projets
ATA/126/1997 ΓÇó Mandatory coverage of hospital rehabilitation after acute illness
ATA/126/1997Cour de justice / Chambre administrative18 févr. 1997Granted
The insured was hospitalized following an infarction and then underwent a rehabilitation stay of more than four months at Beau-Séjour. The court held that because the rehabilitation treatment followed immediately after hospitalization for an acute illness, it had to be borne by the compulsory health insurance under LAMA art. 12 para. 2. The insurer was therefore ordered to assume the costs of the stay.
LAMA art. 12 para. 2; hospital rehabilitation immediately following treatment for an acute illness is compulsory coverage. A rehabilitation stay that is the direct and immediate continuation of acute hospital treatment falls within the mandatory benefits of health insurance and must be borne by the caisse-maladie; the decisive factor is the close temporal and medical connection with the acute episode, not the duration of the rehabilitation stay.
Descripteurs
ASSURANCE SOCIALE; AM; SEJOUR A L'HOPITAL; MESURE MEDICALE DE READAPTATION; INFARCTUS; PRESTATION OBLIGATOIRE; ASSU
Normes
LAMA.12 al.2
Résumé
- Un traitement hospitalier de rééducation qui suit immédiatement une hospitalisation pour maladie aiguë est obligatoirement à la charge des caisses-maladie (application de la LAMA).
- La caisse-maladie a été condamnée à prendre en charge une hospitalisation de plus de 4 mois à Beau-Séjour, lequel faisait suite à un infarctus.