Mrs van Wegberg-van Brederode left the Netherlands in 1995 to live in Spain
with her husband, who receives a Netherlands pension from the competent Netherlands institutions.
They registered with the Spanish sickness insurance institution. Having consulted a Spanish doctor,
who prescribed an operation, Mrs van Wegberg-van Brederode went to the Netherlands to
be operated upon.
ANOZ Zorgverzekeringen, a Netherlands sickness insurance institution, refused the applications for reimbursement by
the two Netherlands hospitals, despite the issuing of a Form E 111 by
the local French and Spanish institutions, because the care in question did not
satisfy the conditions laid down in the Community regulation on social security for
migrant workers. In this case, the persons concerned should have obtained a Form
E 112, required where an insured person wishes to obtain authorisation to move
to another Member State in order to receive medical care there, and the
sickness insurance institutions in the States of residence refused to issue it retroactively.
Mr van der Duin and Mrs van Wegberg-van Brederode brought actions before the
Netherlands courts against the refusal by ANOZ Zorgverzekeringen to assume responsibility.
The Centrale Raad van Beroep (Higher Social Security Court) has asked the Court
of Justice of the EC which Member State must assume responsibility for the
medical care and which sickness insurance institution is competent to issue the prior
authorisation in such a situation.
The Court holds that once a pensioner and the members of his or
her family have registered with the competent institution of the Member State of
residence, they benefit, by virtue of the Community regulation, from a right to
benefits in kind from that sickness insurance institution just like any other pensioner
living in the territory of that Member State.
It follows that the institution which has the authority to authorise those socially
insured persons to go to another Member State, including the Member State liable
for payment of the pension, in order to receive benefits in kind there
under the conditions laid down by the Community regulation, is the institution of
the place of residence of the persons concerned. That institution is the one
best able to verify in a particular case whether the conditions for issuing
prior authorisation are fulfilled.
Available in all languages. For the full text of the Judgment, please consult our internet page www.curia.eu.int at approximately 3 pm today. For additional information please contact Christopher Fretwell: Phone: (00 352) 4303 3355; Fax: (00 352) 4303 2731. |
Regulation No 1408/71, amended by Regulation No 2001/83 (OJ 1993 L 230, p.
6)