C-212/01

UNTERPERTINGER

OPINION OF ADVOCATE GENERAL STIX-HACKL delivered on 30 January 2003 1

I — Introduction the request of employers or insurers, and some involving the preparation of medical certificates or reports designed to establish medical fitness or whether the conditions for particular legal claims are satisfied.

1. All the questions which the Landesger- icht Innsbruck and the VAT and Duties Tribunal, London Tribunal Centre, have 3. Both cases raise questions relating, in referred to the Court of Justice for a particular, to the scope of the judgment in preliminary ruling in these cases, and to the case of D., 2 in which the Court decided which this joined Opinion relates, concern that the establishment of genetic affinity the scope of the exemption in respect of through biological tests does not fall within 'the provision of medical care' under the scope of Article 13A(1)(c) of the Sixth Article 13A(1)(c) of Sixth Council Directive Directive. 77/388/EEC of 17 May 1977 on the har- monisation of the laws of the Member States relating to turnover taxes — Com- mon system of value added tax: uniform basis of assessment (hereinafter 'the Sixth Directive'). I I — Legal background

A — Community law 2. The particular situation in Case C-212/01 involves the assessment by a doctor, acting as an expert instructed by a court or pension insurance institution, of 4. Article 13A(1) of the Sixth Directive the disability or ability of an applicant for a exempts certain 'activities in the public pension. Case C-307/01 concerns a range interest' from VAT. of medical activities, some carried out at

19. Turnover from activity as a doctor, dentist, psychotherapist, midwife or self- employed supplier within the meaning of Paragraph 52(4) of Federal Law BGBl. No 102/1961 in the edition published in B — National law BGBl. No 872/1992 and of Paragraph 7(3) of Federal Law BGBl. No 460/1992; ser- vices supplied by associations whose members belong to the aforesaid profes- sions are, as regards their members, also 1. Case C-212/01 exempt from tax, to the extent that such services are used directly for carrying out the transactions that are exempt from tax under this provision and to the extent that the associations charge to their members only the exact reimbursement of the 6. Tax exemptions in respect of the medical r e s p e c t i v e s h a r e of the c o m m o n professions are governed by Paragraph 6(1) expenses;...'

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2. Case C-307/01 Ill — Facts, procedure and questions referred for a preliminary ruling

7. Item 1(a) in Group 7 — 'Health and Welfare' — in Schedule 9 to the Value Added Tax Act 1994 describes as one of the A — Case C-212/01 supplies that is exempt from VAT under Section 31 of the Act the following:

9. The background to the questions referred in Case C-212/01 is an action before the Landesgericht Innsbruck as employment and social security court in ' 1 . The supply of services by a person which, owing to the death of the plaintiff, registered or enrolled in any of the follow- Ms Margarete Unterpertinger, in the course ing: of the proceedings, the only question which remains to be determined is that of costs.

17. The Court notified the parties that it would give a written decision in respect of 13. After those reports had been obtained, the 20% VAT. That is the context in which the plaintiff died suddenly, and the national the present request for a preliminary ruling court accordingly held that the proceedings has been made. had been cut short.

14. The only point still at issue was the 18. Under the Austrian Gebühren- costs of the proceedings. The defendant and anspruchsgesetz (Law on Entitlement to the expert continued to be parties to the Fees), an expert is entitled to recover proceedings in regard to the outstanding turnover tax on his fee if, and to the extent matters. that, his services are subject to turnover tax.

15. The latter, an expert instructed by the Landesgericht Innsbruck as employment and social security court, and a specialist 19. By its question the national court is in psychiatry and neurology, invoiced VAT therefore asking whether or not the medical for the services supplied by him as an services supplied by the medical witness are expert. exempt from turnover tax.

16. At the hearing for presenting oral argument, the defendant, which is in any 20. In the view of the national court, it is event required to bear the costs incurred on not absolutely clear from the wording of instructing expert witnesses, pursuant to Paragraph 6(1)(19) of the Umsatzsteuerge- I - 13864

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setz whether medical examinations whose and expert opinions based on them for purpose is to establish invalidity, incapacity the purpose of establishing or exclud- to work or disability are covered by the ing disability, incapacity to work or exemption, or are excluded. The court invalidity do not fall within the scope points out that, despite differences in of application of the provision referred wording, the provision represents the trans- to in Question 1 above, whether or not p o s i t i o n i n t o A u s t r i a n l a w of the doctor who acts as an expert is Article 13A(1)(c) of the Sixth Directive, instructed by a court or a pension and must therefore be interpreted in con- insurance institution?' formity with the Directive.

