration and to address directions to it, dismiss that part of the action as inadmissible;
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for the rest, declare the action admissible but unfounded;
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order the applicant to pay the costs.
Admissibility of the action in Case T-33/89
Arguments of the parties
Findings of the Court
Substance
Case T-33/89
The plea of breach of Article 72(1) of the Staff Regulations
Arguments of the parties
Findings of the Court
‘An official, ..., [and] his children ... are insured against sickness [for] up to 80% of the expenditure incurred ... [This rate] shall be increased to 100% in cases of tuberculosis, poliomyelitis, cancer, mental illness and other illnesses recognized by the appointing authority as of comparable seriousness, and for early detection screening and in cases of confinement ...’
In this connection Annex I to the Insurance Rules, entitled ‘Rules Governing the Reimbursement of Medical Expenses’, provides in paragraph IV, ‘Special cases’, that
‘In cases of tuberculosis, poliomyelitis, cancer, mental illness and other illnesses recognized by the appointing authority as of comparable seriousness, expenses shall be reimbursed at the rate of 100%.
...
The appointing authority, or the office responsible for settling claims if the requisite powers have been delegated to it by the said authority, shall take its decision after consulting the Medical Officer of that office, whose opinion shall be based on general criteria drawn up by the Medical Council.’
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regarding the component parts or elements of the programme:
‘... the subjects of which the remedial teaching programme consisted were: geography, biology, human biology, physiology, home economy and nutrition.
Mathematics was one of the subjects of the remedial teaching programme. [The applicant's daughter] continued to study with her class: domestic science, history and English’;
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regarding the persons carrying out the programme:
‘... two teachers taught [the applicant's daughter] ... Both teachers are qualified, but they do not have medical qualifications ... [The first teacher] ... is a teacher of mathematics. [He] has no special medical qualifications. The other teacher ... is a graduate in zoology and botany of the University of London ... and has a teaching diploma, but ... no medical training. They are ... teachers’;
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and, regarding the persons responsible for the programme:
‘I have a degree in psychology. Both teachers are employed [at the British School] for [the applicant's daughter] under my supervision. The programme was basically devised by the two teachers under my supervision. I did not communicate with outside agencies in order to develop this particular programme, and therefore it was not supervised by a doctor. [Dr Boel was not in contact] with me.’
‘I was not on the spot, at the British School. Mr Gillman is himself responsible for the pupils enrolled with him. I have no part to play in his school. I cannot interfere in his programme. I am not familiar with the standards of the British School of Brussels.’
The plea of no legal basis for the contested decision, manifest error, misuse of powers and lack of competence of the person who adopted the decision
Arguments of the parties
Findings of the Court
The plea in law concerning breach of Article 72(3) of the Staff Regulations
Arguments of the parties
Findings of the Court
The plea in law of breach of the duty to have regard to the interests of officials
Arguments of the parties
Findings of the Court
Case T-74/89
The admissibility of the applicant's claim that the Court should recognize his right to 100% reimbursement of the medical and paramedical expenses in connection with his child's serious illness, and the claim that the Court should recognize his right to reimbursement in full of the cost of the remedial teaching programme followed by his daughter
Arguments of the parties
Findings of the Court
Substance
Arguments of the parties
Findings of the Court
Arguments of the parties
Findings of the Court
Arguments of the parties
Findings of the Court
Case T-33/89 and Case T-74/89
Costs
On those grounds,
THE COURT OF FIRST INSTANCE (Fourth Chamber)
hereby:
- 1.Dismisses the actions;
- 2.Orders each party to bear its own costs;
- 3.Orders the applicant to pay the costs in connection with the examination of witnesses.