Accident-related dental treatment not covered by health insurer

ATA/546/1998Court of Justice / Administrative ChamberSep 1, 1998Dismissed

Extracted by Omnilex

Omnilex summary

The case concerns whether a health insurer must reimburse dental treatment made necessary by an accident. The answer is negative: the insurer is not required to bear the costs of the treatment. The only cited legal basis is Art. 31 para. 1 LAMal.

Omnilex headnote

Art. 31 al. 1 LAMal; accident-related dental treatment and allocation of costs; when dental treatment is necessitated by an accident, the health insurer is not liable for the expenses claimed under compulsory health insurance. The decisive criterion is the causal link to the accident; the costs are not shifted to the caisse-maladie on that basis alone.

Full text

Descripteurs

ASSURANCE SOCIALE; AM; AFFECTION DENTAIRE; TRAITEMENT DENTAIRE; ECONOMIE DU TRAITEMENT; ASSU

Normes

LAMAL.31 al.1

Résumé

Le traitement dentaire étant nécessaire en raison d'un accident, la caisse-maladie n'a pas à en supporter les coûts.

Keywords

social insurancehealth insurancedental treatmentaccidentcost coverage

Extracted by Omnilex

Key legal questions extracted by Omnilex

Key legal question

Whether the health insurer must bear the costs of dental treatment necessitated by an accident.

Extracted holding

The health insurer does not have to bear those costs.

Extracted reasoning

The treatment was required because of an accident, so the claimed costs do not fall on the health insurer under the invoked statutory framework.

Accident-related dental treatment not covered by health insurerAI generated