25. By a letter of 29 September 1997, Dr d'Ambrumenil was informed of a decision by the Commissioners of Customs and Excise finding that some of the services — Conducting medical examinations of provided by him and/or DRS fell within individuals for employers. This Item 1(a) of Group 7 in Schedule 9 to the involves a physical and/or mental Value Added Tax Act and were therefore examination of a prospective employee exempt from VAT. carried out for the prospective employer and may involve completing a standard questionnaire. It does not involve the provision of medical treat- ment or advice to the prospective employee as to his medical condition. On certain occasions the prospective 26. The purpose of the main proceedings is employee will be a current or former to adjudicate on an appeal brought by Dr patient of Dr d'Ambrumenil to whom d'Ambrumenil and DRS 3 against that he has provided medical treatment or decision. The matter at issue is how certain advice in the past; on other occasions services are properly to be treated for VAT the individual will be neither a current purposes. Whilst Dr d'Ambrumenil and nor a former patient of Dr d'Am- DRS consider that the services in question brumenil. constitute taxable supplies, the Commis- sioners of Customs and Excise — the respondents in the main proceedings — are of the view that the services are exempt under the provisions of the Value Added Tax Act that transposed Article 13A(1)(c) of the Sixth Directive. — Conducting medical examinations of individuals for insurers. This activity involves a physical and/or mental examination of the prospective insured for the purposes of permanent health insurance or life assurance, and may 27. It has been possible to resolve the involve completing a standard ques- dispute by agreement of the parties or tionnaire. It does not involve the provision of medical treatment or advice to the prospective insured as to 3 — Hereinafter 'the appellants in the main proceedings'. his medical condition. On certain occa-

— Testing for other purposes. The taking of blood or other bodily samples to test for the presence of viruses, infections, or other diseases, including, in particu- — Medical reports regarding personal lar, the HIV virus. This activity is injuries. The preparation of expert conducted on behalf of, and for the medical reports regarding issues of benefit of, employers or insurers and liability and the quantification of dam- may or may not be in respect of current ages for individuals contemplating liti- or former patients of Dr d'Ambrume- gation before courts and tribunals. It nil. involves the use of Dr d'Ambrumenil's medical skills to evaluate the cause, extent and prognosis of the injury and may involve examination of the pros- pective plaintiff. It does not involve treatment of the prospective plaintiff's condition. — Medical certificates. Certification of medical fitness, for example as to fitness to travel, at the request of the individual who may or may not be a current or former patient of Dr d'Am- brumenil. It involves the use of Dr d'Ambrumenil's medical skills and may involve a physical or mental examin- ation. — Medical reports regarding medical neg- ligence. The preparation of expert medical reports for individuals contem- plating litigation regarding profession- al medical negligence. It involves the use of medical skills as to the cause, extent and prognosis of the injury, — Certificates as to a person's health for liability and the quantification of dam- other purposes, such as war pensions. ages, and may but does not normally This involves, for example, certifying, involve examination of the individual. for the purpose of establishing entitle- It does not involve treatment of the ment to a war pension, that an indi- individual's medical condition.

(ii) based on medical notes but with- (b) the taking of blood or other bodily out conducting a medical examin- samples to test for the presence of ation,

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(g) medical examinations conducted with 31. In the view of the Austrian Govern- a view to the preparation of expert ment, the question whether or not the Medical Reports regarding profession- activities of an expert in proceedings before al medical negligence for individuals a social security court are subject to turn- contemplating litigation, and over tax has been sufficiently clarified by the judgment in the D. case. 4 In that decision, the Court of Justice declared that a medical service which consisted 'not in providing care to persons by diagnosing and treating a disease or any other health (h) the preparation of Medical Reports disorder' was subject to turnover tax. If, as the judgment suggests, the exemption in Article 13A(1)(c) of the Sixth Directive only applies to medical services having a therapeutic aim, then the expert services of a doctor whose involvement is confined to (i) following the e x a m i n a t i o n s establishing the disability or ability of an referred to in (g) and applicant for a pension for the purpose of the award of a disability pension must also be assumed not to be exempt. That con- clusion is supported, inter alia, by the principle that provisions that contain exemptions from turnover tax are to be interpreted strictly. (ii) based on medical notes but with- out conducting a medical examin- ation?'

