++++
Social security for migrant workers ° Benefits payable under the legislation
of one Member State for injury sustained in the territory of another Member
State ° Right of recoupment of the institutions responsible for benefits
against the liable third party ° Determination according to the national
law of the institution responsible ° National law not allowing the institution
to be subrogated or bring an action for recoupment ° Not effective against
institutions of the other Member States
(Council Regulation No 1408/71, Art. 93(1))
Article 93(1) of Regulation No 1408/71 must be interpreted as meaning that the
conditions and extent of the right of recoupment which a social security institution
within the meaning of that regulation has against the party who has caused an
injury in the territory of another Member State, which has entailed the payment
of social security benefits intended to cover costs such as hospital and transport
costs, are determined in accordance with the law of the Member State to which
that institution is subject. In particular, provisions of a Member State excluding
subrogation of the institution responsible for benefits to the rights which
the recipient of the benefits has against the third party liable to make good
the damage, and excluding the right of the institution to claim directly against
the third party, do not exclude claims by institutions responsible for benefits
in other Member States.
That provision has the object of allowing a social security institution, which
has paid benefits following an injury sustained in the territory of another
Member State, to exercise against the third party liable for the injury the
rights of action provided for by the legislation which it administers, that
being a logical and fair counterpart to the extension of the obligations of
those institutions throughout the entire Community, and must be seen as a conflict-of-laws
rule requiring the national court hearing an action for compensation brought
against the party liable for the injury to apply the law of the Member State
to which the institution responsible is subject, not only to determine whether
that institution is subrogated by law to the rights of the injured party or
has direct rights against the third party liable, but also to determine the
nature and extent of the claims to which the institution responsible for benefits
is subrogated or which it can bring directly against a third party.
The purpose of Article 93(1) is not, however, to alter the rules applicable
for determining whether and to what extent there is non-contractual liability
on the part of the third party who has caused the injury, so that that liability
remains subject to the substantive rules which are normally to be applied by
the national court before which proceedings are brought by the institution responsible
or by the victim, in other words, in principle the legislation of the Member
State in whose territory the injury has occurred.
In Case C-428/92,
REFERENCE to the Court under Article 177 of the EEC Treaty by the OEstre Landsret,
Denmark, for a preliminary ruling in the proceedings pending before that court
between
Deutsche Angestellten-Krankenkasse (DAK)
and
Laererstandens Brandforsikring G/S
on the scope of Article 93(1) of Council Regulation (EEC) No 1408/71 of 14 June
1971 on the application of social security schemes to employed persons, to self-employed
persons and to members of their families moving within the Community, as amended
and updated by Council Regulation (EEC) No 2001/83 of 2 June 1983 (OJ 1983 L
230, p. 6),
THE COURT (Fifth Chamber),
composed of: J.C. Moitinho de Almeida, President of the Chamber, D.A.O. Edward,
G.C. Rodríguez Iglesias, F. Grévisse (Rapporteur) and M. Zuleeg,
Judges,
Advocate General: C.O. Lenz,
Registrar: H.A. Ruehl, Principal Administrator,
after considering the written observations submitted on behalf of:
- the defendant in the main proceedings, by Mikael Rosenmejer, of the Copenhagen
Bar,
- the German Government, by Ernst Roeder, Ministerialrat in the Federal Ministry
of the Economy, and Claus-Dieter Quassowski, Regierungsdirektor in that ministry,
acting as agents,
- the Greek Government, by Vasileios Kontolaimos, Deputy Legal Adviser in the
State Legal Service, and Ioannis Chalkias, legal representative of the State
Legal Service, acting as Agents,
- the Commission of the European Communities, by Anders Christian Jessen and
Maria Patakia, of its Legal Service, acting as Agents,
having regard to the Report for the Hearing,
after hearing the oral observations of the plaintiff in the main proceedings,
represented by Jeffrey P. Galmond, of the Copenhagen Bar, the defendant in the
main proceedings, the Greek Government and the Commission, represented by Dimitrios
Gouloussis, Legal Adviser, and Anders Christian Jessen, acting as Agents, at
the hearing on 3 March 1994,
after hearing the Opinion of the Advocate General at the sitting on 14 April
1994,
gives the following
Judgment
1 By order of 17 December 1992, received at the Court on 23 December 1992, the
OEstre Landsret (Eastern District Court) referred to the Court for a preliminary
ruling under Article 177 of the EEC Treaty four questions on the interpretation
of Article 93 of Council Regulation (EEC) No 1408/71 of 14 June 1971 on the
application of social security schemes to employed persons, to self-employed
persons and to members of their families moving within the Community, as codified
by Council Regulation (EEC) No 2001/83 of 2 June 1983 (OJ 1983 L 230, p. 6,
hereinafter "the regulation").
