CEDH · CASELAW;REPORTS;ENG — 11 avril 1996

.sDD6737AE { font-size:11pt } .s211D6B00 { margin-top:0pt; margin-bottom:0pt; line-height:normal; widows:0; orphans:0; font-size:8.5pt } .sBB9EE52A { font-family:Arial }                  EUROPEAN COMMISSION OF HUMAN RIGHTS                        Application No. 20837/92                                  M.S.                               against                               Sweden                        REPORT OF THE COMMISSION                     (adopted on 11 April 1996)                            TABLE OF CONTENTS                                                             Page   I.    INTRODUCTION      (paras. 1-15). . . . . . . . . . . . . . . . . . . . . .1        A.    The application           (paras. 2-4). . . . . . . . . . . . . . . . . . . .1        B.    The proceedings           (paras. 5-10) . . . . . . . . . . . . . . . . . . .1        C.    The present Report           (paras. 11-15). . . . . . . . . . . . . . . . . . .2     II.   ESTABLISHMENT OF THE FACTS      (paras. 16-34) . . . . . . . . . . . . . . . . . . . . .3        A.    The particular circumstances of the case           (paras. 16-23). . . . . . . . . . . . . . . . . . .3        B.    Relevant domestic law           (paras. 24-34). . . . . . . . . . . . . . . . . . .4     III. OPINION OF THE COMMISSION      (paras. 35-93) . . . . . . . . . . . . . . . . . . . . .7        A.    Complaints declared admissible           (para. 35). . . . . . . . . . . . . . . . . . . . .7        B.    Points at issue           (para. 36). . . . . . . . . . . . . . . . . . . . .7        C.    As regards Article 8 of the Convention           (paras. 37-63). . . . . . . . . . . . . . . . . . .7             a.    Whether there was an interference with the                applicant's rights under Article 8 para. 1                (paras. 39-42) . . . . . . . . . . . . . . . .7             b.    Whether the interference was in accordance                with the law                (paras. 43-49) . . . . . . . . . . . . . . . .8             c.    Whether the interference pursued a legitimate aim                (paras. 50-52) . . . . . . . . . . . . . . . 10             d.    Whether the interference was necessary                (paras. 53-62) . . . . . . . . . . . . . . . 10             CONCLUSION           (para. 63). . . . . . . . . . . . . . . . . . . . 12        D.    As regards Article 6 of the Convention           (paras. 64-87). . . . . . . . . . . . . . . . . . 12             a.    Applicability of Article 6 para. 1                (paras. 65-78) . . . . . . . . . . . . . . . 12             b.    Compliance with Article 6 para. 1                (paras. 79-86) . . . . . . . . . . . . . . . 14             CONCLUSION           (para. 87). . . . . . . . . . . . . . . . . . . . 15        E.    As regards Article 13 of the Convention           (paras. 88-90). . . . . . . . . . . . . . . . . . 15             CONCLUSION           (para. 90). . . . . . . . . . . . . . . . . . . . 16        F.    Recapitulation           (paras. 91-93). . . . . . . . . . . . . . . . . . 16     PARTLY CONCURRING AND PARTLY DISSENTING OPINION OF MR. H. DANELIUS JOINED BY MM. C.A. NØRGAARD, G. JÖRUNDSSON, M.P. PELLONPÄÄ AND B. MARXER . . . . . . . . 17   SEPARATE OPINION OF MR. S. TRECHSEL . . . . . . . . . . . . 19   DISSENTING OPINION OF MR. C.A. NØRGAARD, MRS. G.H. THUNE, MM. J. MUCHA AND D. SVÁBY. . . . . . . . . 20   DISSENTING OPINION OF MRS. G.H. THUNE, MM. J. MUCHA AND D. SVÁBY . . . . . . . . . . . . . . . . . 22   DISSENTING OPINION OF MR. N. BRATZA . . . . . . . . . . . . 24   APPENDIX: DECISION OF THE COMMISSION AS TO THE           ADMISSIBILITY OF THE APPLICATION. . . . . . . . . 25     I.    INTRODUCTION     1.    The following is an outline of the case as submitted to the European Commission of Human Rights, and of the procedure before the Commission.     A.    The application   2.    The applicant is a Swedish citizen, born in 1951 and resident in Sweden. She is represented before the Commission by Ms. Siv Westerberg, a lawyer practising at Gothenburg.   3.    The application is directed against Sweden. The respondent Government were represented by their agent Ms. Eva Jagander, Ministry for Foreign Affairs.   4.    The application concerns a women's clinic's submission of the applicant's medical records to the Social Insurance Office and the lack of a remedy which she could use to complain about this measure. The applicant invokes Articles 6, 8 and 13 of the Convention.     B.    The proceedings   5.    The application was introduced on 23 September 1992 and registered on 23 October 1992.   6.    On 6 April 1994 the Commission (Second Chamber) decided, pursuant to Rule 48 para. 2 (b) of its Rules of Procedure, to give notice of the application to the respondent Government and to invite the parties to submit written observations on its admissibility and merits.   7.    The Government's observations were submitted on 30 August 1994 after an extension of the time-limit fixed for this purpose. The applicant replied on 25 October 1994.   8.    On 22 May 1995 the Plenary Commission ordered the transfer of the application to it and declared the application admissible.   9.    