The Social Security (Iceland) (Liechtenstein) (Norway) Order (Northern Ireland) 2023

• (2) At the request of the person concerned or of the employer, the competent institution of the State whose legislation is applicable pursuant to Title II of this Convention shall provide an attestation that such legislation is applicable and shall indicate, where appropriate, until what date and under what conditions.

ARTICLE 18 Cooperation between institutions

• (1) The relevant institutions shall communicate to the competent institution of the State whose legislation is applicable to a person pursuant to Title II of this Convention the necessary information required to establish the date on which that legislation becomes applicable and the contributions which that person and their employer(s) are liable to pay under that legislation.

• (2) The competent institution of the State whose legislation becomes applicable to a person pursuant to Title II of this Convention shall make the information indicating the date on which the application of that legislation takes effect available to the institution designated by the competent authority of the State to whose legislation that person was last subject.

ARTICLE 19 Cooperation in case of doubts about the validity of issued documents concerning the applicable legislation

• (1) Where there is doubt about the validity of a document showing the position of the person for the purposes of the applicable legislation or the accuracy of the facts on which the document is based, the institution of the State that receives the document shall ask the issuing institution for the necessary clarification and, where appropriate, the withdrawal or rectification of that document. The requesting institution shall substantiate its request and provide the relevant supporting documentation that gave rise to the request.

• (2) When receiving such a request, the issuing institution shall reconsider the grounds for issuing the document and, where an error is detected, withdraw it or rectify it within 30 working days from the receipt of the request. The withdrawal or rectification shall have retroactive effect. However, in cases where there is a risk of disproportionate outcome, and in particular, of the loss of status as an insured person for the whole or part of the relevant period in the State(s) concerned, the States shall consider a more proportionate arrangement in such case. When the available evidence permits the issuing institution to find that the applicant of the document has committed fraud, it shall withdraw or rectify the document without delay and with retroactive effect.

TITLE III SPECIAL PROVISIONS CONCERNING THE VARIOUS CATEGORIES OF BENEFITS

CHAPTER 1 SICKNESS, MATERNITY AND EQUIVALENT PATERNITY BENEFITS

ARTICLE 20 General implementing provisions

• (1) The competent authorities or institutions shall ensure that any necessary information is made available to insured persons regarding the procedures and conditions for the granting of benefits in kind where such benefits are received in the territory of a State other than that of the competent institution.

• (2) Notwithstanding Article 9(a) of this Convention, a State may become responsible for the cost of benefits in accordance with Article 26 of this Convention only if, either the insured person has made a claim for a pension under the legislation of that State, or in accordance with Articles 27 to 33 of this Convention, they receive a pension under the legislation of that State.

ARTICLE 21 Residence in a State other than the competent State

Procedure and scope of right

• (1) For the purposes of the application of Article 21 of this Convention, the insured person or members of that person’s family shall be obliged to register promptly with the institution of the place of residence. Their right to benefits in kind in the State of residence shall be certified by a document issued by the competent institution upon request of the insured person or upon request of the institution of the place of residence.

• (2) The document referred to in paragraph (1) shall remain valid until the competent institution informs the institution of the place of residence of its cancellation. The institution of the place of residence shall inform the competent institution of any registration under paragraph (1) and of any change or cancellation of that registration.

• (3) This Article applies mutatis mutandis to the persons referred to in Articles 26, 28, 29 and 30 of this Convention.

Health fee reimbursement

• (4) Where a person or the members of that person’s family:

• (a) have been issued with the document referred to in paragraph (1);

• (b) have registered that document with the institution of the place of residence in accordance with paragraph (1); and

• (c) a health fee has been paid by or on behalf of the person or members of their family to the State of residence as part of an application for a permit to enter, stay, work or reside in that State,

that person or members of that person’s family may apply to the institution of the State of residence for reimbursement (in whole or part, as the case may be) of the health fee paid.

• (5) Where a claim is made in accordance with paragraph (1), the institution of the State of residence shall determine that claim within three calendar months, starting on the day the claim was received, and shall make any reimbursement of a health fee paid in accordance with the conditions in this Article.

• (6) Where the period of validity of the document referred to in paragraph (1) is less than the period of time in respect of which the health fee has been paid, the amount reimbursed shall not exceed that portion of the health fee which corresponds to the period for which the document had been issued.

• (7) Where the health fee was paid by another person on behalf of a person to whom this Article applies, reimbursement may be made to that other person.

ARTICLE 22 Stay in a State other than the competent State

Procedure and scope of right

• (1) For the purposes of the application of Article 23 of this Convention, the insured person shall present to the health care provider in the State of stay an entitlement document issued by the competent institution indicating their entitlement to benefits in kind. If the insured person does not have such a document, the institution of the place of stay, upon request or if otherwise necessary, shall contact the competent institution in order to obtain one.

• (2) That document shall indicate that the insured person is entitled to benefits in kind under the conditions laid down in Article 23 of this Convention on the same terms as those applicable to persons insured under the legislation of the State of stay, and shall satisfy the requirements in Appendix 1 of this Annex.

• (3) The benefits in kind referred to in Article 23(1) of this Convention shall refer to the benefits in kind which are provided in the State of stay, in accordance with its legislation, and which become necessary on medical grounds with a view to preventing an insured person from being forced to return, before the end of the planned duration of stay, to the competent State to obtain the necessary treatment.

Procedure and arrangements for meeting the costs and providing reimbursement of benefits in kind

• (4) If the insured person has actually borne the costs of all or part of the benefits in kind provided within the framework of Article 23 of this Convention and if the legislation applied by the institution of the place of stay enables reimbursement of those costs to an insured person, they may send an application for reimbursement to the institution of the place of stay. In that case, that institution shall reimburse directly to that person the amount of the costs corresponding to those benefits within the limits of and under the conditions of the reimbursement rates laid down in its legislation.

• (5) If the reimbursement of such costs has not been requested directly from the institution of the place of stay, the costs incurred shall be reimbursed to the person concerned by the competent institution in accordance with the reimbursement rates administered by the institution of the place of stay or the amounts which would have been subject to reimbursement to the institution of the place of stay, if Article 46 of this Annex had applied in the case concerned.

The institution of the place of stay shall provide the competent institution, upon request, with all necessary information about these rates or amounts.

