PART III
DETAILED PROVISIONS GOVERNING THE VARIOUS
CATEGORIES OF BENEFITS
CHAPTER 1:
INVALIDITY, OLD-AGE AND SURVIVORS' BENEFITS
Common Provisions
ARTICLE 14
Where an insured person has been subject successively or alternatively to the legislation of 2 or more Participating States, such insured person or his survivors shall be entitled to benefits in accordance with the provisions of this Chapter, even if an insured person could be entitled to claim benefits under the legislation of one or more of the Participating States without the provisions of this Chapter being applied.
ARTICLE 15
Where the legislation of a participating State makes the acquisition or maintenance of entitlement to benefits conditional upon the completion of a number of insurance periods, the institution administering that legislation shall, to that end, for the purpose of adding periods together, take account of all insurance periods completed under the legislation of any other Participating State treating them as periods completed under the legislation of the first State.
ARTICLE 16
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1. The institution of each Participating State to whose legislation the person concerned has been subject shall determine, in accordance with the legislation which it applies, whether such person satisfies the conditions for entitlement to benefits having regard, where appropriate, to the provisions of Article 15.
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2. If the person concerned satisfies those conditions, the said institution shall calculate the notional amount of the benefit he could claim if all the insurance periods completed under the different legislation of the Participating States concerned, and taken into account in accordance with the provisions of Article 15 for determining entitlement, had been completed exclusively under the legislation applied by the said institution.
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3. The actual amount payable by the said institution shall bear a direct ratio to the notional amount calculated in accordance with the preceding paragraph as the number of insurance periods completed under the legislation of that institution bears to the total number of insurance periods completed before the contingency arose under the legislation of all the Participating States.
ARTICLE 17
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1. For the purposes of calculating the notional amount referred to in paragraph 2 of Article 16, where the legislation of a Participating State provides that benefits are to be calculated on the sum total of insurable earnings or number of contributions, the earnings or contributions to be taken into account by the competent institution of that State with respect to the periods completed under the legislation of other Participating States shall be determined on the basis of the average earnings or the contributions recorded for the periods completed under the legislation of the first-mentioned State.
ARTICLE 18
Where the legislation of a Participating State provides that the amount of benefit shall vary according to the number of dependants of the insured, the competent institution shall also take account of the dependants resident in the territory of another Participating State, as if such dependants were resident in the territory of the first Participating State.
ARTICLE 19
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1. Where at any given date an insured person does not satisfy the qualifying conditions required by the legislation of all the Participating States concerned (regard being had to to the provisions of Article 15) but satisfies the qualifying conditions required by only one or more of them, then the amount of the benefits payable shall be calculated in accordance with paragraphs 2 and 3 of Article 16 by each of the competent institutions applying the legislation the qualifying conditions of which are fulfilled.
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Provided that—
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(a) Where the insured person concerned satisfied the conditions of at least 2 legislation within any need to include period of insurance completed under legislations, the conditions of which are not fulfilled, such periods shall not be taken into account for the purpose of applying the provisions of paragraphs 2 and 3 of Article 16;
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(b) where the insured person concerned satisfies the qualifying conditions of one legislation only without any need to invoke the provisions of Article 15, the amount of benefit payable shall be calculated exclusively in accordance with the provisions of the legislation the qualifying conditions of which are fulfilled, taking account of periods completed under that legislation only.
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2. Benefits awarded under one or more of the legislations concerned in the cases covered by the preceding paragraph shall be automatically recalculated in accordance with the provisions of paragraphs 2 and 3 of Article 16 as and when the qualifying conditions prescribed by one or more of the other legislations concerned are satisfied, the provisions of Article 15 being taken into account, where applicable.
ARTICLE 20
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1. Where the amount of benefits which an insured person would be entitled to claim under the legislation of a Participating State, disregarding the provisions of Articles 15 and 18 is greater than the sum total of the benefits payable in accordance with those provisions, the competent institution of that State shall pay him a supplement equal to the difference between the 2 amounts and shall bear the whole cost thereof.
