Dental costs from autoimmune disease not covered by compulsory insurance

ATA/54/1997Cour de justice / Chambre administrative21 janv. 1997Dismissed

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Résumé

The dispute concerned whether dental expenses caused by an autoimmune disease had to be reimbursed by compulsory health insurers. The court held that, under the applicable health insurance statute, such dental costs are not covered merely because the underlying condition is autoimmune. The claim for reimbursement was therefore rejected.

Regest

LAMA art. 12; compulsory health insurance coverage for dental treatment costs caused by an autoimmune disease. Dental treatment expenses are not covered merely because they stem from an autoimmune disorder; coverage requires a statutory basis extending the benefit to such treatment, which is absent here.

Texte intégral

Descripteurs

ASSURANCE SOCIALE; AM; AFFECTION DENTAIRE; PRINCIPE DE LA BONNE FOI; TRAITEMENT DENTAIRE; ASSU

Normes

LAMA.12

Résumé

En application de la LAMA, les frais dentaires engendrés par une maladie auto-immune ne doivent pas êtrte pris en charge par les caisses-maladie.

Mots-clés

social insurancehealth insurancedental treatmentautoimmune diseasecoveragegood faith