2 Those questions were raised in proceedings between Deutsche Angestellten-Krankenkasse
("DAK"), a German social security institution, and Laererstandens
Brandforsikring G/S ("LB"), a Danish insurance company which inter
alia writes motor insurance policies, concerning the recoupment of sums paid
by DAK following an accident in Denmark to the daughter of its insured, Andrea
Edith Leipelt.
3 Mrs Leipelt' s daughter was the victim of a road accident on 5 October 1986
caused by a Danish motorist who was insured against third party liability by
LB. She was in hospital in Denmark from 5 to 8 October 1986 and was then transported
to Germany, where she stayed in hospital from 8 October to 9 November 1986.
4 DAK paid the entire cost of the hospital treatment and the transport, namely
DKR 6 600 for the stay in hospital in Denmark, DKR 712.48 for the transport
from Denmark to Germany and DM 8 188.95 for the stay in hospital in Germany.
5 DAK brought proceedings against LB before the Koebenhavns Byret (District
Court, Copenhagen) and, on appeal, the OEstre Landsret for reimbursement of
the sums it had paid. It based its claims on the rights of the victim, to which
it claimed to have been subrogated under Paragraph 116 of Part X of the Sozialgesetzbuch
(German Social Security Code, hereinafter "SGB X").
6 Under Paragraph 116 of the SGB X:
"An insurer or institution responsible for social security shall be subrogated
to rights under other statutory provisions to compensation for damage, to the
extent that, as a result of the event giving rise to the damage, it has to pay
social security benefits which serve to make good damage of the same kind and
relate to the same period of time as the compensation payable by the party causing
the damage."
7 LB argued that such proceedings were blocked by Paragraph 17(1) and Paragraph
22(2) of the Lov om Erstatningsansvar, Law No 228 of 23 May 1984, as amended
(Danish Law on liability for damages, hereinafter "the Danish law").
8 Paragraph 17(1)(1) of the Danish law provides that:
"Benefits under the social legislation, including unemployment benefits,
medical assistance, pensions under the social pension legislation and benefits
under the Law on industrial injury insurance to which an injured party or a
survivor is entitled cannot form the basis for a recoupment action against the
party liable for the damage."
Paragraph 22(2) of that law provides that:
"In the case of life assurance, accident or sickness insurance or other
personal insurance, the company has no claim against the person liable for damage,
whatever the nature of the insurance."
9 DAK counter-argued that the subrogation which it had the benefit of under
German law had to be recognized by the Danish courts, by virtue of Article 93
of the regulation.
10 The OEstre Landsret thereupon considered the scope of that article and whether
the Danish law could be applied to the proceedings before it.
11 In those circumstances the national court stayed the proceedings pending
a preliminary ruling by the Court of Justice on the following questions:
"1. Is Article 93 of Council Regulation (EEC) No 1408/71 to be interpreted
as governing only the conditions for the right of the institution responsible
for benefits to be subrogated to the rights of the injured party against a third
party or does it also govern the rights to which the institution responsible
may be subrogated?
2. If Article 93 also governs the rights to which the institution may be subrogated,
is the decision on that point to be taken under the legislation of the State
in which the institution responsible is established or under the legislation
of the State in which the injury occurred?
3. Is Article 93 to be interpreted as also determining which of the rights to
which the institution responsible is subrogated can be enforced in the State
where the injury occurred against the liable third party?