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2. In cases where the application of the preceding paragraph of this Article would result in payment of the insured person concerned of supplements from the institutions of 2 or more Participating States, he shall be entitled to the largest supplement only, the cost of such supplement being apportioned among the competent institutions of the said Participating States according to the ratio between the amount of the supplement which each of them would have to pay if it alone had been concerned and the amount of the combined supplement which all the said institutions would have had to pay.
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3. The supplement referred to in the preceding paragraphs of this Article shall be deemed to be a component of the benefits provided by the institution liable for payment. Its amount shall be determined once and, and for all, except where it may be necessary to apply the provisions of paragraph 2 of Article 18.
SPECIAL PROVISION CONCERN: INVALIDITY BENEFIT
ARTICLE 21
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1. Where appropriate, invalidity benefits its shall be converted to old-age benefits, subject to the conditions prescribed by the legislation or legislations under which they have been awarded and in accordance with the provisions of Articles 15 to 19.
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2. Where, in the cases referred to in Article 18, a recipient of invalidity benefits payable under the legislation of one or more of the Participating States becomes entitled to old-age benefit, any institution liable to pay invalidity benefits shall continue to pay such recipient the benefit to which he is entitled under the legislation which it applies until such time as the provisions of the preceding paragraph become applicable in respect of that institution.
CHAPTER II:
BENEFITS IN THE CASE OF EMPLOYMENT INJURIES
AND OCCUPATIONAL DISEASE
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1. An insured person resident in the territory of a Participating State other than the competent State, who suffer personal injury caused by accident or contracts an occupational disease shall receive, in the territory of the participating State where he is resident—
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(a) benefits in kind, to be provided directly by the institution of the place of residence, at the expense and on behalf of the competent institution, in accordance with the provisions of the legislation which the institution of the place of residence administers, as if the insured person was subject to the legislation applied by that institution;
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(b) cash benefits, paid out directly by the competent institution under the legislation administered by the institution, as if the insured person were resident in the territory of the competent State; however where an agreement has been reached to this effect between the competent institution and the institution of the place of residence, such cash benefits may be paid out directly by the institution of the place of residence on behalf and at the expense of the competent institution.
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2. Where an insured person covered by this Article transfers his residence to or makes a stay in the territory of the competent State he shall receive benefit in accordance with the provisions of the legislation of the said State, even if he has commenced to draw benefit elsewhere before his stay or transfer of residence.
ARTICLE 23
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1. An insured person, having sustained personal injury caused by accident or having contracted an occupational disease who—
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(a) is staying in the territory of a Participating State other than the competent State; or
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(b) after having become entitled to benefits payable by the competent institution, is authorised by the said institution to return to the territory of a Participating State other than the competent State where he is resident, or to transfer his residence to the territory of a Participating State other than the competent State; or
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(c) is authorised by the competent institution to move to the territory of a Participating State other than the competent State in order to receive the treatment necessary for his condition;
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shall be entitled to—
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(i) benefits in kind provided on behalf and at the expense of the competent institution by the institution of the place of residence or of stay, in accordance with the as if such insured person was subject to the provisions of the legislation applied by that institution,
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(ii) cash benefits, paid out directly by the competent institution, under the provisions of the legislation applied by that institution, as if the insured person were resident or staying in the territory of the competent State; however, where an agreement has been reached to this effect between the competent institution and the institution of the place of stay or residence, such cash benefits may be paid out directly by the institution of the place of stay or residence on behalf and at the expense of the competent institution.
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2.
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(a) The authorisation referred to in sub-paragraph (b) of the preceding paragraph may be refused only it the move might prejudice the health or the course of medical treatment of the insured person.
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(b) The authorisation referred to in sub-paragraph (c) of the preceding paragraph shall not be refused when the requisite treatment cannot be given in the territory of the Participating State in which the insured person resides.
ARTICLE 24
In the cases referred to in paragraph 1 of Article 21 and paragraph (i) of Article 22, the competent authorities of 2 or more Participating States may agree to make the provision of prosthetic appliances, major aids and other major benefits in kind conditional on the prior authorisation of the competent institution.