• (6) By way of derogation from paragraph (5), the competent institution may undertake the reimbursement of the costs incurred within the limits of and under the conditions of the reimbursement rates laid down in its legislation, provided that the insured person has agreed to this provision being applied to them.

• (7) If the legislation of the State of stay does not provide for reimbursement pursuant to paragraphs (4) and (5) in the case concerned, the competent institution may reimburse the costs within the limits of and under the conditions of the reimbursement rates laid down in its legislation, without the agreement of the insured person.

• (8) The reimbursement to the insured person shall not, in any event, exceed the amount of costs actually incurred by them.

• (9) In the case of substantial expenditure, the competent institution may pay the insured person an appropriate advance as soon as that person submits the application for reimbursement to it.

Family Members

• (10) Paragraphs (1) to (9) apply mutatis mutandis to the members of the family of the insured person.

Health fee reimbursement for students

• (11) Where a person:

• (a) holds a valid entitlement document referred to in Appendix 1 of this Annex issued by the competent institution;

• (b) has been accepted by a higher education institution in a State other than the competent State (“State of study”) to pursue a full-time course of study leading to a higher education qualification recognised by that State, including diplomas, certificates or doctoral degrees at a higher education institution, which may cover a preparatory course prior to such education, in accordance with national law, or compulsory training;

• (c) does not exercise, or has not exercised, an activity as an employed or self-employed person in the State of study during the period to which the health fee relates; and

• (d) a health fee has been paid by or on behalf of that person to the State of study as part of an application for a permit to enter, stay or reside for the purposes of pursuing a full-time course of study in that State;

that person may apply to the institution of the State of study for reimbursement (in whole or part, as the case may be) of the health fee paid.

• (12) Where a claim is made in accordance with paragraph (11), the institution of the State of study shall process and settle that claim within a reasonable period but not later than three calendar months starting on the day the claim was received and make any reimbursement of a health fee paid in accordance with the conditions in this Article.

• (13) Where the period of validity of the entitlement document referred to in paragraph (11)(a) is less than the period of time in respect of which the health fee has been paid, the amount of the health fee reimbursed shall be the amount paid which corresponds to the period of validity of that document.

• (14) Where the health fee was paid by another person on behalf of a person to whom this Article applies, reimbursement may be made to that other person.

• (15) Paragraphs (11) to (14) apply mutatis mutandis to the members of the family of that person.

• (16) By way of derogation from Article 8(1) of this Convention, charges may be imposed by the State of study in accordance with its national law in respect of benefits in kind that do not fulfil the criteria set out in Article 23(1)(a) of this Convention and which are provided to a person in respect of whom reimbursement has been made during that person’s stay for the period to which that reimbursement relates.

ARTICLE 23 Scheduled treatment

Authorisation procedure

• (1) For the purposes of the application of Article 24(1) of this Convention, the insured person shall present a document issued by the competent institution to the institution of the place of stay. For the purposes of this Article, the competent institution shall mean the institution which bears the cost of the scheduled treatment; in the cases referred to in Article 24(4) and Article 31(5) of this Convention, in which the benefits in kind provided in the State of residence are reimbursed on the basis of fixed amounts, the competent institution shall mean the institution of the place of residence.

• (2) If an insured person does not reside in the competent State, they shall request authorisation from the institution of the place of residence, which shall forward it to the competent institution without delay.

In that event, the institution of the place of residence shall certify in a statement whether the conditions set out in the second sentence of Article 24(2) of this Convention are met in the State of residence.

The competent institution may refuse to grant the requested authorisation only if, in accordance with the assessment of the institution of the place of residence, the conditions set out in the second sentence of Article 24(2) of this Convention are not met in the State of residence of the insured person, or if the same treatment can be provided in the competent State itself, within a time-limit which is medically justifiable, taking into account the current state of health and the probable course of illness of the person concerned.

The competent institution shall inform the institution of the place of residence of its decision.

In the absence of a reply within the deadlines set by its national legislation, the authorisation shall be considered to have been granted by the competent institution.

• (3) If an insured person who does not reside in the competent State is in need of urgent vitally necessary treatment, and the authorisation cannot be refused in accordance with the second sentence of Article 24(2) of this Convention, the authorisation shall be granted by the institution of the place of residence on behalf of the competent institution, which shall be immediately informed by the institution of the place of residence.

The competent institution shall accept the findings and the treatment options of the doctors approved by the institution of the place of residence that issues the authorisation, concerning the need for urgent vitally necessary treatment.

• (4) At any time during the procedure granting the authorisation, the competent institution shall retain the right to have the insured person examined by a doctor of its own choice in the State of stay or residence.

• (5) The institution of the place of stay shall, without prejudice to any decision regarding authorisation, inform the competent institution if it appears medically appropriate to supplement the treatment covered by the existing authorisation.

Meeting the cost of benefits in kind incurred by the insured person

• (6) Without prejudice to paragraph (7), Article 22(4) and (5) of this Annex apply mutatis mutandis.

• (7) If the insured person has actually borne all or part of the costs for the authorised medical treatment themselves and the costs which the competent institution is obliged to reimburse to the institution of the place of stay or to the insured person according to paragraph (6) (actual cost) are lower than the costs which it would have had to assume for the same treatment in the competent State (notional cost), the competent institution shall reimburse, upon request, the cost of treatment incurred by the insured person up to the amount by which the notional cost exceeds the actual cost. The reimbursed sum may not, however, exceed the costs actually incurred by the insured person and may take account of the amount which the insured person would have had to pay if the treatment had been delivered in the competent State.

Meeting the cost of travel and stay as part of scheduled treatment

• (8) Where the national legislation of the competent institution provides for the reimbursement of the costs of travel and stay which are inseparable from the treatment of the insured person, such costs for the person concerned and, if necessary, for a person who must accompany them, shall be assumed by this institution when an authorisation is granted in the case of treatment in another State.

Family Members

• (9) Paragraphs (1) to (8) apply mutatis mutandis to the members of the family of the insured person.

ARTICLE 24 Cash benefits relating to incapacity for work in the event of stay or residence in a State other than the competent State

Procedure to be followed by the insured person

• (1) If the legislation of the competent State requires that the insured person presents a certificate in order to be entitled to cash benefits relating to incapacity for work pursuant to Article 25(1) of this Convention, the insured person shall ask the doctor of the State of residence who established that person’s state of health to certify their incapacity for work and its probable duration.

• (2) The insured person shall send the certificate to the competent institution within the time limit laid down by the legislation of the competent State.

