Who is writing this guide?
I have been an airline pilot (ATPL) for about twenty years (business jet, Falcon 2000LX) and a former flight instructor. Before aviation, I was a nurse for several years in cardiology, cardiac intermediate care, and emergencies at the CHUV in Lausanne. On a topic like unfitness, this dual perspective matters: I know both what a licence means for someone who makes a living from it, and the logic behind a medical file. This guide gathers what you need to know before panicking, and above all, before missing a deadline.
In brief
Medical unfitness is almost never a definitive end: many cases are temporary or lead to fitness subject to limitations after further examination. According to Fabian Voncken, an airline pilot (ATPL) and former nurse, the classic mistake is believing that a 'no' from the aeromedical examiner (AME) is final. In reality, the national medical authority reviews the file and makes a decision at the second instance, and other levels of appeal exist in the event of a disagreement, with strict deadlines that must not be missed.
Unfitness does not mean « grounded forever »
The word 'unfit' falls like a guillotine, but it covers very different realities. A medical examination has three outcomes: fit, fit with restrictions (mandatory glasses, day flying only, qualified co-pilot required on board, shortened validity period…), or unfit.
And unfitness itself varies: temporary while blood pressure stabilises, recovering from surgery, completing an assessment, or permanent. In France, temporary unfitness is a category in its own right: it leads to a re-examination at a later date by your examiner, or to a referral to the licensing authority. On what happens next, practice is not uniform and two aeromedical examiners gave us different readings: for one, the refusal acts as a first-instance decision and opens up the appeal; for the other, the regulation does not provide for a certificate of unfitness but a referral to the authority, and writing such a certificate would trigger the appeal deadline while closing the possibility of obtaining fitness after consultation. The European text, for its part, only acknowledges the referral. We clarify this point before going any further. Most situations encountered during a medical examination are not outright exclusions: they are 'not right now' or 'yes, but under conditions'.
Point of accuracy. The aeromedical examiner (AME) does not 'punish' the pilot. When a regulatory criterion is not met, they cannot issue the certificate themselves; it is not an arbitrary refusal, but rather a limitation of their scope. The file is then referred to the medical assessor of the licensing authority, who has a power the AME does not have: issuing the certificate subject to limitations.
Who decides what: AME, aeromedical centre (AeMC), national authority
Three levels of decision-making, not to be confused.
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01
The AME / AeMC applies the standards. If they find a criterion is not met, they refer the file to the medical assessor of the licensing authority for Class 1, or consult with them for Class 2.
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02
The national medical authority (aviation medicine section) reviews the file and may issue the certificate subject to limitations: this is the review provided for by MED.B.001.
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03
The appeals body / administrative justice intervenes if the pilot disputes the authority's decision.
The main takeaway: declared unfit by an AME ≠ unfit forever. The real decision-maker in a dispute is the authority, not the first doctor you see.
Referral to the licensing authority: the avenue pilots underestimate
The referral is the most important mechanism, and the least understood. The principle is written in MED.B.001: if the applicant does not fully meet the requirements but is not considered likely to jeopardise flight safety, the AME refers the decision to the medical assessor of the licensing authority for Class 1, or consults with them for Class 2. The certificate may then be issued subject to one or more limitations, often with further examinations and close follow-up. This is particularly true for vision, hearing, and certain stabilised cardiac conditions.
In other words: failing to meet a standard does not automatically rule out the applicant. Fitness may be granted after further assessment, when fitness to fly safely is demonstrated; these decisions rest with the aeromedical centre (AeMC), the aeromedical examiner, or the authority, depending on the case. This is the mechanism provided for by MED.B.001 of Part-MED (EU Regulation 1178/2011). The word 'derogation' does not appear anywhere: the regulation only speaks of referral, consultation, and limitations.
Formal appeals: deadlines you cannot recover from
Beyond the referral, which remains an assessment procedure, there are appeals against a decision of unfitness. The critical point is the deadline, and it varies by country.