The text of the Commission's decision on admissibility was sent to the parties on 2 June 1995 and they were invited to submit such further information or observations on the merits as they wished. The Government submitted further observations on 7 July 1995, whereas the applicant did not submit any further information or observations on the merits.   10.   After declaring the case admissible, the Commission, acting in accordance with Article 28 para. 1 (b) of the Convention, also placed itself at the disposal of the parties with a view to securing a friendly settlement. In the light of the parties' reaction, the Commission now finds that there is no basis on which such a settlement can be effected.   C.    The present Report   11.   The present Report has been drawn up by the Commission in pursuance of Article 31 of the Convention and after deliberations and votes, the following members being present:             MM.   S. TRECHSEL, President                H. DANELIUS                E. BUSUTTIL                C.A. NØRGAARD                G. JÖRUNDSSON                A.S. GÖZÜBÜYÜK                A. WEITZEL                J.-C. SOYER                H.G. SCHERMERS           Mrs. G.H. THUNE           Mr.   F. MARTINEZ           Mrs. J. LIDDY           MM.   L. LOUCAIDES                J.-C. GEUS                M.P. PELLONPÄÄ                B. MARXER                M.A. NOWICKI                I. CABRAL BARRETO                B. CONFORTI                N. BRATZA                I. BÉKÉS                J. MUCHA                E. KONSTANTINOV                D. SVÁBY                G. RESS                A. PERENIC                C. BÎRSAN   12.   The text of this Report was adopted on 11 April 1996 by the Commission and is now transmitted to the Committee of Ministers of the Council of Europe, in accordance with Article 31 para. 2 of the Convention.   13.   The purpose of the Report, pursuant to Article 31 of the Convention, is:        (i)   to establish the facts, and        (ii) to state an opinion as to whether the facts found disclose           a breach by the State concerned of its obligations under           the Convention.   14.   The Commission's decision on the admissibility of the application is annexed hereto.   15.   The full text of the parties' submissions, together with the documents lodged as exhibits, are held in the archives of the Commission.   II.   ESTABLISHMENT OF THE FACTS   A.    The particular circumstances of the case   16.   On 9 October 1981 the applicant allegedly injured her back while working at a day care centre. She was at the time pregnant and contacted the same day the women's clinic at the regional hospital in her home town.   17.   On 13 March 1991 the applicant claimed compensation under the Industrial Injury Insurance Act (Lagen om arbetsskadeförsäkring, 1976:380; hereinafter "the Insurance Act") from the Social Insurance Office (Försäkringskassan). She was later asked to supplement her claim, which she did on 11 May 1992. She stated that, as a consequence of the above injury, she had been on sick leave during the periods 9 October 1981 - 4 April 1982, 12 May 1986 - 24 January 1989, 11 - 17 February 1991 and from 20 February 1991.   18.   Upon request the applicant thereafter received a copy of the file which had been compiled by the Social Insurance Office for the purpose of examining her claim. From the documents in the file she learned that, on 25 March 1992, the Office had made the following request to the above women's clinic:   (translation)        "[The applicant] has reported an industrial injury which      occurred on 9 October 1981. She contacted your clinic as      she was pregnant at the time. The Social Insurance Office      requests copies of medical records from that time. We hope      you will assist us as soon as possible as the matter has      been pending for some time and as we need the records to be      able to determine the matter."   19.   The applicant further learned that, on 30 March 1992, the head of the clinic in reply had submitted copies of her medical records containing information on treatment received in October 1981, March 1982 and October 1985 - February 1986. The applicant had not in any way been involved in, or consented to, the disclosure of the information.   20.   According to the records from October 1981, the applicant had expressed, inter alia, that she had pains in her hips and back and that her back had felt tired for two weeks. There is no indication of the applicant alleging that she had injured herself at work. The records from October 1985 - February 1986 concerned an abortion performed on 22 October 1985 and the following after-treatment. All medical interventions documented in the separate medical records, including the abortion, had been partly related to the applicant's back problems.   21.   On 19 May 1992 the Social Insurance Office rejected the applicant's request for compensation under the Insurance Act, finding that her sick leave had not been caused by an industrial injury. Following the applicant's request for a review, the decision was upheld by the Social Insurance Board (Socialförsäkringsnämnden) on 5 August 1992.   22.   