• (3) Where the doctors providing treatment in the State of residence do not issue certificates of incapacity for work, and where such certificates are required under the legislation of the competent State, the person concerned shall apply directly to the institution of the place of residence. That institution shall immediately arrange for a medical assessment of the person’s incapacity for work and for the certificate referred to in paragraph (1) to be drawn up. The certificate shall be forwarded to the competent institution forthwith.

• (4) The forwarding of the document referred to in paragraphs (1), (2) and (3) shall not exempt the insured person from fulfilling the obligations provided for by the applicable legislation, in particular with regard to that person’s employer. Where appropriate, the employer or the competent institution may call upon the employee to participate in activities designed to promote and assist their return to employment.

Procedure to be followed by the institution of the State of residence

• (5) At the request of the competent institution, the institution of the place of residence shall carry out any necessary administrative checks or medical examinations of the person concerned in accordance with the legislation applied by this latter institution. The report of the examining doctor concerning, in particular, the probable duration of the incapacity for work, shall be forwarded without delay by the institution of the place of residence to the competent institution.

Procedure to be followed by the competent institution

• (6) The competent institution shall reserve the right to have the insured person examined by a doctor of its choice.

• (7) Without prejudice to the second sentence of Article 25(1) of this Convention, the competent institution shall pay the cash benefits directly to the person concerned and shall, where necessary, inform the institution of the place of residence thereof.

• (8) For the purposes of the application of Article 25(1) of this Convention, the particulars of the certificate of incapacity for work of an insured person drawn up in another State on the basis of the medical findings of the examining doctor or institution shall have the same legal value as a certificate drawn up in the competent State.

• (9) If the competent institution refuses the cash benefits, it shall notify its decision to the insured person and at the same time to the institution of the place of residence.

Procedure in the event of a stay in a State other than the competent State

• (10) Paragraphs (1) to (9) apply mutatis mutandis when the insured person stays in a State other than the competent State.

ARTICLE 25 Contributions by pensioners

If a person receives a pension from more than one State, the amount of contributions deducted from all the pensions paid shall, under no circumstances, be greater than the amount deducted in respect of a person who receives the same amount of pension from the competent State.

CHAPTER 2 BENEFITS IN RESPECT OF ACCIDENTS AT WORK AND OCCUPATIONAL DISEASES

ARTICLE 26 Right to benefits in kind and in cash in the event of residence or stay in a State other than the competent State

• (1) For the purposes of the application of Article 37 of this Convention, the procedures laid down in Articles 21 to 24 of this Annex apply mutatis mutandis.

• (2) When providing special benefits in kind in connection with accidents at work and occupational diseases under the national legislation of the State of stay or residence, the institution of that State shall without delay inform the competent institution.

ARTICLE 27 Procedure in the event of an accident at work or occupational disease which occurs in a State other than the competent State

• (1) If an accident at work occurs or an occupational disease is diagnosed for the first time in a State other than the competent State, the declaration or notification of the accident at work or the occupational disease, where the declaration or notification exists under national legislation, shall be carried out in accordance with the legislation of the competent State, without prejudice, where appropriate, to any other applicable legal provisions in force in the State in which the accident at work occurred or in which the first medical diagnosis of the occupational disease was made, which remain applicable in such cases. The declaration or notification shall be addressed to the competent institution.

• (2) The institution of the State in the territory of which the accident at work occurred or in which the occupational disease was first diagnosed, shall notify the competent institution of medical certificates drawn up in the territory of that State.

• (3) Where, as a result of an accident while travelling to or from work which occurs in the territory of a State other than the competent State, an inquiry is necessary in the territory of the first State in order to determine any entitlement to relevant benefits, a person may be appointed for that purpose by the competent institution, which shall inform the authorities of that State. The institutions shall cooperate with each other in order to assess all relevant information and to consult the reports and any other documents relating to the accident.

• (4) Following treatment, a detailed report accompanied by medical certificates relating to the permanent consequences of the accident or disease, in particular the injured person’s present state and the recovery or stabilisation of injuries, shall be sent upon request of the competent institution. The relevant fees shall be paid by the institution of the place of residence or of stay, where appropriate, at the rate applied by that institution to the charge of the competent institution.

• (5) At the request of the institution of the place of residence or stay, where appropriate, the competent institution shall notify it of the decision setting the date for the recovery or stabilisation of injuries and, where appropriate, the decision concerning the granting of a pension.

ARTICLE 28 Disputes concerning the occupational nature of the accident or disease

• (1) Where the competent institution disputes the application of the legislation relating to accidents at work or occupational diseases under Article 37(2) of this Convention, it shall without delay inform the institution of the place of residence or stay which provided the benefits in kind, which will then be considered as sickness insurance benefits.

• (2) When a final decision has been taken on that subject, the competent institution shall, without delay, inform the institution of the place of residence or stay which provided the benefits in kind.

Where an accident at work or occupational disease is not established, benefits in kind shall continue to be provided as sickness benefits if the person concerned is entitled to them.

Where an accident at work or occupational disease is established, sickness benefits in kind provided to the person concerned shall be considered as accident at work or occupational disease benefits from the date on which the accident at work occurred or the occupational disease was first medically diagnosed.

• (3) Article 6(6) of this Annex applies mutatis mutandis.

ARTICLE 29 Procedure in the event of exposure to the risk of an occupational disease in two or more States

• (1) In the case referred to in Article 39 of this Convention, the declaration or notification of the occupational disease shall be sent to the competent institution for occupational diseases of the last State under the legislation of which the person concerned pursued an activity likely to cause that disease.

When the institution to which the declaration or notification was sent establishes that an activity likely to cause the occupational disease in question was last pursued under the legislation of another State, it shall send the declaration or notification and all accompanying certificates to the equivalent institution in that State.

• (2) Where the institution of the last State under the legislation of which the person concerned pursued an activity likely to cause the occupational disease in question establishes that the person concerned or their survivors do not meet the requirements of that legislation, inter alia, because the person concerned had never pursued in that State an activity which caused the occupational disease or because that State does not recognise the occupational nature of the disease, that institution shall forward without delay the declaration or notification and all accompanying certificates, including the findings and reports of medical examinations performed by the first institution to the institution of the previous State under the legislation of which the person concerned pursued an activity likely to cause the occupational disease in question.