ARTICLE 25
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1. Where the legislation of the competent State provides for payment of the cost of transporting the injured person to his place of residence or to hospital, the cost of transport to the corresponding place in the territory of another Participating State where he is resident shall be defrayed by the competent institution, in accordance with the provisions of the legislation it applies; provided it has given prior authorisation for the said transport, due account being taken of the reasons justifying it.
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2. Where the legislation of the competent State makes provision for the payment of the cost of transporting the body of a deceased worker to the place of burial, the cost of transport to the corresponding burial place in the territory of another Participating State where the deceased was resident shall be borne by the competent institution, in accordance with the legislation it applies.
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3. The application of the paragraphs of this Article between 2 or more of the Participating States may be subject to the making of agreements between the said States.
ARTICLE 26
A Participating State shall provide benefits in kind for employment injuries to any person insured with another Participating State who happens to be in the territory of the first-mentioned Participating State.
ARTICLE 27
Where the legislation of a Participating State explicitly or implicitly provides that previous employment injuries or occupational diseases shall be taken into account in the assessment of the degree of incapacity, the competent institution of that State shall also take into account for this purpose employment injuries or occupational diseases previously recognised in accordance with the legislation of any other Participating State, as if they had occurred under the legislation of that State.
ARTICLE 28
Where the legislation of a Participating State fixes a maximum period for the provision of benefits the institution which applies that legislation may, where appropriate, take account of any period during which benefits have already been provided by the institution of another Participating State for the same case of employment injury or occupational disease.
Where the legislation of a Participating State provides that cash benefits are payable to dependents, the competent institution of the said State shall also take account of dependents resident in the territory of another participating State, as if they reside in the territory of the first-mentioned State, and appropriate apportionments shall be made accordingly where possible.
ARTICLE 30
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1. Where an insured person certified as having contracted an occupational disease was engaged, under the legislation of 2 or more participating States, in an activity likely to cause such disease, the benefit entitlement of such insured person or his dependents shall be assessed exclusively under the legislation of the last of such Participating States whose conditions for entitlement are fulfilled.
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2. Where the legislation of a participating State makes entitlement to benefits for occupational disease conditional on the occupation liable to cause the disease in question having been followed for a specified period, the competent institution of that State shall take into account, to the extent necessary, all periods during which such an occupation was followed in the territory of any other participating State.
ARTICLE 31
Where an insured person having contracted an occupational disease has received or continues to receive benefit paid by the institution of a participating State, and, in the event of an aggravation of his condition, claims benefit from the institution of another Participating State, the following provisions shall apply:
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(a) where the insured person was not engaged, under the legislation of the second State, in an occupation liable to cause or aggravate the disease in question, the competent institution of the first State shall bear the cost of the benefit, taking the aggravation into account, in accordance with the legislation it applies;
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(b) where the insured person was engaged in such an occupation under the legislation of the second State, the competent institution of the first State shall bear the cost of the benefit, leaving the aggravation out of account, in accordance with the legislation applied by it; the competent institution of the second State shall grant a benefit supplement equal to the difference between the rate of benefit payable after the aggravation of his condition and the rate previously payable, in accordance with the legislation applied by it.
ARTICLE 32
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1. The competent institution shall reimburse the cost of benefits in kind paid out on its behalf by the institution of the place of residence or stay under paragraph 1 (a) of Article 21 and paragraph 1 (c) (i) of Article 22.
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2. The reimbursements referred to in the preceding paragraph shall be determined and made under arrangements to be agreed between the competent authorities of the Participating States.
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3. Two or more Participating Sates may agree that there shall be no refunds between the institutions in their jurisdiction.
ARTICLE 33
Where the legislation of a Participating State makes the acquisition, maintenance or recovery of entitlement of funeral benefits conditional upon the completion of a number of insurance periods, the institution administering the said legislation shall, to that end, for the purpose of adding periods together, take account, to the extent necessary, of all insurance periods completed under the legislation of any of the other Participating States, treating them as periods completed under the legislation of the first State.