4. Is Article 93 to be interpreted as also affording a basis for a recoupment
action by the institution responsible against the liable third party in a case
in which such an action would otherwise have been precluded under the legislation
in the State in which the injury occurred as a result of rules corresponding
to Paragraph 17(1) and Paragraph 22(2) of the Danish Law on liability for damage?"
12 In those four questions, which should be examined together in view of the
close connections between them, the national court is essentially asking which
is the national law applicable under Article 93 of the regulation to determine
the conditions and extent of the right of recoupment of a social security institution
within the meaning of the regulation against the party causing an injury, where
the injury has occurred in the territory of another Member State and has entailed
the payment of social security benefits. The national court wishes to know,
more particularly, whether provisions such as those of Paragraphs 17(1) and
22(2) of the Danish law exclude the bringing of an action by an institution
responsible for benefits in another Member State.
13 The Commission and the German and Greek Governments submit that Article 93
of the regulation requires that the law of the Member State to which the institution
responsible for benefits is subject be applied to determine not only the conditions
but also the extent of the right of recoupment of the institution where the
injury has occurred in the territory of another Member State. In their opinion,
provisions such as Paragraph 17(1) and Paragraph 22(2) of the Danish law thus
do not exclude the bringing of an action by the institution, where that action
is provided for by the law of the Member State to which it is subject.
14 LB considers, on the other hand, that Article 93 of the regulation requires
only that the law of the Member State to which the institution responsible for
benefits is subject be applied to determine whether that institution has a right
of recoupment against a liable third party, but that the extent of that right
must by contrast be determined by the legislation applicable in the Member State
where the event causing the injury has occurred. In its opinion, provisions
such as Paragraph 17(1) and Paragraph 22(2) of the Danish law thus exclude the
bringing of an action by the institution responsible for benefits, even if the
institution is given that right by the legislation of the Member State to which
it is subject.
15 Although the questions as worded refer to Article 93 of the regulation as
a whole, it must be observed that in the light of the statement of grounds accompanying
them, those questions in fact relate solely to the interpretation of Article
93(1). That paragraph reads as follows:
"If a person receives benefits under the legislation of one Member State
in respect of an injury resulting from an occurrence in the territory of another
State, any rights of the institution responsible for benefits against a third
party bound to compensate for the injury shall be governed by the following
rules:
(a) where the institution responsible for benefit is, by virtue of the legislation
which it administers, subrogated to the rights which the recipient has against
the third party, such subrogation shall be recognized by each Member State;
(b) where the said institution has direct rights against the third party, such
rights shall be recognized by each Member State."
16 Like Article 52 of Regulation No 3 of the Council of 25 September 1958 concerning
social security for migrant workers (Journal Officiel 1958 No 30, p. 561), whose
wording it largely reproduces, Article 93(1) of the regulation has the object
of allowing a social security institution, which has paid social security benefits
following an injury sustained in the territory of another Member State, to exercise
against the third party liable for the injury the rights of action provided
for by the legislation which it administers, either by means of subrogation
or by any other legal method (see the judgment in Case 27/69 Entr' aide Médicale
v Assurances Générales [1969] ECR 405, paragraph 15). The rights
thus conferred on national social security institutions constitute a logical
and fair counterpart to the extension of the obligations of those institutions
throughout the entire Community as a result of the provisions of the regulation
(see the judgments in Case 33/64 Betriebskrankenkasse Heseper Torfwerk v Koster
[1965] ECR 97 and Case 44/65 Hessische Knappschaft v Singer [1965] ECR 965).
17 To that end, Article 93(1) of the regulation provides that each Member State
is to recognize the subrogation of the institution responsible for benefits
to the rights which the recipient of the benefits has against the third party
bound to compensate for the injury, or the direct rights of the institution
responsible against the third party, where that institution is so subrogated
or has such rights under the legislation of the Member State to which it is
subject.
18 Article 93(1) must thus be seen as conflict-of-laws rule, which requires
the national court hearing an action for compensation brought against the party
liable for the injury to apply the law of the Member State to which the institution
responsible is subject, not only to determine whether that institution is subrogated
by law to the rights of the injured party or has direct rights against the third
party liable, but also to determine the nature and extent of the claims to which
the institution responsible for benefits is subrogated or which it can bring
directly against the third parties.
