Absence of opposition makes appeal inadmissible under LAMal

ATA/350/1996Cour de justice / Verwaltungskammer21.06.1996Inadmissible

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Omnilex-Zusammenfassung

The court held that, under the LAMal system, opposition is a mandatory procedural step between the insurer's formal decision and access to the cantonal insurance court. Because that step had not been taken, the appeal could not be heard on the merits. It was therefore declared inadmissible and sent to the insurer so that it could be processed as an opposition.

Omnilex-Regeste

LAMal art. 85; opposition as a condition of admissibility in social insurance proceedings: unlike under the former LAMA, the insured must first challenge the insurer's formal decision by opposition before seizing the cantonal insurance court. If an appeal is filed directly against such a decision, the court must declare it inadmissible and forward the submission to the insurer for treatment as an opposition; the omission is not cured by immediate judicial filing.

Gesamter Gesetzestext

Descripteurs

ASSURANCE SOCIALE; OPPOSITION(PROCEDURE); CONDITION DE RECEVABILITE; AM

Normes

LAMAL.85

Résumé

Par rapport à l'ancienne LAMA, la LAMal a introduit une procédure d'opposition qui s'intercale entre la décision formelle de l'assureur et la procédure judiciaire devant le Tribunal cantonal des assurances. Sauf à respecter cette procédure, un recours doit être déclaré irrecevable et transmis à la caisse pour qu'elle le traite comme une opposition.

Schlagwörter

social insuranceopposition procedureadmissibilityinsurance appealprocedural prerequisite

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Von Omnilex extrahierte Kernrechtsfragen

Kernrechtsfrage

Whether a judicial appeal is admissible without first filing an opposition to the insurer's formal decision under LAMal

Extrahierter Entscheid

The appeal is inadmissible if the opposition stage was bypassed; the filing must be treated as an opposition and sent to the insurer.

Extrahierte Begründung

Compared with the former LAMA, LAMal introduced an opposition procedure between the insurer's formal decision and judicial proceedings before the cantonal insurance court. That step is a condition of admissibility.

Absence of opposition makes appeal inadmissible under LAMalKI-generiert