• (3) Where appropriate, the institutions shall reiterate the procedure set out in paragraph (2) going back as far as the equivalent institution in the State under whose legislation the person concerned first pursued an activity likely to cause the occupational disease in question.

ARTICLE 30 Exchange of information between institutions and advance payments in the event of an appeal against rejection

• (1) In the event of an appeal against a decision to refuse benefits taken by the institution of a State under the legislation of which the person concerned pursued an activity likely to cause the occupational disease in question, that institution shall inform the institution to which the declaration or notification was sent, in accordance with the procedure provided for in Article 29(2) of this Annex, and shall subsequently inform it when a final decision is reached.

• (2) Where a person is entitled to benefits under the legislation applied by the institution to which the declaration or notification was sent, that institution shall make the advance payments, the amount of which shall be determined, where appropriate, after consulting the institution which made the decision against which the appeal was lodged, and in such a way that overpayments are avoided. The latter institution shall reimburse the advance payments made if, as a result of the appeal, it is obliged to provide those benefits. That amount will then be deducted from the benefits due to the person concerned, in accordance with the procedure provided for in Articles 55 and 56 of this Annex.

• (3) Article 6(6) of this Annex applies mutatis mutandis.

ARTICLE 31 Aggravation of an occupational disease

In the cases covered by Article 40 of this Convention, the claimant must provide the institution in the State from which they are claiming entitlement to benefits with details concerning benefits previously granted for the occupational disease in question. That institution may contact any other previously competent institution in order to obtain the information it considers necessary.

ARTICLE 32 Assessment of the degree of incapacity in the event of occupational accidents or diseases which occurred previously or subsequently

Where a previous or subsequent incapacity for work was caused by an accident which occurred when the person concerned was subject to the legislation of a State which makes no distinction according to the origin of the incapacity to work, the competent institution or the body designated by the competent authority of the State in question shall:

• (a) upon request by the competent institution of another State, provide information concerning the degree of the previous or subsequent incapacity for work, and where possible, information making it possible to determine whether the incapacity is the result of an accident at work within the meaning of the legislation applied by the institution in another State;

• (b) take into account the degree of incapacity caused by these previous or subsequent cases when determining the right to benefits and the amount, in accordance with the applicable legislation.

ARTICLE 33 Submission and investigation of claims for pensions or supplementary allowances

In order to receive a pension or supplementary allowance under the legislation of a State, the person concerned or their survivors residing in the territory of another State shall submit, where appropriate, a claim either to the competent institution or to the institution of the place of residence, which shall send it to the competent institution.

The claim shall contain the information required under the legislation applied by the competent institution.

CHAPTER 3 DEATH GRANTS

ARTICLE 34 Claim for death grants

For the purposes of Articles 43 and 44 of this Convention, the claim for death grants shall be sent either to the competent institution or to the institution of the claimant’s place of residence, which shall send it to the competent institution.

The claim shall contain the information required under the legislation applied by the competent institution.

CHAPTER 4 INVALIDITY BENEFITS AND OLD-AGE AND SURVIVORS’ PENSIONS

ARTICLE 35 Additional provisions for the calculation of the benefit

• (1) For the purposes of calculating the theoretical amount and the actual amount of the benefit in accordance with Article 51(1)(b) of this Convention, the rules provided for in Article 11(3) to (6) of this Annex apply.

• (2) Where periods of voluntary or optional continued insurance have not been taken into account under Article 11(3) of this Annex, the institution of the State under whose legislation those periods were completed shall calculate the amount corresponding to those periods under the legislation it applies. The actual amount of the benefit, calculated in accordance with Article 51(1)(b) of this Convention, shall be increased by the amount corresponding to periods of voluntary or optional continued insurance.

• (3) The institution of each State shall calculate, under the legislation it applies, the amount due corresponding to periods of voluntary or optional continued insurance which, under Article 52(3)(c) of this Convention, shall not be subject to another State’s rules relating to withdrawal, reduction or suspension.

Where the legislation applied by the competent institution does not allow it to determine this amount directly, on the grounds that that legislation allocates different values to insurance periods, a notional amount may be established. The Joint Administrative Committee shall lay down the detailed arrangements for the determination of that notional amount.

ARTICLE 36 Claim for benefits

Submission of claims for old-age and survivors’ pensions

• (1) The claimant shall submit a claim to the institution of their place of residence or to the institution of the last State whose legislation was applicable. If the person concerned was not, at any time, subject to the legislation applied by the institution of the place of residence, that institution shall forward the claim to the institution of the last State whose legislation was applicable.

• (2) The date of submission of the claim shall apply in all the institutions concerned.

• (3) By way of derogation from paragraph (2), if the claimant does not, despite having been asked to do so, notify the fact that they have been employed or has resided in other States, the date on which the claimant completes their initial claim or submits a new claim for their missing periods of employment or/and residence in a State shall be considered as the date of submission of the claim to the institution applying the legislation in question, subject to more favourable provisions of that legislation.

ARTICLE 37 Certificates and information to be submitted with the claim by the claimant

• (1) The claim shall be submitted by the claimant in accordance with the provisions of the legislation applied by the institution referred to in Article 36(1) of this Annex and be accompanied by the supporting documents required by that legislation. In particular, the claimant shall supply all available relevant information and supporting documents relating to periods of insurance (institutions, identification numbers), employment (employers) or self-employment (nature and place of activity) and residence (addresses) which may have been completed under other legislation, as well as the length of those periods.

• (2) Where, in accordance with Article 49(1) of this Convention, the claimant requests deferment of the award of old-age benefits under the legislation of one or more States, the claimant shall state that in their claim and specify under which legislation the deferment is requested. In order to enable the claimant to exercise that right, the institutions concerned shall, upon the request of the claimant, notify the claimant of all the information available to the institutions so that the claimant can assess the consequences of concurrent or successive awards of benefits which they might claim.

• (3) Should the claimant withdraw a claim for benefits provided for under the legislation of a particular State, that withdrawal shall not be considered as a concurrent withdrawal of claims for benefits under the legislation of another State.

ARTICLE 38 Investigation of claims by the institutions concerned

Contact institution

• (1) The institution to which the claim for benefits is submitted or forwarded in accordance with Article 36(1) of this Annex shall be referred to hereinafter as the “contact institution”. The institution of the place of residence shall not be referred to as the contact institution if the person concerned has not, at any time, been subject to the legislation which that institution applies.