France. In France, contesting an unfitness decision goes through the Civil Aviation Medical Council (CMAC). Legal basis: Articles R6511-8 and following of the Transport Code, created by Decree No. 2023-1008 of 31 October 2023, in force since 1 November 2023. (Article D424-2 of the Civil Aviation Code, still often cited, has been repealed since that date.)
The appeal must be lodged within a two-month period, and Article R6511-10 adds a decisive clarification: 'Exercising this appeal is a mandatory preliminary step before applying to the administrative judge.' A pilot who does not apply to the CMAC will find their appeal before the judge inadmissible.
Pay attention to the starting point: Article D6511-25 3° starts these two months 'following the date of the decision', and not its notification. But Article R421-5 of the Administrative Justice Code qualifies this: 'The deadlines for appealing against an administrative decision are only enforceable on the condition that they, as well as the avenues of appeal, were mentioned in the notification of the decision.' If your notification is silent on the avenues and deadlines for appeal, the deadline cannot be enforced against you.
Following the CMAC's decision, referring the matter to the administrative judge is subject to a separate deadline: two months from the date of notification (R421-1 CJA). These are not 'two months then two months' of the same sequence: they are two deadlines of a different nature, with different starting points.
Can you fly during the procedure? In principle, no: the appeal does not have a suspensive effect, and MED.A.020 (a) prohibits the exercise of privileges as soon as one is aware of a decrease in medical fitness. There is a narrow exception: Article D6511-25 4° paragraph 2 allows the chief medical officer of an aeromedical centre or the aeromedical examiner, 'in the event of a slight deficiency from a medical standard remaining compatible with flight safety', to declare the person concerned fit for a maximum period of forty-five days, until the CMAC decision. This is not a right: it is an option for the doctor, and it is linked to applications for derogations.
- Belgium, Switzerland, Luxembourg. Each has its own deadline, not to be confused with the French system. Details are in the table below.
The circuit country by country (BE / FR / CH / LU)
The EASA certificate is common to the four countries, but the body that decides on unfitness and the appeal deadline change depending on the country. The safe reflex, here more than anywhere else: start from the official portal of your licensing authority, never from contact details picked up on a forum.
France
Decision reviewed by the Aircrew Medical Hub (DSAC / DGAC). Derogations and appeals before the CMAC (Civil Aviation Medical Council), then the Administrative Tribunal and, ultimately, the Council of State.
Deadlines: 2 months from the date of the decision (CMAC, mandatory preliminary step); then 2 months from notification (administrative judge).
Belgium
Review by the DGTA / BCAA (FPS Mobility).
In Belgium, contesting an unfitness decision goes through the Appeals Commission. The appeal is sent to the Director General by registered letter, within 30 days of receiving the decision (Royal Decree of 12 July 2013, art. 11 §2). It is not suspensive: upon delivery of the refusal, you must refrain from exercising the privileges of your licence (art. 11 §1 and art. 51). You then have 15 days from the introduction of the appeal to send a report refuting the reasons invoked (art. 11 §4).
The commission includes a French-speaking chamber and a Dutch-speaking chamber (art. 7). It issues an opinion: it is the medical assessor who issues or refuses the certificate (art. 12). The action for annulment before the Council of State (60 days) only comes afterwards, against the final decision, and it judges legality, not your fitness.
Switzerland
Review by the Aviation Medicine Section of the FOCA. Against the FOCA's decision (Verfügung), appeal to the Federal Administrative Court (FAC).
Deadline: 30 days (art. 50 APA).
The FOCA (Aviation Medicine Section, AMS) is the first instance of appeal in the event of a conflict; its decision (Verfügung) can then be brought before the FAC. (Source: FOCA/BAZL.)
Luxembourg
Directorate of Civil Aviation (DAC). Against the DAC's decision, appeal to the Administrative Tribunal within 3 months; a prior non-contentious appeal to the DAC is possible, and the appeal is then made to the Administrative Court within 40 days.