IV — Arguments of the parties 32. The Commission's arguments accord for the most part with those of the Austrian Government. The Commission submits that, contrary to the position under Para- graph 4(1)(19) of the Austrian Umsatz- steuergesetz, under Article 13A(1)(c) of the A — Case C-212/01 Sixth Directive, not all activities carried on by a doctor are exempt. The Commission disagrees with the United Kingdom's view that the notion of a doctor's function in Council Directive 93/16/EEC to facilitate 30. The Austrian Government, like the the free movement of doctors and the Commission, did not submit observations on the second question referred separately but answered both questions together. 4 — Cited in footnote 2.

33. In the Commission's view, however, establishing whether an applicant for a pension is disabled for the purpose of court proceedings does not have a therapeutic aim, as the sole purpose is to resolve a question of law. Accordingly, this exercise 35. The United Kingdom submits that the must, for turnover tax purposes, be treated activities at issue in this case, namely in the same way as the activity of expert carrying out a medical examination and witnesses from other disciplines such as, then determining a person's state of health, — in effect, therefore, in its sub- mission, making a medical diagnosis —, are 5 — Council Directive of 5 April 1993 (OJ 1993 L 165, p. 1), central functions of the medical profession hereinafter 'Directive 93/16'. and therefore fall within the scope of the 6 — Cited in footnote 2. exemption in Article 13A(1)(c) of the Sixth 7 —Judgment in Case C-76/99 Commission v France [2001] ECR I-249, paragraph 24. Directive.

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39. As to the second question referred, the United Kingdom draws attention to the difference between this case and the situ- ation in the case of D. Unlike the activities here, the establishing by an expert of 37. The medical activity in point here is the paternity, which was at issue in that case, making of a diagnosis. The issue raised by had nothing to do with health. The pro- the questions referred for a preliminary cedure at issue in this case, in contrast, is ruling is whether the purpose for which the concerned with the diagnosis of diseases, which does fall within the exemption, according to the decision in D. 10 8 — The United Kingdom bases its argument that Directive 93/16 may be transposed to this case on the decision in Case C-349/96 Card Protection Plan [1999] ECR I-973, para- graph 18. 9 — Cited in footnote 7. 10 —Judgment in D. (cited in footnote 2), paragraph 18.

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OPINION OF MRS STIX-HACKL — OPINION IN CASES C-212/01 AND C-307/01

41. In view of the appellants in the main proceedings, it follows from the judgments 43. The wording of the exemption requires of the Court of Justice in the cases of D. 11 that two conditions be met. First of all, the and Commission v United Kingdom 12 that service must be performed in the exercise of the activities described in the question a medical or paramedical profession and, referred for a preliminary ruling do not fall secondly, it must constitute medical care. within the exemption in Article 13A(1)(c) There is no doubt that the first condition is and are therefore taxable. That is because met in this case because Dr d'Ambrumenil that case-law, and the judgment in the case performs the services in the exercise of his of Commission v France 13 — though the medical profession. However, his services latter is not otherwise relevant to this case cannot be described as involving the provi- sion of medical care. The words 'medical care' cannot encompass all activities car- 11 — Cited in footnote 2. 12 —Judgment in Case 353/85 Commission v United Kingdom [1988] ECR 817. 14 — Judgment in Case 348/87 Stichting Uitvoering [1989] ECR 13 — Cited in footnote 7, paragraph 24. 1737, paragraph 13.

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ried out by a person in the exercise of the 46. The appellants in the main proceedings medical profession. If they did, then the argue that none of the activities enumer- second condition would be otiose and the ated in the order for reference are per- Directive could simply have exempted 'ser- formed for the purposes of protecting the vices', as in Article 13A(1)(e). health of any person or curing or treating any medical condition. They are not carried out for any therapeutic purpose and are no different in essence from paternity testing with which the case of D. was concerned, and should not therefore be exempt.