The applicant appealed to the local County Administrative Court (Länsrätten). On 21 December 1992 the Court rejected the appeal. Noting that the applicant had changed her initial account of the alleged injury and that she had suffered from a disease affecting her back since the age of 14, the Court considered that there were weighty reasons for believing that the sick leave beginning on 9 October 1981 had not been caused by that injury. The Court further found that the later periods of sick leave were not related to the alleged injury.   23.   On 2 May 1995 the Administrative Court of Appeal (Kammarrätten) in Jönköping upheld on appeal the County Administrative Court's judgment. On 26 February 1996 the Supreme Administrative Court (Regeringsrätten) refused the applicant leave to appeal.   B.    Relevant domestic law   24.   Under Sections 1 and 2 of Chapter 2 of the Freedom of the Press Act (Tryckfrihetsförordningen), which is part of the Swedish Constitution, everyone is entitled to have access to public documents unless, within defined areas, access is limited by law. The Secrecy Act (Sekretesslagen, 1980:100) contains such limitations.   25.   The main provision on the confidentiality of information in the field of health and medical care is found in Chapter 7, Section 1 of the Secrecy Act, the relevant parts of which read as follows:   (translation)        "Secrecy applies ... in the field of health and medical      care to information on the individual's state of health or      otherwise concerning his or her private life, unless it is      clear that the information can be disclosed without any      harm to the individual or persons closely related to him or      her. ..."   26.   As appears from this provision, there is a presumption of confidentiality. It is applicable not only in relation to the public, but also in relation to other public authorities. There are, however, legal provisions to the effect that health and medical care authorities shall submit information to another public authority. Thus, Chapter 14, Section 1 of the Secrecy Act provides the following:   (translation)        "Secrecy does not prevent ... the disclosure of information      to another public authority, if an obligation to disclose      the information is laid down in an act of law or a      Government ordinance."   27.   Such an obligation follows from in Chapter 8, Section 7 of the Insurance Act which, in relevant parts, reads as follows:   (translation)        "A public authority ... [is] obliged to submit, on request,      to the courts, the National Social Insurance Board [or] the      Social Insurance Office ... information on a named person      concerning circumstances of importance to the application      of this Act. ..."   28.   In this context, a physician employed by a public hospital, as in the present case, is regarded as a representative of a public authority. A corresponding duty of the Social Insurance Office to request information is found in the Ordinance on Industrial Injury Insurance and State Injury Compensation Guarantee (Förordning om arbetsskadeförsäkring och statligt personskadeskydd, 1977:284; hereinafter "the Insurance Ordinance"), Section 13 of which provides, in so far as relevant, the following:   (translation)        "The Social Insurance Office shall obtain a physician's      opinion on a reported industrial injury. ..."   29.   Furthermore, the person applying for compensation under the Insurance Act is, according to Chapter 8, Section 6 of the Act, obliged to provide the Social Insurance Office with information of importance.   30.   If information is submitted to the Social Insurance Office, the confidentiality of that information is regulated by Chapter 7, Section 7 of the Secrecy Act which, in so far as relevant, provides the following:   (translation)        "Secrecy applies at the Social Insurance Office, the      National Social Insurance Board and the courts in matters      arising under the legislation on ... industrial injury      insurance ... in respect of information on an individual's      state of health or otherwise concerning his or her private      life, if it can be assumed that the individual concerned or      persons closely related to him or her will be harmed if the      information is disclosed. ..."   31.   Thus, whereas a presumption of confidentiality applies within the field of health and medical care to information concerning an individual's private life, there is no such presumption in respect of information kept at the Social Insurance Office.   32.   Under the Freedom of the Press Act and the Secrecy Act, there is a right to appeal against a decision not to grant access to public documents. There is, however, no such right in respect of decisions to grant access to information contained in public documents. Furthermore, there is no right for the individual concerned to be consulted before such information is disclosed or to be notified of the disclosure afterwards.   33.   Under Chapter 20, Section 3 of the Penal Code (Brottsbalken), a physician who, intentionally or through negligence, discloses information which should be kept confidential according to law is guilty of breach of professional secrecy. Proceedings may be brought in the ordinary courts by the public prosecutor or, if the public prosecutor decides not to prosecute, the aggrieved individual. Such a breach of professional secrecy may also constitute a basis for claiming damages under Chapter 2, Section 1 or Chapter 3, Section 1 of the Tort Liability Act (Skadeståndslagen, 1972:207). Action may be taken by the individual in the ordinary courts against the physician or his or her employer.   