Refusal of supplemental insurance offer after prior treatments

ATA/373/1998Court of Justice / Administrative ChamberJun 16, 1998Dismissed

Extracted by Omnilex

Omnilex summary

The insured person challenged the insurer's refusal to accept an offer for complementary insurance after having previously undergone various treatments covered by supplemental insurance. The court upheld the refusal, indicating that the insurer was entitled to decline the application in these circumstances.

Omnilex headnote

LAMAL 12; complementary insurance offer and admissibility of refusal by the insurer; where an applicant has previously undergone treatments giving rise to intervention by the complementary insurer, the insurer may refuse the new offer if the relevant insurance conditions so allow and the refusal is justified by the coverage history.

Full text

Descripteurs

ASSURANCE SOCIALE; ASSURANCE COMPLEMENTAIRE; AFFILIATION; ASSU

Normes

LAMAL.12

Résumé

Une assurance est en droit de refuser une offre d'assurance complémentaire présentée par un assuré qui a suivi divers traitements ayant précédemment donné lieu à l'intervention de l'assurance-complémentaire.

Keywords

social insurancecomplementary insuranceaffiliationrefusalcoverage history

Extracted by Omnilex

Key legal questions extracted by Omnilex

Key legal question

Whether the insurer could refuse the insured person's application for complementary insurance after prior treatments had already led to supplemental coverage payments.

Extracted holding

Yes. The insurer was entitled to refuse the offer of complementary insurance in these circumstances.

Extracted reasoning

The decision accepts that, in view of the insured person's treatment history and the insurer's prior intervention in complementary insurance, refusal of the new offer was permissible under the applicable insurance rules.

Refusal of supplemental insurance offer after prior treatmentsAI generated