projects
ATA/175/1996 ΓÇó LAMal appeal must be treated as opposition
ATA/175/1996Court of Justice / Administrative ChamberMar 26, 1996Remanded
The court held that, under the LAMal system, an appeal filed against a formal decision of a health insurer does not immediately proceed to judicial review. Since the statute introduced an opposition stage between the insurer’s decision and the court phase, the filing had to be forwarded to the insurer and treated as an opposition. The practical result was a remittal/transmission to the caisse for further processing in that form.
LAMal art. 85; opposition procedure as a prerequisite to judicial review: under the new health insurance scheme, the opposition stage interposes itself between the formal decision and the court action. A submission that attacks such a decision must, where it was not already treated as opposition, be transmitted ex officio to the insurer for handling as opposition; direct judicial treatment is excluded until that administrative remedy has been exhausted.
Descripteurs
PROCEDURE ADMINISTRATIVE; AM; CONDITION DE RECEVABILITE; OPPOSITION(PROCEDURE); ASSURANCE SOCIALE; ASSU
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 et la procédure judiciaire. Recours transmis à la caisse pour qu'elle le traite comme une opposition.