34.   Public authorities and their employees are, furthermore, subject to the supervision of the Chancellor of Justice (Justitiekanslern) and the Parliamentary Ombudsman (Justitieombudsmannen). The Chancellor and the Ombudsman investigate whether those exercising public powers abide by laws and follow applicable instructions and may prosecute a certain individual or refer the matter to disciplinary action by the relevant authority.   III. OPINION OF THE COMMISSION   A.    Complaints declared admissible   35.   The Commission has declared admissible the applicant's complaints under Article 8 (Art. 8) of the Convention that the submission of her medical records to the Social Insurance Office constituted an unjustified interference with her right to respect for her private life and under Articles 6 and 13 (Art. 6, 13) of the Convention that she had no remedy which she could use to complain about this measure.     B.    Points at issue   36.   Accordingly, the issues to be determined are        - whether there has been a violation of Article 8 (Art. 8) of the Convention;        - whether there has been a violation of Article 6 (Art. 6) of the Convention; and        - whether there has been a violation of Article 13 (Art. 13) of the Convention.     C.    As regards Article 8 (Art. 8) of the Convention   37.   Article 8 (Art. 8) of the Convention reads as follows:        "1. Everyone has the right to respect for his private and      family life, his home and his correspondence.        2. There shall be no interference by a public authority      with the exercise of this right except such as is in      accordance with the law and is necessary in a democratic      society in the interests of national security, public      safety or the economic well-being of the country, for the      prevention of disorder or crime, for the protection of      health and morals, or for the protection of the rights and      freedoms of others."   38.   The Commission first recalls that in its decision on the admissibility of the present application, the Commission, disagreeing with the Government's opinion, found that no express waiver of a right to protection of confidential information had been made by the applicant nor could an unequivocal waiver be inferred from the fact that she had made a claim for compensation under the Industrial Injury Insurance Act. The Commission thus concluded that Article 8 (Art. 8) of the Convention applies to the present complaint.        a.    Whether there was an interference with the applicant's           rights under Article 8 para. 1 (Art. 8-1)   39.   The applicant submits that the women's clinic's submission of copies of her medical records to the Social Insurance Office without her knowledge or consent interfered with her right to respect for her private life. She maintains that the information contained in these records were of a highly sensitive and private nature. Allegedly, she could not anticipate, when she claimed compensation from the Office, that information on the abortion performed several years after the alleged back injury would be forwarded to the Office. She further refers to the fact that the information in question is not protected by the same level of confidentiality at the Office as at the clinic.   40.   The Government submit that there has been no interference with the applicant's rights under Article 8 para. 1 (Art. 8-1). The Government contend that the submission of information to the Social Insurance Office was initiated by the applicant's claim for compensation under the Insurance Act. The Office's obligation to request information from the women's clinic and the corresponding duty of the clinic to submit that information were easily accessible elements of Swedish law and the applicant was thus, at the time when she lodged her claim, able to anticipate that the information in question would be obtained by the Office. As the abortion was related to the applicant's back condition, it was furthermore not surprising that the clinic chose to include copies of the medical records concerning this operation in its submissions to the Office. The Government further submit that it should be taken into account that the information in question has not been made public and will, due to its highly personal nature, remain confidential at the Social Insurance Office.   41.   The Commission notes that, as a result of the submission of the applicant's medical records from the women's clinic to the Social Insurance Office, information of a private and sensitive nature was disclosed to a certain number of people at the Office. The Commission finds that this amounted to an interference with the applicant's right to respect for her private life as ensured by Article 8 para. 1 (Art. 8-1) (cf. Eur. Court H.R., Leander judgment of 26 March 1987, Series A no. 116, p. 22, para. 48).   42.   