• (2) In addition to investigating the claim for benefits under the legislation which it applies, that institution shall, in its capacity as contact institution, promote the exchange of data, the communication of decisions and the operations necessary for the investigation of the claim by the institutions concerned, and supply the claimant, upon request, with any information relevant to the aspects of the investigation which arise under this Convention, and keep the claimant informed of its progress.

Investigation of claims for old-age and survivors’ pensions

• (3) The contact institution shall, without delay, send claims for benefits and all the documents which it has available and, where appropriate, the relevant documents supplied by the claimant to all the institutions in question so that they can all start the investigation of the claim concurrently. The contact institution shall notify the other institutions of periods of insurance or residence subject to its legislation. It shall also indicate which documents shall be submitted at a later date and supplement the claim as soon as possible.

• (4) Each of the institutions in question shall notify the contact institution and the other institutions in question, as soon as possible, of the periods of insurance or residence subject to their legislation.

• (5) Each of the institutions in question shall calculate the amount of benefits in accordance with Article 51 of this Convention and shall notify the contact institution and the other institutions concerned of its decision, of the amount of benefits due and of any information required for the purposes of Articles 52 to 54 of this Convention.

• (6) Should an institution establish, on the basis of the information referred to in paragraphs (2) and (3) of this Article, that Article 56(2) or (3) of this Convention is applicable, it shall inform the contact institution and the other institutions concerned.

ARTICLE 39 Notification of decisions to the claimant

Each institution shall notify the claimant of the decision it has taken in accordance with the applicable legislation. Each decision shall specify the remedies and periods allowed for appeals.

ARTICLE 40 Determination of the degree of invalidity

Each institution shall, in accordance with its legislation, have the possibility of having the claimant examined by a medical doctor or other expert of its choice to determine the degree of invalidity. However, the institution of a State shall take into consideration documents, medical reports and administrative information collected by the institution of any other State as if they had been drawn up in its own territory.

ARTICLE 41 Provisional instalments and advance payment of a benefit

• (1) Notwithstanding Article 7 of this Annex, any institution which establishes, while investigating a claim for benefits, that the claimant is entitled to an independent benefit under the applicable legislation, in accordance with Article 51(1)(a) of this Convention, shall pay that benefit without delay. That payment shall be considered provisional if the amount might be affected by the result of the claim investigation procedure.

• (2) Whenever it is evident from the information available that the claimant is entitled to a payment from an institution under Article 51(1)(b) of this Convention, that institution shall make an advance payment, the amount of which shall be as close as possible to the amount which will probably be paid under Article 51(1)(b) of this Convention.

• (3) Each institution which is obliged to pay the provisional benefits or advance payment under paragraph (1) or (2) shall inform the claimant without delay, specifically drawing the claimant’s attention to the provisional nature of the measure and any rights of appeal in accordance with its legislation.

ARTICLE 42 New calculation of benefits

• (1) Where there is a new calculation of benefits in accordance with Article 49(4) and Article 57(1) of this Convention, Article 41 of this Annex shall apply mutatis mutandis.

• (2) Where there is a new calculation, withdrawal or suspension of the benefit, the institution which took the decision shall inform the person concerned without delay and shall inform each of the institutions in respect of which the person concerned has an entitlement.

ARTICLE 43 Measures intended to accelerate the pension calculation process

• (1) In order to facilitate and accelerate the investigation of claims and the payment of benefits, the institutions to whose legislation a person has been subject shall:

• (a) exchange with or make available to institutions of other States the elements for identifying persons who change from one applicable national legislation to another, and together ensure that those identification elements are retained and correspond, or, failing that, provide those persons with the means to access their identification elements directly;

• (b) sufficiently in advance of the minimum age for commencing pension rights or before an age to be determined by national legislation, exchange with or make available to the person concerned and to institutions of other States information (periods completed or other important elements) on the pension entitlements of persons who have changed from one applicable legislation to another or, failing that, inform those persons of, or provide them with, the means of familiarising themselves with their prospective benefit entitlement.

• (2) For the purposes of paragraph (1), the Joint Administrative Committee shall agree the elements of information to be exchanged or made available and shall establish the appropriate procedures and mechanisms, taking account of the characteristics, administrative and technical organisation, and the technological means at the disposal of national pension schemes. The Joint Administrative Committee shall ensure the implementation of those pension schemes by organising a follow-up to the measures taken and their application.

• (3) For the purposes of paragraph (1), the institution in the first State where a person is allocated a Personal Identification Number (PIN) for the purposes of social security administration should be provided with the information referred to in this Article.

ARTICLE 44 Coordination measures in the States

Without prejudice to Article 50 of this Convention, where national legislation includes rules for determining the institution responsible or the scheme applicable or for designating periods of insurance to a specific scheme, those rules shall be applied, taking into account only periods of insurance completed under the legislation of the State concerned.

CHAPTER 5 UNEMPLOYMENT BENEFITS

ARTICLE 45 Aggregation of periods and calculation of benefits

• (1) Article 11(1) of this Annex applies mutatis mutandis to Article 58 of this Convention. Without prejudice to the underlying obligations of the institutions involved, the person concerned may submit to the competent institution a document issued by the institution of the State to whose legislation they were subject in respect of that person’s last activity as an employed or self-employed person specifying the periods completed under that legislation.

• (2) For the purpose of applying Article 59 of this Convention, the competent institution of a State whose legislation provides that the calculation of benefits varies with the number of members of the family shall also take into account the members of the family of the person concerned residing in another State as if they resided in the competent State. This provision shall not apply where, in the State of residence of members of the family, another person is entitled to unemployment benefits calculated on the basis of the number of members of the family.

TITLE IV FINANCIAL PROVISIONS

CHAPTER 1 REIMBURSEMENT OF THE COST OF BENEFITS IN APPLICATION OF ARTICLE 36 AND ARTICLE 42 OF THIS CONVENTION

SECTION 1 REIMBURSEMENT ON THE BASIS OF ACTUAL EXPENDITURE

ARTICLE 46 Principles

• (1) For the purpose of applying Articles 36 and 42 of this Convention, the actual amount of the expenses for benefits in kind, as shown in the accounts of the institution that provided them, shall be reimbursed to that institution by the competent institution, except where Article 56 of this Annex is applicable.

