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

52 Special Solidarity Fund KCE Reports 133
The judgements of the labour court are not systematically monitored by the SSF and do
not serve as guidelines for decisions on individual cases (personal communication
medical directors). This is not so surprising since there’s no continuity and uniformity in
the interpretation of some of the eligibility criteria by the courts. The following
examples illustrate the divergence of judgements.
• Expensive
There is no consensus between labor courts about the fact if the personal financial
situation of the respective patient has to be taken into account. For instance, the labor
court of Antwerp 23 stated that given the social basis inherent to the SSF, the assessment
of the term “expensive” has to be related to the financial situation of the patient. The
labor court of Gent 24 on the other hand judged that the notion “expensive” has to be
set according to objective standards and in function of the treatment and the aim of
treatment.
• Threatening the vital functions of the patient
There is a tendency towards a broader interpretation of this criterion in Jurisprudence.
According to the strict interpretation of the Labor Court in 1999 25 , the criterion has to
be understood as following: “necessary functions of the human body, such as
conscience, respiration, the heart and blood circulation”. 18 Broad interpretations refer
to a primordial interest for living or functioning 27 . In that scope psychosocial diseases
and quality of life can also be taken into account. 28-30 In the preparatory documents of
the law of 2005 the Minister has explicated that a vital function is an essential function
such as the sight, even if the disease the patient is suffering from is not life threatening. 31
The labor Court of Antwerp supported this vision in its decision of 10 May 2005 stating
that the requirement of the life threatening character of the disease adds a criterion
that is not provided in law. 32
• Steps from application to reimbursement
The consecutive steps from submitting a request for reimbursement till the final
payment of the amount approved by the SSF are summarized the figure below:
18 other court rulings supporting the strict interpretation: Arbh. Gent 10 mei 2002, vijfde kamer, A.R. nr.
2001/164, quoted by J. Diependaele 19; Arbh. Gent (afd. Gent) 14 juni 2004 26