It must accordingly be examined whether this interference was justified under the terms of Article 8 para. 2 (Art. 8-2). In this respect, three conditions must be satisfied: the interference must be "in accordance with the law", it must pursue one or more of the legitimate aims enumerated in para. 2 and it must be "necessary in a democratic society" for that or those aims.        b.    Whether the interference was in accordance with the law   43.   The applicant claims that the women's clinic's submission of information was not in accordance with domestic law, as it went beyond the Social Insurance Office's request. She points to the fact that the clinic forwarded copies of her medical records covering the period October 1981 - February 1986, although the Office had only requested the records from the time of the alleged injury. The later records were thus not submitted on request, as required by Chapter 8, Section 7 of the Insurance Act.   44.   The Government contend that the provisions applicable in the present case were easily accessible to the applicant, as they are published on a yearly basis in the Swedish Code of Statutes. Moreover, they had foreseeable consequences, as the respective obligations of the Social Insurance Office and the women's clinic to obtain and submit information were unconditional. Furthermore, the rationale behind the provision obliging the Social Insurance Office to obtain information is that the Office should acquire all information relevant to a particular compensation claim. The Government share the clinic's apparent opinion that the information on the abortion was of relevance to the applicant's claim. The information was thus forwarded in accordance with the law although the Office's request explicitly referred only to the time when the alleged injury occurred.   45.   The Commission recalls that the expression "in accordance with the law", within the meaning of Article 8 para. 2 (Art. 8-2), requires firstly that the impugned measures should have a basis in domestic law. It also refers to the quality of the law in question, requiring that it be accessible to the persons concerned and formulated with sufficient precision to enable them - if need be, with appropriate advice - to foresee, to a degree that is reasonable in the circumstances, the consequences which a given action may entail. A law which confers a discretion is not in itself inconsistent with this requirement, provided that the scope of the discretion and the manner of its exercise are indicated with sufficient clarity, having regard to the legitimate aim in question, to give the individual adequate protection against arbitrary interference (cf., e.g., Eur. Court H.R., Margareta and Roger Andersson v. Sweden judgment of 25 February 1992, Series A no. 226-A, p. 25, para. 75).   46.   The Commission notes that pursuant to Chapter 8, Section 7 of the Insurance Act the women's clinic was obliged to submit, on request by the Social Insurance Office, information of importance to the determination of the applicant's claim for compensation under that Act.   47.   It is true that the Social Insurance Office's request to the clinic referred only to the applicant's medical records from the time of the back injury she had allegedly sustained at work on 9 October 1981. It could thus be argued that the medical records for the time that followed were not submitted on request and thus not pursuant to Chapter 8, Section 7 of the Insurance Act. However, the provision stipulates that information of importance to the application of the Act shall be submitted. The Office's request was made expressly to provide a basis for its determination of the applicant's claim for compensation. The abortion performed in 1985 and the other treatment documented in the medical records had been partly related to the applicant's back problems. It appears that the clinic, for this reason, regarded the submitted information to be of importance to the Office's determination of that claim. The Commission therefore considers that the information in question was submitted pursuant to Chapter 8, Section 7 of the Insurance Act.   48.   Having further regard to the Social Insurance Office's duty under Section 13 of the Insurance Ordinance to obtain a physician's opinion on a reported industrial injury, the Commission considers that it was reasonably foreseeable to the applicant that the information in question could be imparted to the Office following her compensation claim. On account of their publication, the applicable provisions were, furthermore, easily accessible to the applicant.   49.   Accordingly, the Commission finds that the information in the present case can reasonably be regarded as having been submitted "in accordance with the law" within the meaning of Article 8 para. 2 (Art. 8-2).        c.    Whether the interference pursued a legitimate aim   50.   The applicant does not submit any observations on this point.   51.   The Government contend that if the Social Insurance Office, in determining compensation claims under the Insurance Act, were to depend entirely on evidence either submitted by the claimants or obtained with their consent, the Office would have to pay out compensation to almost every claimant. As the economic resources available to the Office are limited, the submission of information in the present case pursued the legitimate aims of protecting the economic well-being of the country and the rights of those who are in the greatest need of compensation.   