• (2) If any or part of the actual amount of the expenses for benefits referred to in paragraph (1) is not shown in the accounts of the institution that provided them, the amount to be refunded shall be determined on the basis of a lump-sum payment calculated from all the appropriate references obtained from the data available. The Joint Administrative Committee shall agree the bases to be used for calculation of the lump-sum payment and shall decide the amount thereof.

• (3) Higher rates than those applicable to the benefits in kind provided to insured persons subject to the legislation applied by the institution providing the benefits referred to in paragraph (1) may not be taken into account in the reimbursement.

SECTION 2 REIMBURSEMENT ON THE BASIS OF FIXED AMOUNTS

ARTICLE 47 Identification of the State(s) concerned

• (1) The States referred to in Article 36(2) of this Convention, whose legal or administrative structures are such that the use of reimbursement on the basis of actual expenditure is not appropriate, are listed in Appendix 2 of this Annex.

• (2) In the case of the States listed in Appendix 2 of this Annex, the amount of benefits in kind supplied to:

• (a) family members who do not reside in the same State as the insured person, as provided for in Article 21 of this Convention; and to

• (b) pensioners and members of their family, as provided for in Article 28(1), Article 29 and Article 30 of this Convention,

shall be reimbursed by the competent institutions to the institutions providing those benefits, on the basis of a fixed amount established for each calendar year. This fixed amount shall be as close as possible to actual expenditure.

ARTICLE 48 Calculation method of the monthly fixed amounts and the total fixed amount

• (1) For each creditor State, the monthly fixed amount per person (Fi) for a calendar year shall be determined by dividing the annual average cost per person (Yi), broken down by age group (i), by 12 and by applying a reduction (X) to the result in accordance with the following formula:

Fi = Yi1/12(1-X)

Where:

• the index (i = 1, 2 and 3) represents the three age groups used for calculating the fixed amounts:

• i = 1: persons aged under 20,

• i = 2: persons aged from 20 to 64,

• i = 3: persons aged 65 and over,

• Yi represents the annual average cost per person in age group i, as defined in paragraph (2),

• the coefficient X (0.20 or 0.15) represents the reduction as defined in paragraph (3).

• (2) The annual average cost per person (Yi) in age group ishall be obtained by dividing the annual expenditure on all benefits in kind provided by the institutions of the creditor State to all persons in the age group concerned subject to its legislation and residing within its territory by the average number of persons concerned in that age group in the calendar year in question.

• (3) The reduction to be applied to the monthly fixed amount shall, in principle, be equal to 20% (X = 0.20). It shall be equal to 15% (X = 0.15) for pensioners and members of their family where the competent State is not listed in Appendix 2 of this Annex.

• (4) For each debtor State, the total fixed amount for a calendar year shall be the sum of the products obtained by multiplying, in each age group i, the determined monthly fixed amounts per person by the number of months completed by the persons concerned in the creditor State in that age group.

The number of months completed by the persons concerned in the creditor State shall be the sum of the calendar months in a calendar year during which the persons concerned were, because of their residence in the territory of the creditor State, eligible to receive benefits in kind in that territory at the expense of the debtor State. Those months shall be determined from an inventory kept for that purpose by the institution of the place of residence, based on documentary evidence of the entitlement of the beneficiaries supplied by the competent institution.

• (5) The Joint Administrative Committee may present a proposal containing any amendments which may prove necessary in order to ensure that the calculation of fixed amounts comes as close as possible to the actual expenditure incurred and the reductions referred to in paragraph (3) do not result in unbalanced payments or double payments for the States.

• (6) The Joint Administrative Committee shall establish the methods for determining the elements for calculating the fixed amounts referred to in this Article.

ARTICLE 49 Notification of annual average costs

The annual average cost per person in each age group for a specific year shall be notified to the Joint Administrative Committee at the latest by the end of the second year following the year in question. If the notification is not made by this deadline, the annual average cost per person which the Joint Administrative Committee has last determined for a previous year will be taken.

SECTION 3 COMMON PROVISIONS

ARTICLE 50 Procedure for reimbursement between institutions

• (1) Reimbursements between the States shall be made as promptly as possible. Every institution concerned shall be obliged to reimburse claims before the deadlines mentioned in this Section, as soon as it is in a position to do so. A dispute concerning a particular claim shall not hinder the reimbursement of another claim or other claims.

• (2) The reimbursements between the institutions of the EEA EFTA States and the United Kingdom, provided for in Articles 36 and 42 of this Convention, shall be made via the liaison body. There may be a separate liaison body for reimbursements under Articles 36 and 42 of this Convention.

ARTICLE 51 Deadlines for the introduction and settlement of claims

• (1) Claims based on actual expenditure shall be introduced to the liaison body of the debtor State within 12 months of the end of the calendar half-year during which those claims were recorded in the accounts of the creditor institution.

• (2) Claims for fixed amounts for a calendar year shall be introduced to the liaison body of the debtor State within the 12-month period following the month during which the average costs for the year concerned were approved by the Joint Administrative Committee. The inventories referred to in Article 48(4) of this Annex shall be presented by the end of the year following the reference year.

• (3) In the case referred to in Article 6(6) of this Annex, the deadline set out in paragraphs (1) and (2) of this Article shall not start before the competent institution has been identified.

• (4) Claims introduced after the deadlines specified in paragraphs (1) and (2) shall not be considered.

• (5) The claims shall be paid to the liaison body of the creditor State referred to in Article 50 of this Annex by the debtor institution within 18 months of the end of the month during which they were introduced to the liaison body of the debtor State. This does not apply to the claims which the debtor institution has rejected for a relevant reason within that period.

• (6) Any disputes concerning a claim shall be settled, at the latest, within 36 months following the month in which the claim was introduced.

• (7) The Joint Administrative Committee shall facilitate the final closing of accounts in cases where a settlement cannot be reached within the period set out in paragraph (6), and, upon a reasoned request by one of the parties in the dispute, shall give its opinion on a dispute within six months following the month in which the matter was referred to it.

ARTICLE 52 Interest on late payments and down payments

• (1) From the end of the 18-month period set out in Article 51(5) of this Annex, interest can be charged by the creditor institution on outstanding claims, unless the debtor institution has made, within six months of the end of the month during which the claim was introduced, a down payment of at least 90% of the total claim introduced pursuant to Article 51(1) or (2) of this Annex. For those parts of the claim not covered by the down payment, interest may be charged only from the end of the 36-month period set out in Article 51(6) of this Annex.

