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Right to be heard in social insurance medical file access

ATA/725/1997Court of Justice / Administrative ChamberNov 25, 1997Confirmed

Open source

Extracted by Omnilex

Omnilex summary

The recourant contested the termination of daily benefits in a social insurance case and argued that his right to be heard had been breached because access to the medical file was requested only after counsel's appointment. The court held that the decisive medical evidence had already been established before that request, so the recourant had not been prevented from commenting on essential evidence. On the merits, the medical opinions supported the cessation of daily benefits, which was therefore confirmed.

Omnilex headnote

LAMal art. 67; right to be heard in relation to access to the medical file and cessation of daily benefits. The right to be heard is not violated where the decisive evidentiary material was established before the appointment of counsel and before a request for file inspection, provided the party was not prevented from commenting on essential evidence. In the assessment of entitlement to daily benefits, the deciding authority may rely on coherent medical opinions establishing the end of incapacity or entitlement (consid. unspecified).

Full text

Descripteurs

ASSURANCE SOCIALE; AM; DROIT D'ETRE ENTENDU; INDEMNITE JOURNALIERE; PERTE DE GAIN; ASSU

Normes

LAMAL.67

Résumé

Les pièces déterminantes ayant été établies antérieurement à la constitution de l'avocat du recourant et à la demande de celui-ci d'obtenir une copie du dossier médical, le droit d'être entendu du recourant n'a pas été violé. En particulier, il n'a pas été empêché de s'exprimer sur des preuves essentielles. Confirmation de la cessation des indemnités journalières, au vu des avis médicaux.

Keywords

social insuranceright to be heardmedical filedaily benefitsloss of earningsmedical opinions

Extracted by Omnilex

Key legal questions extracted by Omnilex

Key legal question

Whether the recourant's right to be heard was violated because access to the medical file was sought only after the decisive evidence had been established.

Extracted holding

No violation occurred, because the decisive documents had already been established before counsel was appointed and before the request for a copy of the medical file.

Extracted reasoning

The recourant was not prevented from commenting on essential evidence; the timing of the establishment of the decisive pieces excluded a denial of the right to be heard.

Key legal question

Whether the cessation of daily benefits was justified on the basis of the medical opinions.

Extracted holding

The cessation of daily benefits was confirmed in light of the medical opinions.

Extracted reasoning

The available medical assessments supported the end of entitlement to daily benefits.

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