52.   The Commission accepts that the respective legal obligations to submit and obtain information in cases like the present one and the actual submission of information in the present case served the legitimate aim of protecting the economic well-being of the country. It does not find it necessary to examine the Government's other contention on this point.        d.    Whether the interference was necessary   53.   The applicant maintains that it was not necessary for the Social Insurance Office to have access to medical records on her gynaecological treatment. Instead, the Office could have obtained information by requesting the applicant to submit a medical certificate on the alleged back injury. In this way, the applicant could have decided herself whether she wanted information on the gynaecological treatment to be disclosed to the Office and, if such information was necessary for the Office's determination of her compensation claim, whether she wanted to pursue the claim. In this connection, the applicant further refers to the lower level of confidentiality applicable at the Social Insurance Office.   54.   The Government submit that the burden on the applicant caused by the disclosure of information was not excessive. The Government argue that the applicant claimed compensation although it must have been clear to her that information could be released from the clinic where she had previously received treatment. The applicant has later appealed to the courts against the Social Insurance Office's decision to reject her claim and thus does not seem to mind that the information obtained by the Office becomes known in even larger circles. Moreover, the information in question has not been made public and will, according to the Government, remain confidential at the Social Insurance Office.   55.   The Commission recalls that the notion of necessity implies that the interference corresponds to a pressing social need and, in particular, that it is proportionate to the legitimate aim pursued. The Commission has to take into account that a margin of appreciation is left to the Contracting States. That does not mean, however, that the Commission's review is limited to ascertaining whether the respondent State has exercised its discretion reasonably, carefully and in good faith. The Commission must determine whether the reasons adduced to justify the interference are relevant and sufficient (cf., e.g., Eur. Court H.R., Olsson judgment of 24 March 1988, Series A no. 130, pp. 31-32, paras. 67-68).   56.   The Commission notes that, following the applicant's claim for compensation, the Social Insurance Office had to examine whether the applicant had injured her back and, if so, whether the injury had occurred at her place of work. If it had found that the applicant was entitled to compensation under the Insurance Act, the further question of the amount to be awarded would have arisen.   57.   It is not for the Commission to decide which information the Social Insurance Office required for its determination of these issues, the evaluation of evidence being a question for the domestic authority. Instead, the question to be decided is whether it was necessary, in the circumstances of the case, that information on the gynaecological treatment received by the applicant at the women's clinic, including the abortion, was forwarded from the clinic to the Office.   58.   The Commission notes that the applicant claimed compensation under the Insurance Act due to back problems allegedly caused by an accident at her place of work on 9 October 1981. As is evident from the Social Insurance Office's request to the women's clinic on 25 March 1992, the Office was aware, apparently from information supplied by the applicant, that she had consulted the clinic on the day of the alleged accident. The medical records concerning the treatment received that day were therefore clearly material to the determination of her claim. This does not seem to be disputed by the applicant.   59.   The Commission further notes that, according to the medical records from October 1985 - February 1986, the applicant's abortion and the following after-treatment were partly related to her back problems. As the Social Insurance Office had to determine whether the applicant was entitled to compensation not only for the months following the alleged accident but also for periods subsequent to the abortion, in particular the period starting on 12 May 1986, it appears that also these later records were of relevance to the Office's examination. This must have been apparent to the applicant when she claimed compensation.   60.   Under Chapter 8, Section 6 of the Insurance Act, the Social Insurance Office could have requested the applicant to submit information. In fact, the Office asked the applicant to supplement her compensation claim, which she did on 11 May 1992. However, if the Office were to rely entirely on submissions made by the applicant or obtained with her consent, there would have been an obvious risk of the applicant withholding important information. It was therefore reasonable for the Office to request information directly from the clinic where the applicant had received treatment. Since the medical records appeared to be relevant to the matter to be decided by the Office, it was also reasonable that the clinic made the records available to the Office.   