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treating him, or the degree of confidence tion depends on what is meant by 'medical that exists, to which the Court referred in care'. In the case of D., the Court held on Case C-353/85, 15an appropriate criterion, this point that the medical intervention and it ought not to be so construed. must have a therapeutic aim, broadly con- Whether the examination is carried out by strued, in other words, its aim must be the the patient's own doctor or another doctor diagnosis, treatment and, so far as possible, cannot be material. the cure of diseases and health disorders. The Court reiterated its emphasis on this requirement in the case of Commission v France. Application of this test does not give rise to any special problems, at least no more than are raised by the interpretation of other tax exemptions. The Commission also affirms that it does not consider the 48. The United Kingdom points to the fact identity of the person who commissions the that all the activities described in the order medical procedure to be relevant. for reference involve the making of a medical diagnosis for the purpose of being communicated to a third party, with the diagnosis being commissioned by the third party in some cases. At any rate Dr D'Ambrumenil is in all cases providing medical care by using his medical know- ledge to diagnose a patient's state of health. This can be distinguished from the act, exemplified by the case of D., of giving an opinion on a question of paternity, which has nothing to do with health.

51. As regards the individual activities at relation to periodic medical examinations issue here, the Commission sees no reason which are routinely required by employers to distinguish between the services or insurers. Such examinations may have a described at points (e) to (h) of the order therapeutic aim, in that they encourage the for reference. What is common to all these persons concerned to discuss their state of is the purpose of the examination, which is health with the doctor and to obtain to determine the victim's physical condition appropriate recommendations. Such exam- and the origin and extent of the harm inations do involve a relationship of doctor alleged to have been suffered, in order to and patient, unlike examinations requested assess any potential damages. Such an solely for the purpose of determining examination, at least where the expert is aptitude for employment or assessing an not the victim's own physician, does not insurance risk. These medical activities may have any therapeutic aim or direct con- therefore be deemed to be covered by the nection with the medical treatment of that exemption. The same applies to the prep- harm. The taxation of such services con- aration of certificates and the carrying out sequently has no impact on the ease of of examinations in so far as they form part access to healthcare. The same may be said of the ongoing provision of medical care by of points (c) and (d). Where a medical a doctor to his patient. The other types of certificate is issued in the context of a service set out in the order for reference are routine consultation or ongoing medical taxable supplies. care, the provision of the certificate may be regarded as merely ancillary to the main purpose of the service, which is the medical care of the person concerned. But the resolution of that question is a matter for the national tribunal.

A — General observations on the scope of 56. The object of Article 13A of the Sixth the exemption in Article 13A(1)(c) of the Directive is to exempt certain activities that Sixth Directive are in the public interest from VAT, limited, however, to the activities which are specifically set out and described in detail therein. 17 In addition it is settled case-law that the exemptions constitute independent concepts of Community law which must be placed in the general context of the common system of VAT introduced by the Directive 18 and are to be interpreted 54. I should like to start by considering the strictly, since they constitute exceptions to issue raised by the United Kingdom, con- the general principle that turnover tax is to cerning the extent to which, under the Sixth be levied on all services supplied for con- Directive, conclusions may be drawn from sideration by a taxable person. 19 Directive 93/16 as to the scope of the exemption here.

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58. With regard, therefore, to the scope of 61. The United Kingdom, and the national the exemption, as the appellants in the tribunal in Case C-307/01, 2 2regard as main proceedings in Case C-307/01 cor- critical the fact that, unlike the activities in r e c t l y s t a t e d , t h e w o r d i n g of this case, establishing paternity, as in the Article 13A(1)(c) of the Sixth Directive case of D., has nothing to do with the makes it clear that two conditions must be health of any person. met. There must be provision of medical care, and it must be supplied by a person who possesses the necessary professional qualifications for a medical or paramedical profession. 20

62. That approach differentiates between a medical act whose object is purely to establish certain biological characteristics and one whose object is to ascertain a person's state of health.

59. It is common ground that the services in question in both these cases were pro- vided by a doctor. The question is therefore whether those services, by reason of their i n t r i n s i c n a t u r e , fall within Article 13A(1)(c). The point at issue, then, 63. However the Commission rightly is the interpretation of the words 'provision rejected such a distinction, based on the of medical care'. type of medical act, or the actual medical procedure carried out or treatment given. It is not, to my mind, possible to infer such a distinction from the decision in D., nor would it be practicable to do so.

