projets
ATA/350/1996 ΓÇó Absence of opposition makes appeal inadmissible under LAMal
ATA/350/1996Cour de justice / Chambre administrative21 juin 1996Inadmissible
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.
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.
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.