61.   It is true that the medical records received from the women's clinic contained information of a highly private and sensitive nature, which the applicant wished to be kept secret. In this respect, the Commission notes, however, that the information has not been made public and will, due to its contents and to the relevant legal obligation, remain confidential at the Social Insurance Office, which is used to deal with cases of this kind. The Commission therefore considers that the interference created by the disclosure of information was of a limited nature.   62.   In the light of the foregoing, the Commission finds that the disclosure of information to the Social Insurance Office was supported by relevant and sufficient reasons. Having regard to their margin of appreciation, the Swedish authorities were entitled to think that this measure was necessary. Accordingly, the Commission concludes that the disclosure of information can reasonably be regarded as "necessary in a democratic society" within the meaning of Article 8 para. 2 (Art. 8-2) of the Convention.        CONCLUSION   63.   The Commission concludes, by 22 votes to 5, that there has been no violation of Article 8 (Art. 8) of the Convention.   D.    As regards Article 6 (Art. 6) of the Convention   64.   Article 6 (Art. 6) of the Convention reads, in so far as relevant, as follows:        "1.   In the determination of his civil rights and      obligations ..., everyone is entitled to a ... hearing by      [a] ... tribunal ..."        a. Applicability of Article 6 para. 1 (Art. 6-1)   65.   The applicant submits that it is not consistent with the Convention that a physician may decide to forward medical records containing information of a private and sensitive nature to the Social Insurance Office without the individual being notified thereof and without there being a possibility to appeal to a court before the decision is executed. This is especially true in the present case, as the applicant could hardly foresee, when claiming compensation from the Office, that information on treatment received several years after the alleged industrial injury would be disclosed. Moreover, this information was not of importance to the Office's determination of her compensation claim. Furthermore, although an appeal to a court could have delayed the determination, the delay would have been of no significance, as, in any event, the proceedings before the Office allegedly take several months or years.   66.   The Government submit that the applicant cannot claim, on arguable grounds, that she was entitled under Swedish law to protection of confidentiality of the information in question in relation to the Social Insurance Office. There was thus no "right" at stake. The Government therefore contest the applicability of Article 6 (Art. 6) in the present case and maintain that this complaint should be declared incompatible with the Convention ratione materiae.   67.   The Government argue that the applicant had no standing under Swedish law in procedures concerning the granting of access to official documents. Thus, she could not appeal against a decision to grant access to medical records containing information concerning her, nor was her consent to the disclosure of information required.   68.   The Government further refer to Chapter 14, Section 1 of the Secrecy Act, according to which the secrecy which otherwise applies shall not prevent the communication of information to another authority if there is an obligation under the law to communicate the information in question. Such an obligation is laid down in the Insurance Act.   69.   Should the Commission be of the opinion that the applicant had a "right" under Swedish law in the present case, the Government reserve its position as to whether there was a genuine and serious dispute, the outcome of which was decisive for such a right, and as to whether the entitlement in issue was a "civil right".   70.   The Commission recalls that the applicability of Article 6 (Art. 6) depends on whether there was a dispute over a "right" which can be said, at least on arguable grounds, to be recognised under domestic law, and, if so, whether this right was of a "civil" character within the meaning of Article 6 para. 1 (Art. 6-1). In particular, the dispute must be genuine and serious, it may relate not only to the actual existence of a right but also to its scope and the manner of its exercise and, finally, the results of the proceedings concerning the dispute must be directly decisive for such a right (cf., e.g., Eur. Court H.R., Zander v. Sweden judgment of 25 November 1993, Series A no. 279-B, p. 38, para. 22). The notion of a dispute should be given a substantive rather than a formal meaning (cf., e.g., Eur. Court H.R., Le Compte, Van Leuven and De Meyere judgment of 23 June 1981, Series A no. 43, p. 20, para. 45).   71.   