Optimalisatie van de werkingsprocessen van het Bijzonder ... - KCE

50 Special Solidarity Fund KCE Reports 133
Figure 12: Proportion of completed SSF applications in the SSF sample by
year in function of type between 2004 and 2008 (only applications taking
longer than 30 days are shown)
5.2.5 Appeal procedure
If the patient disagrees with the decisions of the SSF, he can launch an appeal to the
labour court (Art. 580, 2° Gerechtelijk Wetboek 17 en art. 167, 1° van de Wet
betreffende de verplichte verzekering voor geneeskundige verzorging en uitkeringen,
gecoördineerd op 14 juli 1994). 1817
The content of the competence of the labour courts was for a long time under
discussion. It was affirmed by jurisprudence and doctrine however that if the College of
medical directors judges on the eligibility criteria, this is not a discretionary power. 22
Discretionary power implies freedom of judgement (when a criterion is vague and has
to be interpreted) and policy freedom (freedom to decide, even if a situation complies
with the criteria). The fact that the College can only strictly apply the legal criteria
implies that in case the labour courts have full judicial power (on the reasonability of
decision-making and on the content of the decision). With regard to the amount that
will be allocated however, the college has discretionary powers. Consequently labour
courts solely have the competence to judge the reasonability of decision-making, not
the content of the decision (= the amount). This implies that a judge can annul the
decision of the College on the allocated amount but not judge on the amount itself.
The numbers of registered cases that were introduced to the labour courts varies from
100 in 2004, 74 in 2005, 44 in 2006, 52 in 2007 to 23 in 2008. These numbers reflect
the number of cases that were brought to court during those years. They can be related
to decisions of the SSF from different years. In the SSF sample, the applications treated
by the labour court amount to 144 decisions (1.75% of all applications and 2.56% of all
accepted applications). Mostly decisions concerning diseases of the nervous or the
circulatory system (see table 8); and implants and drugs are brought before the labour
court (see table 9).
17 For an overview of judgments of the labour courts, J. Diependaele, “Het Bijzonder Solidariteitsfonds,
blijvende bron van controverses” 19, J. Put, “Het Bijzonder Solidariteitsfonds: interpretatie en beleid”, noot
onder Arbeidshof Gent 3 maart 2000 20, W. Bourry, “Het bijzonder solidariteitsfonds: een deur die nooit
opengaat”. 21