The 3-month deadline does not run from mere notification: it runs from the moment the decision was brought to your attention and you were instructed on the avenues of appeal (Grand Ducal Regulation of 8 June 1979, art. 7 and 14). If the decision does not mention the avenues of appeal, the deadline does not start.
The non-contentious appeal suspends the deadline, but the suspension is capped: if more than three months pass without a new decision, the contentious deadline restarts at the end of the third month (Law of 21 June 1999, art. 13(3)).
The internal process at the DAC is to be confirmed on dac.gouvernement.lu.
Who reviews the unfitness and how to appeal (by country)
| Country | Authority that reviews | Fitness with limitations? | Contentious appeal | Key deadline |
|---|---|---|---|---|
| 🇫🇷 France | Aircrew Medical Hub (DSAC) | Yes, via CMAC | CMAC → Administrative Tribunal → (Council of State) | 2 months from the date of the decision (CMAC, mandatory preliminary step); then 2 months from notification (administrative judge) |
| 🇧🇪 Belgium | DGTA/BCAA | Yes (authority) | Appeals Commission; then Council of State (annulment) | 30 days (Appeals Commission) |
| 🇨🇭 Switzerland | Aviation Medicine Section, FOCA | Yes (authority) | Federal Administrative Court (FAC) | 30 days (art. 50 APA) |
| 🇱🇺 Luxembourg | Directorate of Civil Aviation (DAC) | Yes (Part-MED framework) | Administrative Tribunal → Administrative Court | 3 months (non-contentious appeal possible, suspensive within a limit of 3 months) |
The EASA medical certificate is common to the four countries; only the national body that decides and the deadlines differ. Always check the exact deadline on the notification you receive and start from the official portal of your licensing authority.
The financial aspect: what if the unfitness lasts?
For a professional pilot, unfitness is not just a medical problem: it is an income problem. This is where loss of licence insurance comes in, which pays compensation in the event of the loss of the Class 1 certificate for health reasons, whether temporary or permanent depending on the cover taken out.
The pilot's takeaway
I have been a member of one of these insurance policies for nearly seven years, and I should make it clear before writing the rest: I am not neutral on the subject, I am a client.
What made up my mind was not abstract. A colleague of my age permanently lost his licence in his mid-forties. He was covered, and the compensation left him with enough to build something else. I looked at my loans, and I took out a policy.
What I had not realised when signing, on the other hand: the premium scale rises with age, and the guaranteed capital eventually starts to decrease. On my contract, it decreases by a fixed percentage each year from the age of fifty. This is not written in large print: it is in the rules, and you have to read them.
- The rule that decides everything: the maximum age for joining. At APPN, no membership is possible after 45 (35 for trainees). Past this date, the subject is closed: it is no longer a question of price, access simply no longer exists. This is the only information on this page that has a personal expiry date.
- Subscribing early structurally costs less. The APPN scale applies a reduction before the age of 30 and an increase from 40, which becomes even heavier after 45. The same contract therefore does not have the same price depending on the year it is signed, regardless of health status.
- Psychological disorders have their own excess. The APPN rules provide for an excess of 50% of the basic compensation during the six years following the entry into effect of each loss of licence guarantee. In other words, full cover for this reason is only acquired over time, another reason not to wait.
- The declaration deadline is short. A claim must be reported to the APPN within 5 days. At the moment when one is dealing with an unfitness, this is exactly the kind of deadline that gets missed.
- Temporary and permanent are two separate guarantees. You can take out one, the other, or both, usually with a death component added. Temporary loss of licence is not reserved for any company or any union: at APPN, union membership only changes the amount of the association subscription, by a few euros per month.
- The French-speaking market is structured. In France, the APPN (a non-profit association created in 1957, managed by pilots, roughly 23,000 members) and specialised brokers such as SAAM Verspieren have been covering this risk for decades. Mentioned here as an illustration of the market's existence, this is not a recommendation.
Resuming after temporary unfitness
Lifting a temporary unfitness follows a logical path:
Treat or stabilise the cause of the unfitness.
