Document Symbol/Reference:
ST/AI/2019/1
Document Type:
Link to UN Official Document (ODS)
Tags:
ST/AI
Document Body:
United Nations ST/AI/2019/1
Secretariat
15 February 2019
19-03760 (E) 080319
*1903760*
Administrative instruction
Resolution of disputes relating to medical determinations
The Under-Secretary-General for Management Strategy, Policy and
Compliance, pursuant to section 4.2 of Secretary-General’s bulletin ST/SGB/2009/4,
and for the purpose of implementing staff rules 6.2 (j)–(l) and article 5.1 of appendix
D to the Staff Rules of the United Nations and establishing conditions and procedures
for medical reviews by an independent medical practitioner or a medical board,
promulgates the following:
Section 1
General provisions
1.1 The present instruction establishes the procedures for resolving disputes relating
to any medical determination by the United Nations Medical Director or a medical
practitioner duly authorized by the Medical Director.
1.2 A request for review of a medical determination does not have the effect of
suspending the implementation of any administrative decision taken on the basis of
the contested medical determination.
1.3 If there is a conflict of interest, independent medical practitioners or Chairs of
medical boards selected to conduct the review of the contested medical determination
must recuse themselves. A conflict of interest shall comprise any instance in which
such medical practitioner’s professional or personal relationships, activities or
interests may impair or reasonably give the appearance of impairing the practitioner’s
impartiality and independence. Former employees of a United Nations organization,
regular treating physicians and members of the same medical office as regular treating
physicians of the staff member must not act as an independent medical practitioner or
as the Chair of a medical board.
Section 2
Requests for review and scope
2.1 Requests for review of medical determinations shall be submitted by staff
members within 60 calendar days of the date on which they received notification,
electronically or in hard copy, of the administrative decisions based on the contested
medical determination.
2.2 Staff members shall submit their requests in writing to one of the following:
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(a) The secretary of the Advisory Board on Compensation Claims, who shall
forward the request to the Medical Director, regarding claims filed under appendix D
to the Staff Rules;
(b) The Medical Director or a duly authorized medical officer, for all other
medical disputes.
2.3 Staff members shall include in their application whether they request a review
of the medical determination by an independent medical practitioner, in accordance
with the procedures set out in section 3 below, or by a medical board, in accordance
with the procedures set out in section 4 below.
Terms of reference
2.4 Once the request for review is received, the Medical Director shall draft the
proposed terms of reference of the independent medical practitioner or medical board,
together with any necessary guidance, and shall provide them to the staff member.
2.5 The terms of reference shall include the following:
(a) The scope of the review, which shall be limited to the medical aspects of
the contested medical determination;
(b) The maximum fees per hour and the reimbursable expenses of the
independent medical practitioner or medical board conducting the review, which shall
be based on reasonable and customary rates applicable to the location, qualification
and specialization of the participants, and the expected duration of the review.
2.6 The staff member may suggest amendments within 14 calendar days of receipt
of the terms of reference. The Medical Director shall have the discretion as to whether
to incorporate the staff member’s suggested amendments into the proposed terms of
reference. The Medical Director shall promptly provide the staff member’s
application and the final terms of reference to the staff member and the independent
medical practitioner or medical board that will conduct the review.
2.7 The Medical Director should engage the medical practitioners conducting the
review through an appropriate individual contractor or consultancy arrangement .
2.8 The projected costs of the review shall be agreed to by the Assistant Secretary-
General for Human Resources or an official with delegated authority before engaging
an independent medical practitioner or the members of a medical board.
Basis of the review
2.9 The review by an independent medical practitioner or medical board shall be
based on the documentation available when the contested medical determination was
issued. Staff members may be required by the independent medical practitioner or
medical board to undergo further medical examinations or diagnostic tests. Any costs
associated with these additional examinations or tests shall form part of the expenses
of the independent medical practitioner or medical board. If staff members refuse to
undergo the additional examinations or tests, the review of the contested medical
determination shall be denied.
2.10 Where a request for review is based on new medical information or on a change
in medical circumstances after the original medical determination was made, the
Medical Director or a duly authorized medical officer shall either confirm the original
determination or issue a new one as follows:
(a) Should the original medical determination be confirmed, the review of the
medical determination shall continue in accordance with the procedures described in
section 3 or 4 below, as applicable;
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(b) Should there be a new medical determination by the Medical Director, the
staff member shall, within 30 days, take one of the following steps:
(i) Agree to the new determination and withdraw the request for review;
(ii) Request for an independent medical practitioner or medical board to
proceed with the review of the new medical determination in accordance with
the procedures described in section 3 or 4 below, as applicable.
2.11 Once an independent medical practitioner has been appointed in accordance
with the procedures set out in section 3 below or a medical board has been convened
in accordance with the procedures set out in section 4 below, any new medical
information or change in medical circumstances must be promptly brought to the
attention of the independent medical practitioner or the Chair of the medical board,
as applicable, who may accept or reject it on the basis of its relevance to the terms of
reference.