19 If the national court were to apply the law of the Member State in whose
territory the injury was sustained to determine the extent of the rights of
the institution responsible, as LB argues, it might have to deprive Article
93(1) of part or all of its practical effect. That would be the case in particular
if the legislation of the Member State in whose territory the injury had been
sustained provided that the subrogation or direct rights did not cover certain
types of claim which the institution responsible could enforce, by means of
subrogation or direct rights, in the Member State to which it was subject.
20 The rights referred to in Article 93(1) of the regulation relate, however,
in accordance with the wording of that article, only to social security benefits
payable as a result of an injury which has occurred in the territory of another
Member State (see the judgment in Case 72/76 Landesversicherungsanstalt Rheinland-Pfalz
v Toepfer [1977] ECR 271, paragraphs 13 to 15). Since LB in its observations
expressed doubt as to whether those rights could relate to benefits intended
to cover costs such as the costs of Miss Leipelt' s hospital treatment in Denmark
and the transport from Denmark to Germany, it must be stated that the benefits
referred to in Article 93(1) include benefits intended to cover costs, such
as hospital or transport costs, incurred in a Member State other than that in
which the institution responsible is established.
21 Finally, it should be noted that Article 93(1) of the regulation is intended
only to ensure that the rights which the institution responsible may have by
virtue of the legislation which it administers are recognized by the other Member
States. Its purpose is not to alter the rules applicable for determining whether
and to what extend there is non-contractual liability on the part of the third
party who has caused the injury. The third party' s liability remains subject
to the substantive rules which are normally to be applied by the national court
before which proceedings are brought by the institution responsible or by the
victim, in other words, in principle the legislation of the Member State in
whose territory the injury has occurred (see on this point the judgments in
Hessische Knappschaft, cited above, and Case 78/72 L' Etoile v Syndicat Général
[1973] ECR 499, paragraph 6).
22 It follows that provisions such as Paragraph 17(1) and Paragraph 22(2) of
the Danish law, which relate to the rights of recoupment of social security
institutions against third parties bound to compensate for injuries as a result
of which social security benefits have been paid, cannot be applied to determine
whether and to what extent an institution responsible for benefits in another
Member State has a right of recoupment against the party who has caused an injury
in the territory of the Member State where those provisions apply. Such provisions
therefore do not preclude a claim by an institution responsible for benefits
in a Member State other than that in which they apply.
23 Consequently, the answer to the national court' s questions must be that
Article 93(1) of the regulation is to be interpreted as meaning that the conditions
and extent of the right of recoupment which a social security institution within
the meaning of the regulation has against the party who has caused an injury
in the territory of another Member State, which has entailed the payment of
social security benefits, are determined in accordance with the law of the Member
State to which that institution is subject. In particular, provisions such as
Paragraph 17(1) and Paragraph 22(2) of the Danish law do not exclude claims
by institutions responsible for benefits in other Member States.
Costs
24 The costs incurred by the German and Greek Governments and by the Commission
of the European Communities, which have submitted observations to the Court,
are not recoverable. Since these proceedings are, for the parties to the main
proceedings, in the nature of a step in the action pending before the national
court, the decision on costs is a matter for that court.
On those grounds,
THE COURT (Fifth Chamber),
in answer to the questions referred to it by the OEstre Landsret by order of
17 December 1992, hereby rules:
Article 93(1) of Council Regulation (EEC) No 1408/71 of 14 June 1971 on the
application of social security schemes to employed persons, to self-employed
persons and to members of their families moving within the Community, as codified
by Regulation (EEC) No 2001/83 of 2 June 1983, must be interpreted as meaning
that the conditions and extent of the right of recoupment which a social security
institution within the meaning of that regulation has against the party who
has caused an injury in the territory of another Member State, which has entailed
the payment of social security benefits, are determined in accordance with the
law of the Member State to which that institution is subject. In particular,
provisions such as Paragraph 17(1) and Paragraph 22(2) of the Lov om Erstatningsansvar,
Law No 228 of 23 May 1984, as amended, do not exclude claims by institutions
responsible for benefits in other Member States.
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