Provide the documents: medical reports, specialist opinions, further examinations.
Re-evaluation by the AME or the authority.
Two constants, which also apply to the medical examination itself: honesty of the file, and the fact that the AME is an ally, not an opponent. A complete and sincere file is what advances a case referred to the authority; an omission discovered later is what sinks it.
Frequently asked questions
Is unfitness necessarily permanent?
The AME refused my certificate: is it final?
What is a derogation?
How much time do I have to appeal?
Can I continue to fly during the procedure?
Is there financial assistance if I lose my licence?
Does a Class 1 unfitness also deprive me of Class 2?
Prevention, the other side of the problem
An unfitness related to hearing or the heart leads back to prevention, that is, what can still be done before the issue reaches the AME's desk.
- Protecting your hearing in flight Cockpit noise, its effects on hearing, and protection (passive, earplugs, ANR headsets).
- Decoding your audiogram Read
- Carbon monoxide in the cabin Read
« The same eye, four different measurements »: Laurent's journey
Keratoconus in the right eye, corrected by a scleral lens. First initial examination in Belgium in 2013: unfit. Second Belgian attempt in 2015: refused on the spot. France next, in August 2015: refused based on an acuity measured at 6/10. He contested, obtained a second expert opinion in December: that day he was measured at 10/10. He was still declared unfit, on the grounds that he could lose his lens in flight.
Appeal before the medical council in May 2016, alone facing about ten doctors, topography in hand. Unfitness confirmed.
Five years later, he relaunched a file in Luxembourg. The examination once again recorded 6/10. He appealed. The chief medical officer requested that the examination be redone: 8/10. Class 1 certificate issued in December 2022, with restrictions.
A medical file is not a statistic. This journey does not say that one country is more flexible than another, and it says nothing about yours. It shows one thing, and one thing only: a file rejected four times was not a closed file.
Published with the agreement of Laurent, who proofread this text. First name only, at his request.
The action that takes a minute and changes a situation
When something is refused or blocked orally, ask for the reason in writing. An appointment you are not given, a file that is not transferred, an additional examination imposed on you without telling you on what grounds: the question fits into one sentence, and it is asked politely.
It is not an escalation, and it is not an act of defiance. It is what transforms a position into a decision. A position does not have to be justified. A written decision does: it must be based on something, and you can finally know on what.
A pilot told us about a file transfer block between two centres that lasted a week. What unblocked it on his end: having asked the centre that was refusing to write down the reason for its refusal.
And keep a record. An email is better than a call, not because it is more polite, but because it still exists three months later.
Starting again elsewhere does not erase a refusal
It is the idea that comes up most often when a file has just been refused: going to try again in the neighbouring country, starting from scratch. The medical certificate is indeed recognised wherever the European system applies, and taking your examination with an aeromedical examiner from another State is common. But this recognition applies to a certificate you have been issued, not to a refusal you would like to leave behind.
At the beginning of each examination, you sign a declaration. It asks whether you have ever undergone a fitness examination, with which doctor and with what result, and whether you have ever been declared unfit, suspended, or had a certificate revoked. This is not a polite formality: it is a signed document, and it is legally binding.
In other words, changing countries does not reset the clock, and it is not because you are being watched: it is because you are the one declaring it. Concealing a previous refusal means signing a false declaration, and that carries more weight, and for longer, than the original medical reason. You should also be aware that you can only hold one medical certificate at a time.
The intended path when a decision does not seem justified to you is the one described earlier on this page: ask for the reason in writing, request your file, and appeal within the deadline. It is slower, and it is the only one that will not backfire on you.
Deadlines run from notification, not from the day you understand
This is the trap of this stage. Referral, temporary unfitness, and permanent unfitness do not open the same doors or the same calendars, and the time you spend looking for information is time taken away from your appeal.
The guide provides the five-step process, the deadlines for your country, the calendar reminders to set from day one, and the template letter to request your medical file.
See the guide, €59