67. In its decision in the case of D., the Court found, on the basis of a comparison 65. Furthermore, in view of the complexity of the various language versions of of the human organism and the cor- Article 13A(1)(c), that the term 'does not responding multiplicity of methods of treat- lend itself to an interpretation which ment which a doctor is necessarily called includes medical interventions carried out upon to administer in the exercise of his for a purpose other than that of diagnosing, profession, it does not seem either very treating and, in so far as possible, curing helpful or even possible to distinguish diseases or health disorders'. 2 3Therefore between various individual methods or services 'not having a therapeutic aim' medical procedures according to whether must, in view of the principle that any they are more or less central to or char- provision establishing an exemption from acteristic of the medical profession. There VAT is to be interpreted strictly, be can be no question that establishing pater- e x c l u d e d f r o m t h e s c o p e of nity, as in the case of D., requires specialist Article 13A(1)(c) of the Sixth Directive. 24 medical knowledge and therefore falls The Court of Justice has confirmed that within the tasks of the medical profession. case-law in its judgments in the cases of That is exactly the reason for engaging a Commission v France 25 and Kügler. 26 doctor as an expert. The application of medical skill, or the 'central functions of the medical profession', on which the United Kingdom bases its argument, at least in part, cannot therefore be decisive.

72. It is apparent from both the purpose of the exemption, as just set out, and the case-law of the Court that, contrary to the United Kingdom's view, activities whose direct purpose is not to cure but is merely preventive do constitute activities with a 'therapeutic aim' which are to be regarded 70. The Court has stated with respect to as involving the provision of medical care Article 13A(1)(b) that 'the exemption of and thus exempt. activities closely related to hospital and medical care is designed to ensure that the benefits flowing from such care are not hindered by the increased costs of provid- ing it that would follow if it, or closely related activities, were subject to VAT'. 27 It is to be noted in that regard that subparagraph (c) of Article 13A(1) of the Sixth Directive is intended, in conjunction with subparagraph (b), to regulate compre- hensively exemptions for services in the area of medical care. Article 13A(1)(b) covers services provided in hospitals, and 73. Indeed it is precisely preventive medi- subparagraph (c) covers medical care pro- cine that helps to keep medical costs down, vided outside hospitals, both at the private both on an individual level and in national address of the person providing the care economic terms. Preventive medical pro- and at the patient's home, or at any other cedures must therefore be covered by the place. 28 exemption in order to ensure consistency with its purpose, which is to facilitate access to medical treatment. 27 — Commission v France (cited in footnote 7), paragraph 23. 28 — See the judgment in Kügler (cited in footnote 20), paragraph 36. See also my Opinion in Case C-45/01 Christoph-Domier-Stiftung [2002) ECR I-12911, points 45 29 — See the Opinion of Advocate General Saggio in D. (cited in and 46. footnote 2), point 16.

75. It may therefore be said in general that the classification of a medical procedure for 78. It may not be easy in individual cases to the purposes of Article 13A(1)(c) depends distinguish medical care within the mean- on whether the procedure may be char- ing of the exemption at issue here — acterised as care provided with a view to which is to say medical procedures having 'prevention, diagnosis or treatment', and a therapeutic aim — from other medical must be assessed in the light of the purpose activities. However, firstly, the need for the of that provision, which is to exempt from distinction is clear from the wording of tax such medical services as are supplied to Article 13A(l)(c) of the Directive, which protect or restore a person's health, and states that it is not activities undertaken by which ought therefore to be available to physicians in general that benefit from the individuals at as low a cost as possible. exemption but 'the provision of medical care'; and, secondly, the problem of where to draw the line in relation to the con- ditions attaching to tax exemptions com- monly do give rise to difficulties.

76. It is clear from the foregoing that the Court excluded establishing the genetic 79. Whether a supply by a doctor falls affinity of individuals from the scope of within the exemption or not is ultimately to Article 13A(1)(c) of the Sixth Directive in be determined on the basis of the facts, or the case of D., not because the object of the factual context of the particular medi- that test was to ascertain a person's bio- cal transaction. logical characteristics rather than their state of health, but because the medical procedure in that case served a purpose that was other than therapeutic, namely the drawing up of an expert opinion. 80. In so doing it is necessary to separate 30 — See the judgment in Kügler (cited in footnote 20), the factual aspects of the medical supply paragraph 40. under consideration from the legal criteria I - 13880

82. The United Kingdom and the Commis- sion are correct to argue that the identity of 84. Finally, this is an appropriate point at the person who commissions or causes a which to consider the premiss, on which medical examination to be carried out is the United Kingdom's submission is based, not material to the exemption in that the activities described in both these Article 13A(1)(c) of the Sixth Directive — cases involve medical diagnosis in the both on the wording of the provision and widest sense, and that the exemption can- according to the case-law. 31 But it is one of not depend on the person who requested the factors that help to determine whether the diagnosis, or the reason for making it. the procedure constitutes treatment having a therapeutic aim. 32 — Judgment cited in footnote 12, paragraph 33. 33 — See also my Opinion in Case C-45/01 of 10 December 31 — Cf the judgment in D. (cited in footnote 2), paragraph 22. 2002 (cited in footnote 28), points 45 and 46.

