Service Incurred Accident or Illness – Appendix D

This section outlines the process for submitting claims related to medical expenses resulting from an accident or illness attributable to the performance of official duties on behalf of the employing organization.

Naturally, this section is only applicable to staff members, not to dependents and retirees.

 

Incidents/accidents generally considered service-incurred:

  • Injury, illness or death that occurs while engaged in an activity and at a place required for the performance of official duties
  • Incidents that occur during official travel
  • Injury, illness or death that was directly due to presence, in accordance with an assignment by the United Nations, in an area involving special hazards identified by UN security, and occurred as a result of such hazards

 

Exclusions:

  • Misconduct, recklessness, gross negligence, wilful intent
  • Disregard of security requirements, or failure to use safety devices or medical prophylaxis
  • Physical confrontation or violence
  • Pre-existing medical condition

It is necessary to file any work-related accident for compensation under Appendix D of the UN Staff Rules, which contains the provisions for accidents, illnesses and death related to performance of official functions as per Rule VIII/Article 7(d) of UNSMIS Internal Rules, as defined below:

“Benefits shall be waived altogether or reduced to take account of recoveries available (i) from the United Nations under the Staff Rules or other provisions; (ii) from a third party who is liable in respect of the illness or accident giving rise to the claim; (iii) from another insurance providing coverage of the illness or accident giving rise to the claim.”

When a claim is related to a service-incurred illness or injury, it does not need to be submitted through the eClaims portal or the UNSMIS mobile app. The reason is very simple; a claim recognized as service incurred is reimbursed at up to 100% under Appendix D, whilst non-service incurred claims are reimbursed in accordance with the rules and regulations of UNSMIS, often at 80% of expenses.
However, as in case of claims submitted under Appendix D, the review process may take significant time, you may submit the claim on eClaims as usual. UNSMIS will advance reimbursement in accordance with its rules and regulations.

  • Should the accident or illness be recognized as service incurred, once the Appendix D is finalized, members will be reimbursed additionally for the part of the expenses not covered by UNSMIS.
  • Should the accident or illness not be recognized as service incurred, members will have already been reimbursed in advance by UNSMIS.

Either way, as a staff member and an insured member of UNSMIS, you are not penalized for pursuing a service incurred claim.

 

How to file a claim under Appendix D

This section provides guidance on how to submit a claim under Appendix D, including the documents required for review. As each case is assessed individually, additional documentation may be requested during the evaluation process.

All documentation—such as medical reports and invoices—must be submitted in either English or French, the official working languages of the United Nations, or accompanied by translations into one of these languages.

Claims must be submitted within twelve months from the date of the injury or the onset of the illness.

 

Requested documents:

  • To file a claim, an electronic compensation claim form (available here) should be completed.
    • Although it is in an electronic format, the claim must be printed and duly signed to be receivable.
  • Medical reports relating to the injury or illness being claimed should be submitted.
    • If the illness being claimed is a psychiatric condition, a report from a psychiatrist (not a psychologist) is required.
  • Any other documentation, information or data requested which is relevant to assessing the claim, e.g., security or police reports, etc. should be attached as well.
  • Medical bills must be submitted in original form, together with the corresponding proof of payment under cover of a claim form (available here).

For cases involving harassment, abuse of authority, or burnout, additional documentation is required. The summary below is intended to guide you in preparing and submitting the necessary supporting documents.

 

How to submit a claim for for harassment or abuse of authority

As it is not within the purview of the Advisory Board on Compensation Claims (ABCC) to verify an allegation of harassment or abuse of authority and as the Organization has established legislation, procedures and recourse for such allegations, claims based on such allegations are receivable by the ABCC only when the Organization has made a definitive finding on whether there has been harassment or an abuse of authority in a specific case.

 

How to submit a claim for “burnout”

Claims based on allegations of burnout are receivable by the Advisory Board on Compensation Claims (ABCC) only when they meet both a medical and administrative burden of proof.
Medically, claimants must provide a report from a psychiatrist that gives a summary of the illness, including a diagnosis, treatment to date, any proposed treatment and prognosis. Administratively, claimants must provide evidence that

  • their workload was in excess of that outlined in the job description and inconsistent with their position or grade;
  • they raised the issue of the excess workload and its impact on health through appropriate channels, and that their supervisor(s) were aware of the claim that their workload was affecting their health; and
  • having raised the issue, their requests were not reasonably addressed and/or there was inadequate organizational support provided to mitigate the impacts on their health.

Upon receipt of the claim, the relevant Medical Services Division (MSD) will conduct a review to determine whether the medical expense is:

  • directly related to the service-incurred injury/illness,
  • a reasonable treatment for the condition, and
  • charged at a reasonable cost for the service provided.

If the claim is approved, the following types of compensation may be granted:

  • reimbursement of medical expenses (as certified by the Medical Services Division)
  • a one-time lump-sum payment for a permanent loss of function or impairment total disability benefit
  • compensation to surviving spouses and dependent children in cases of death
  • coverage of certain funeral expenses

The following items are not eligible for compensation under Appendix D:

  • legal fees and associated expenses
  • transportation costs
  • other non-medical expenses
  • consequential damages
  • pain and suffering

For further information, please contact the Compensation Claim Unit at the United Nations Office in Geneva (UNOG) via compensationclaims@un.org or consult their website (available here).

UNHCR staff member should contact UNHCR’s Headquarters Liaison & Compensation Unit, HR Staff Services via hqappdxd@unhcr.org.