• (2) The interest shall be calculated on the basis of the reference rate agreed by the Joint Administrative Committee. The reference rate applicable shall be that in force on the first day of the month on which the payment is due.

• (3) No liaison body shall be obliged to accept a down payment as provided for in paragraph (1). If however, a liaison body declines such an offer, the creditor institution shall no longer be entitled to charge interest on late payments related to the claims in question other than under the second sentence of paragraph (1).

ARTICLE 53 Statement of Annual Accounts

The States shall notify each other of the amount of the claims introduced, settled or contested (creditor position) and the amount of claims received, settled or contested (debtor position).

CHAPTER 2 RECOVERY OF BENEFITS PROVIDED BUT NOT DUE, RECOVERY OF PROVISIONAL PAYMENTS AND CONTRIBUTIONS, OFFSETTING AND ASSISTANCE WITH RECOVERY

SECTION 1 PRINCIPLES

ARTICLE 54 Common provisions

For the purposes of applying Article 67 of this Convention and within the framework defined therein, the recovery of claims shall, wherever possible, be by way of offsetting either between the institutions of the States concerned, or vis-à-vis the natural or legal person concerned in accordance with Articles 55 to 57 of this Annex. If it is not possible to recover all or any of the claim via this offsetting procedure, the remainder of the amount due shall be recovered in accordance with Articles 58 to 68 of this Annex.

SECTION 2 OFFSETTING

ARTICLE 55 Benefits received unduly

• (1) If the institution of a State has paid undue benefits to a person, that institution may, within the terms and limits laid down in the legislation it applies, request the institution of the State responsible for paying benefits to the person concerned to deduct the undue amount from arrears or on-going payments owed to the person concerned regardless of the social security branch under which the benefit is paid. The institution of the latter State shall deduct the amount concerned subject to the conditions and limits applying to this kind of offsetting procedure in accordance with the legislation it applies in the same way as if it had made the overpayments itself, and shall transfer the amount deducted to the institution that has paid undue benefits.

• (2) By way of derogation from paragraph (1), if, when awarding or reviewing benefits in respect of invalidity benefits, old-age and survivors’ pensions pursuant to Chapters 3 and 4 of Title III of this Convention, the institution of a State has paid to a person benefits of undue sum, that institution may request the institution of the State responsible for the payment of corresponding benefits to the person concerned to deduct the amount overpaid from the arrears payable to the person concerned. After the latter institution has informed the institution that has paid an undue sum of these arrears, the institution which has paid the undue sum shall within two months communicate the amount of the undue sum. If the institution which is due to pay arrears receives that communication within the deadline it shall transfer the amount deducted to the institution which has paid undue sums. If the deadline expires, that institution shall without delay pay out the arrears to the person concerned.

• (3) If a person has received social welfare assistance in one State during a period in which they were entitled to benefits under the legislation of another State, the body which provided the assistance may, if it is legally entitled to reclaim the benefits due to the person concerned, request the institution of any other State responsible for paying benefits in favour of the person concerned to deduct the amount of assistance paid from the amounts which that State pays to the person concerned.

This provision applies mutatis mutandis to any family member of a person concerned who has received assistance in the territory of a State during a period in which the insured person was entitled to benefits under the legislation of another State in respect of that family member.

The institution of a State which has paid an undue amount of assistance shall send a statement of the amount due to the institution of the other State, which shall then deduct the amount, subject to the conditions and limits laid down for this kind of offsetting procedure in accordance with the legislation it applies, and transfer the amount without delay to the institution that has paid the undue amount.

ARTICLE 56 Provisionally paid benefits in cash or contributions

• (1) For the purposes of applying Article 6 of this Annex, at the latest three months after the applicable legislation has been determined or the institution responsible for paying the benefits has been identified, the institution which provisionally paid the cash benefits shall draw up a statement of the amount provisionally paid and shall send it to the institution identified as being competent.

The institution identified as being competent for paying the benefits shall deduct the amount due in respect of the provisional payment from the arrears of the corresponding benefits it owes to the person concerned and shall without delay transfer the amount deducted to the institution which provisionally paid the cash benefits.

If the amount of provisionally paid benefits exceeds the amount of arrears, or if arrears do not exist, the institution identified as being competent shall deduct this amount from ongoing payments subject to the conditions and limits applying to this kind of offsetting procedure under the legislation it applies, and without delay transfer the amount deducted to the institution which provisionally paid the cash benefits.

• (2) The institution which has provisionally received contributions from a legal or natural person shall not reimburse the amounts in question to the person who paid them until it has ascertained from the institution identified as being competent the sums due to it under Article 6(4) of this Annex.

Upon request of the institution identified as being competent, which shall be made at the latest three months after the applicable legislation has been determined, the institution that has provisionally received contributions shall transfer them to the institution identified as being competent for that period for the purpose of settling the situation concerning the contributions owed by the legal or natural person to it. The contributions transferred shall be retroactively deemed as having been paid to the institution identified as being competent.

If the amount of provisionally paid contributions exceeds the amount the legal or natural person owes to the institution identified as being competent, the institution which provisionally received contributions shall reimburse the amount in excess to the legal or natural person concerned.

ARTICLE 57 Costs related to offsetting

No costs are payable where the debt is recovered via the offsetting procedure provided for in Articles 55 and 56 of this Annex.

SECTION 3 RECOVERY

ARTICLE 58 Definitions and common provisions

• (1) For the purposes of this Section:

• (a) “claim” means all claims relating to contributions or to benefits paid or provided unduly, including interest, fines, administrative penalties and all other charges and costs connected with the claim in accordance with the legislation of the State making the claim;

• (b) “applicant party” means, in respect of each State, any institution which makes a request for information, notification or recovery concerning a claim as defined above;

• (c) “requested party” means, in respect of each State, any institution to which a request for information, notification or recovery can be made.

• (2) Requests and any related communications between the States shall, in general, be addressed via designated institutions.

• (3) Practical implementation measures, including, among others, those related to Article 4 of this Annex and to setting a minimum threshold for the amounts for which a request for recovery can be made, shall be taken by the Joint Administrative Committee.

ARTICLE 59 Requests for information

• (1) At the request of the applicant party, the requested party shall provide any information which would be useful to the applicant party in the recovery of its claim.