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85. Very broadly, the Court's case-law says in such circumstances is clear from that in order to assess a transaction in the Article 17(5) of the Sixth Directive, which context of the Community VAT system, the states that the proportion of VAT that is nature of the transaction must be con- deductible for such goods and services is to sidered overall; artificial distinctions are to be determined by reference to all the trans- be avoided, and regard must be had to the actions carried out by the taxable person. 35 perspective of the average consumer. 34

34 — Cf the judgment in Case C-349/96 (cited in footnote 8), 35 — See also my Opinion in Case C-16/00 Cibo Participations paragraph 29. [2001] ECR I-6663, point 6.

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90. The activity of the doctor in such a case 93. The fact that a medical examination is consists in making an expert assessment of carried out at the instigation, or on the the degree of a person's disability, for the instructions, of an employer or insurer does purposes of evaluating the basis of a claim not automatically mean that it does not for a disability pension in the context of have a therapeutic aim, which is the critical court proceedings. The medical interven- condition for the exemption to apply. The tion has no therapeutic aim and it does not example cited by the Commission of (peri- therefore fall within the exemption in odic) medical examinations and tests to Article 13A(1)(c). which employees frequently have to submit as a duty owed to their employer under employment law seems to me to be illus- trative in this connection. Such routine examinations fulfil a therapeutic goal, in so far as their purpose is to maintain the employee's health or to prevent the onset of disease. Similarly, it is conceivable that an insurer might require certain preventive C — Case C-307/01 tests to be performed on its insureds. Such examinations, too, would fall to be classi- fied as medical treatment with the aim of preventing, diagnosing and, where possible, curing, regardless of the identity of the 1. Paragraphs (a) and (b) of the question person requesting them. The same would referred for a preliminary ruling be true of medicals in schools of the type alluded to at the hearing. The purpose of such medicals is not to obtain an expert opinion, even though they are carried out on the instructions of the school and not the pupils who undergo the examination, but to protect and, if possible, restore those 91. By paragraphs (a) and (b) of the ques- pupils' health. tion, the national tribunal is asking whether medical activities of examining persons and taking bodily samples for the purposes of testing for viruses, infections and other diseases, carried out for or on the instruc- tions of employers or insurers, fall within the exemption in Article 13A(1)(c).

97. In my view, the tribunal makes an erroneous distinction in the way it puts its question between certificates and reports 99. It is true that certifying whether a on the one hand, and the examinations person is medically fit may indeed have a performed in order to produce them on the 'prophylactic' function in the widest sense, other. The latter may be regarded as merely in that the person examined may, for ancillary since they do not serve any instance, refrain from undertaking a jour- purpose in themselves for the person ney which his health could not withstand. requesting them; they are simply the means Similarly, the award of a war pension or employed to produce the certificate or damages may also contribute to a person's report. 36 Nor does it make any difference health or its restoration in the broadest to the aim of the medical procedure — sense. But in the case of both these medical which is the crucial factor — whether the activities it is clearly the expert's opinion that is uppermost, any therapeutic impli- cations being only very indirect, so that to 36 — Cf the judgment in the Card Protection Plan case (cited in my mind such medical services cannot be footnote 8), paragraph 30. regarded as having any therapeutic aim.

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VI — Conclusion

100. In the light of all of the foregoing, I propose that the Court should reply to the questions referred for a preliminary ruling as follows.

A — Case C-212/01

for or on behalf of an employer or insurance company are not exempt from VAT if they do not have any therapeutic aim, such as the medical treatment of the individuals by means of prevention, diagnosis or treatment, but serve some other purpose, such as the compilation of health-related information by an expert for employers or insurance companies.

(2) The aim of medical activities such as

— certification of medical fitness such as, for example, fitness to travel,

— giving certificates as to a person's medical condition for purposes such as entitlement to a war pension, I-13886

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— preparing medical reports following medical examinations, including conducting such medical examinations, or on the basis of medical notes without any medical examination being carried out, in connection with issues of liability and the quantification of damages for individuals contemplating personal injury litigation, and