Section 3
Review by an independent medical practitioner
3.1 An independent medical practitioner shall be a qualified medical practitioner
who is licensed to practise in the area of medicine that the Medical Director has
determined relevant for the review. The independent medical practitioner shall work
in an official language of the United Nations.
Procedure
3.2 Where a staff member requests a review by an independent medical practitioner,
the Medical Director shall propose a medical practitioner to perform this function and
provide the proposed medical practitioner’s curriculum vitae and associated fees to
the staff member.
3.3 The proposed independent medical practitioner shall be considered accepted if,
within 14 calendar days of receipt of the proposal, the staff member does not refuse
the medical practitioner proposed by the Medical Director.
3.4 If the proposed independent medical practitioner is refused, the staff member
shall provide reasons for such refusal. The Medical Director shall then propose a new
independent medical practitioner in accordance with the procedure described in
sections 3.2 and 3.3 above. The request for review shall be deemed withdrawn after
the staff member’s third refusal of the proposed practitioner.
3.5 The independent medical practitioner shall submit to the Medical Director and
the staff member a report containing a reasoned opinion and advice as to whether to
confirm, modify or reject the contested medical determination, in line with the terms
of reference and written in an official language of the United Nations.
Section 4
Review by a medical board
Composition
4.1 A medical board shall be composed of the following three members:
(a) A qualified medical practitioner selected by the staff member;
(b) The Medical Director or a medical practitioner designated by the Medical
Director;
(c) An independent medical practitioner selected by agreement between the
other two members.
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4.2 Staff members must provide information on the fees of the medical practitioner
they have selected to the Medical Director within 30 calendar days of the finalization
of the terms of reference. The fees of the medical practitioner selected by the staff
member shall not exceed those established in the terms of reference in accordance
with section 2.5 (b) above.
4.3 The third independent medical practitioner selected by the other two members
of the medical board shall be the Chair of the board. If the other two members do not
reach an agreement, the Medical Director must refer the decision to an appropriate
external medical authority, who shall select the Chair. The fees of the Chair shall not
exceed those established in the terms of reference in accordance with section 2.5 (b)
above.
Procedure
4.4 The members of the medical board shall meet in a location and manner
determined by the Chair, including in person, by teleconference or by
videoconference. Necessary travel must be authorized by the Medical Director before
it is undertaken and shall be considered as official business travel governed by
administrative instruction ST/AI/2013/3 on official travel. Travel costs shall be
considered part of the expenses of the medical board.
4.5 The Chair shall provide a report in line with the terms of reference, written in
an official language of the United Nations and containing the following:
(a) The majority view advising, in a reasoned opinion, as to whether to
confirm, modify or reject the contested medical determination;
(b) A dissenting opinion, if any.
The report shall be signed by the Chair and submitted to the Medical Director and the
staff member.
Section 5
Implementation of advice issued by an independent medical practitioner or
medical board
5.1 The Medical Director shall review the report of the independent medical
practitioner or medical board and assess whether it is in line with the terms of
reference provided, and shall take one of the following actions:
(a) When the report is in line with the terms of reference and it is advised to
reject or modify the contested medical determination, the Medical Director shall
rescind the contested medical determination and issue a new medical determination,
taking into account the advice provided by the independent medical practitioner or
medical board;
(b) When the report is not in line with the terms of reference, the Medical
Director may either request the independent medical practitioner or medical board to
revise the report in order to align it with the terms of reference or confirm the
contested medical determination.
5.2 Staff members who have contested a medical determination and officials who
have taken administrative decisions on the basis of the original medical determination
shall be promptly informed of the outcome of the review of the report by the Medical
Director and of any new medical determination taken as a result thereof. Staff
members shall also be informed of any subsequent modified or new administrative
decisions taken on the basis of a new medical determination.
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Section 6
Cost recovery and payment
6.1 If the disputed medical determination is confirmed, if the proposed
modifications have no effect on any administrative decision taken on the basis of the
contested medical determination or if the staff member withdraws the request for
review after the review has begun, the following expenses shall be borne by the staff
member, as applicable:
(a) The medical fees and any expenses of the independent medical
practitioner;
(b) The medical fees and expenses of the Chair and of the practitioner selected
by the staff member.
6.2 The costs of the Medical Director or the medical practitioner designated by the
Medical Director to be a member of the medical board shall be borne by the
Organization.
6.3 If the contested medical determination is not confirmed and its revision triggers
a modification of an administrative decision taken on the basis of the contested
medical determination, the expenses of the independent medical practitioner or
medical board shall be borne by the Organization.
Section 7
Application for review by the United Nations Dispute Tribunal
In accordance with staff rule 11.2 (b), staff members wishing to formally contest
an administrative decision taken pursuant to advice obtained from an independent
medical practitioner or a medical board are not required to request a management
evaluation before filing an application to the United Nations Dispute Tribunal.
Section 8
Final provisions
The present instruction shall enter into force on the date of its issuance.
(Signed) Jan Beagle
Under-Secretary-General
for Management Strategy, Policy and Compliance
Publication Date:
Friday, 15 February 2019
Document Topic/Theme:
Archived:
No
Superseded:
Symbol year:
2019
Symbol Number:
1