• (2) In order to obtain that information, the requested party shall make use of the powers provided for under the laws, regulations or administrative practices applying to the recovery of similar claims arising in its own State. The request for information from the applicant party shall indicate the name, last known address, and any other relevant information relating to the identification of the legal or natural person concerned to whom the information to be provided relates and the nature and amount of the claim in respect of which the request is made.

• (3) The requested party shall not be obliged to supply information:

• (a) which it would not be able to obtain for the purpose of recovering similar claims arising in its own territory;

• (b) which would disclose any commercial, industrial or professional secrets; or

• (c) the disclosure of which would be liable to prejudice the security of or be contrary to the public policy of a State.

• (4) The requested party shall inform the applicant party of the grounds for refusing a request for information.

ARTICLE 60 Notification

• (1) The requested party shall, at the request of the applicant party, and in accordance with the rules in force for the notification of similar instruments or decisions in its own territory, notify the addressee of all instruments and decisions, including those of a judicial nature, which come from the State of the applicant party and which relate to a claim or to its recovery.

• (2) The request for notification shall indicate the name, address and any other relevant information relating to the identification of the addressee concerned to which the applicant party normally has access, the nature and the subject of the instrument or decision to be notified and, if necessary the name, address and any other relevant information relating to the identification of the debtor and the claim to which the instrument or decision relates, and any other useful information.

• (3) The requested party shall without delay inform the applicant party of the action taken on its request for notification and, particularly, of the date on which the decision or instrument was forwarded to the addressee.

ARTICLE 61 Request for recovery

• (1) At the request of the applicant party, the requested party shall recover claims that are the subject of an instrument permitting enforcement issued by the applicant party to the extent permitted by and in accordance with the laws and administrative practices in force in the State of the requested party.

• (2) The applicant party may only make a request for recovery if:

• (a) it also provides to the requested party an official or certified copy of the instrument permitting enforcement of the claim in the State of the applicant party;

• (b) the claim or instrument permitting its enforcement are not contested in its own State;

• (c) it has, in its own State, applied appropriate recovery procedures available to it on the basis of the instrument referred to in paragraph (1), and the measures taken will not result in the payment in full of the claim;

• (d) the period of limitation according to its own legislation has not expired.

• (3) The request for recovery shall indicate:

• (a) the name, address and any other relevant information relating to the identification of the natural or legal person concerned or to the identification of any third party holding that person’s assets;

• (b) the name, address and any other relevant information relating to the identification of the applicant party;

• (c) a reference to the instrument permitting its enforcement, issued in the State of the applicant party;

• (d) the nature and amount of the claim, including the principal, interest, fines, administrative penalties and all other charges and costs due indicated in the currencies of the State(s) of the applicant and requested parties;

• (e) the date of notification of the instrument to the addressee by the applicant party or by the requested party;

• (f) the date from which and the period during which enforcement is possible under the laws in force in the State of the applicant party;

• (g) any other relevant information.

• (4) The request for recovery shall also contain a declaration by the applicant party confirming that the conditions laid down in paragraph (2) have been fulfilled.

• (5) The applicant party shall forward to the requested party any relevant information relating to the matter which gave rise to the request for recovery, as soon as this comes to its knowledge.

ARTICLE 62 Instrument permitting enforcement of recovery

• (1) In accordance with Article 67(2) of this Convention, the instrument permitting enforcement of the claim shall be directly recognised and treated automatically as an instrument permitting the enforcement of a claim of the State of the requested party.

• (2) Notwithstanding paragraph (1), the instrument permitting enforcement of the claim may, where appropriate and in accordance with the provisions in force in the State of the requested party, be accepted as, recognised as, supplemented with, or replaced by an instrument authorising enforcement in the territory of that State.

• (3) Within three months of the date of receipt of the request for recovery, the State(s) shall endeavour to complete the acceptance, recognition, supplementing or replacement, except in cases where paragraph (4) applies. States may not refuse to complete these actions where the instrument permitting enforcement is properly drawn up. The requested party shall inform the applicant party of the grounds for exceeding the three-month period.

• (4) If any of these actions should give rise to a dispute in connection with the claim or the instrument permitting enforcement issued by the applicant party, Article 64 of this Annex shall apply.

ARTICLE 63 Payment arrangements and deadline

• (1) Claims shall be recovered in the currency of the State of the requested party. The entire amount of the claim that is recovered by the requested party shall be remitted by the requested party to the applicant party.

• (2) The requested party may, where the laws, regulations or administrative provisions in force in its own State so permit, and after consulting the applicant party, allow the debtor time to pay or authorise payment by instalment. Any interest charged by the requested party in respect of such extra time to pay shall also be remitted to the applicant party.

• (3) From the date on which the instrument permitting enforcement of the recovery of the claim has been directly recognised in accordance with Article 62(1) of this Annex or accepted, recognised, supplemented or replaced in accordance with Article 62(2) of this Annex, interest shall be charged for late payment under the laws, regulations and administrative provisions in force in the State of the requested party and shall also be remitted to the applicant party.

ARTICLE 64 Contestation concerning the claim or the instrument permitting enforcement of its recovery and contestation concerning enforcement measures

• (1) If, in the course of the recovery procedure, the claim or the instrument permitting its enforcement issued in the State of the applicant party are contested by an interested party, the action shall be brought by this party before the appropriate authorities of the State of the applicant party, in accordance with the laws in force in that State. The applicant party shall without delay notify the requested party of this action. The interested party may also inform the requested party of the action.

• (2) As soon as the requested party has received the notification or information referred to in paragraph (1) either from the applicant party or from the interested party, it shall suspend the enforcement procedure pending the decision of the appropriate authority in the matter, unless the applicant party requests otherwise in accordance with the second sub-paragraph of this paragraph. Should the requested party deem it necessary, and without prejudice to Article 67 of this Annex, it may take precautionary measures to guarantee recovery insofar as the laws or regulations in force in its own State allow such action for similar claims.

Notwithstanding the first sub-paragraph, the applicant party may, in accordance with the laws, regulations and administrative practices in force in its own State, request the requested party to recover a contested claim, insofar as the relevant laws, regulations and administrative practices in force in the requested party’s State allow such action. If the result of the contestation is subsequently favourable to the debtor, the applicant party shall be liable for the reimbursement of any sums recovered, together with any compensation due, in accordance with the legislation in force in the requested party’s State.

• (3) Where the contestation concerns enforcement measures taken in the State of the requested party, the action shall be brought before the appropriate authority of that State in accordance with its laws and regulations.