ARTICLE 34
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1. Where a person dies in the territory of a Participating State other than the competent State, the death shall be deemed to have occurred in the territory of the competent State.
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2. The competent institution shall provide funeral benefits due under the legislation which it applies, even if the beneficiary resides in the territory of a Participating State other than the competent State.
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3. Where funeral benefits are payable in respect of the same death under the legislation of 2 or more Participating States only the largest of these benefits shall be paid; all the benefits payable under the different legislation shall be added together firstly and each Participating State shall be liable to pay a proportion of the largest benefit, such proportion representing the ratio which the benefit payable under each Participating State's legislation bears to the sum total of all the benefits payable under the different legislation.
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4. The provisions of the preceding paragraphs of this Article shall apply also where death results from employment injuries or occupational diseases.
CHAPTER IV:
SICKNESS AND MATERNITY
ARTICLE 35
Where the legislation of a Participating State makes the acquisition or maintenance of entitlement to benefits conditional upon the completion of a number of insurance periods, the institution administering that legislation shall, to that end, for the purpose of adding periods together, take account of all insurance periods completed under the legislation of any other Participating State, treating them as periods completed under the legislation of the first State.
ARTICLE 36
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1. An insured person resident in the territory of a Participating State other than the competent State and who satisfies the conditions for entitlement specified by the legislation of the latter State, regard being had, where appropriate, to the provisions of Article 34, shall receive in the territory of the Participating State in which he or she is resident, cash benefits, paid out directly by the competent institution under the legislation administered by that institution, as if the insured person were resident in the territory of the competent State, however, where an agreement had been reached to this effect between the competent institution and the institution of the place of residence, such cash benefits may be paid out directly by the institution of the place of residence on behalf of and at the expense of the competent institution.
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2. Where an insured person covered by this Article transfers residence to or makes a stay in the territory of the competent state he or she shall receive benefits in accordance with the provisions of the said legislation of the said State even if he or she has commenced to draw benefit for the same case of sickness or maternity elsewhere before the stay or transfer of residence.
ARTICLE 37
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1. An insured person who satisfies the conditions for entitlement to benefits under the legislation of the competent State, regard being had, where appropriate, to the provisions of Article 34, and who:
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(a) has a condition which necessitates the immediate provision of benefits during a stay in the territory of a Participating State other than the competent State; or
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(b) after having become entitled to benefits payable by the competent institution, is authorised by the said institution to return to the territory of a Participating State other than the competent State where he or she is resident or to transfer residence to the territory of a Participating State other than the competent State; or
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(c) is authorised by the competent institution to move to the territory of a Participating Sate other than the competent State in order to receive the treatment necessary for his or her condition,
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shall be entitled to cash benefits, paid out directly by the competent institution under the provisions of the legislation applied by that institution, as if the insured person were resident or staying in the territory of the competent State; however, where an agreement has been reached to this effect between the competent institution and the institution of the place of stay or residence, such cash benefits may be paid by the institution of the place of stay or residence, on behalf and at the expense of the competent institution.
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2.
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(a) The authorisation referred to in sub-paragraph (b) of the preceding paragraph may be refused only if the move might prejudice the health or the course of medical treatment of the insured person;
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(b) the authorisation referred to in sub-paragraph (c) of the preceding paragraph shall not be refused when the requisite treatment cannot be given in the territory of the Participating Sate in which the insured person resides.
ARTICLE 38
Where the legislation of a Participating State provides that cash benefits are payable to dependents, the competent institution of the said State shall also take account of dependents resident in the territory of another Participating State, as if they were resident in the territory of the first-mentioned State and appropriate apportionment shall be made accordingly where possible.
ARTICLE 39
Where the legislation of a Participating State fixes a maximum period for the provision of benefits, the competent institution of the said Participating State shall also, where appropriate, take account of any period during which benefits have already been provided by any other of the Participating States for the same case of sickness or maternity.