The Commission further recalls that Chapter 7, Section 1 of the Secrecy Act contains a presumption that information on an individual's state of health or otherwise concerning his or her private life shall be kept secret by authorities and practitioners within the field of health and medical care. This presumption applies not only in relation to the public, but also in relation to other authorities.   72.   However, according to Chapter 14, Section 1 of the Secrecy Act, the above provision does not prevent the disclosure of information to another authority, if an obligation to disclose information is prescribed by law. Such an obligation is laid down in Chapter 8, Section 7 of the Insurance Act, which provides that a public authority, including the women's clinic in the present case, is obliged to submit, on the Social Insurance Office's request, information concerning circumstances of importance to the application of the Insurance Act.   73.   The Commission notes that Chapter 8, Section 7 of the Insurance Act contains a restriction on the individual's right to protection of confidentiality of information. It might therefore be argued, as do the Government, that the individual does not have a right to confidentiality if information is forwarded pursuant to that provision. However, information shall be forwarded by the responsible authority only to the extent that it is of importance to the Social Insurance Office's determination of a compensation claim. Information deemed to be of no such importance shall not be disclosed and shall thus remain confidential at the responsible authority. Thus, the authority must make an assessment as to which information it should forward. In a particular case, the individual concerned may therefore disagree with the authority's assessment and claim that he or she is entitled to confidentiality under the law, namely Chapter 7, Section 1 of the Secrecy Act. The individual may claim that certain pieces of information should not be submitted to the Social Insurance Office as they are of no importance to the Office's determination.   74.   The Commission is therefore of the opinion that an individual challenging the assessment made by the submitting authority under Chapter 8, Section 7 of the Insurance Act has an arguable right to confidentiality recognised by Swedish law.   75.   In the present case, the applicant challenges the women's clinic's decision to forward medical records containing information on her gynaecological treatment to the Social Insurance Office, claiming that the information was of no importance to the Office's determination of her compensation claim.   76.   The Commission finds that, in this respect, the applicant claims an arguable right to confidentiality of the information in question. Accordingly, there was a genuine and serious dispute, albeit latent as the applicant was not informed before the disclosure, between the applicant and the women's clinic as to the necessity of forwarding the information to the Social Insurance Office. Moreover, the clinic's decision to forward the information was directly decisive for the applicant's alleged right to confidentiality.   77.   As regards the character of the right at issue, the Commission notes that the right related to information on the medical treatment received by the applicant. It thus concerned her private life. Consequently, the right at issue must be considered a civil right.   78.   The Commission therefore finds that Article 6 para. 1 (Art. 6-1) of the Convention is applicable to the applicant's complaint.        b.   Compliance with Article 6 para. 1 (Art. 6-1)   79.   The next issue to be determined is whether the applicant had at her disposal a procedure satisfying the requirements of Article 6 para. 1 (Art. 6-1) of the Convention with regard to the above dispute.   80.   In this respect, the Government submit that a general provision providing for a court review before information is submitted from one authority to another would give rise to serious practical problems. As an example, the Government refer to cases of child abuse, in which a requirement to obtain a court permission before the relevant information is forwarded to the responsible Social Council would inevitably delay the Council's intervention and could entail grave risks of further abuse of the child whose life and safety may be at stake.   81.   The Commission recalls that a physician who discloses information which should be kept confidential according to law may be prosecuted, by the public prosecutor or the aggrieved individual, for breach of professional secrecy under the Penal Code. Such a breach may also constitute a basis for claiming damages under the Tort Liability Act. A physician in public service is, furthermore, subject to the supervision of the Chancellor of Justice and the Parliamentary Ombudsman, who may prosecute a physician who has not followed the applicable instructions or refer the matter to disciplinary action by the relevant authority. An individual who does not consent to a decision to submit information to the Social Insurance Office has, however, no right to have the dispute determined by a court or other authority before the disclosure.   82.   The Commission first finds that the Chancellor of Justice and the Parliamentary Ombudsman cannot