Mandatory coverage of hospital rehabilitation after acute illness

ATA/126/1997Cour de justice / Chambre administrative18 févr. 1997Granted

Extrait par Omnilex

Résumé Omnilex

The insured was hospitalized following an infarction and then underwent a rehabilitation stay of more than four months at Beau-Séjour. The court held that because the rehabilitation treatment followed immediately after hospitalization for an acute illness, it had to be borne by the compulsory health insurance under LAMA art. 12 para. 2. The insurer was therefore ordered to assume the costs of the stay.

Regeste Omnilex

LAMA art. 12 para. 2; hospital rehabilitation immediately following treatment for an acute illness is compulsory coverage. A rehabilitation stay that is the direct and immediate continuation of acute hospital treatment falls within the mandatory benefits of health insurance and must be borne by the caisse-maladie; the decisive factor is the close temporal and medical connection with the acute episode, not the duration of the rehabilitation stay.

Texte intégral

Descripteurs

ASSURANCE SOCIALE; AM; SEJOUR A L'HOPITAL; MESURE MEDICALE DE READAPTATION; INFARCTUS; PRESTATION OBLIGATOIRE; ASSU

Normes

LAMA.12 al.2

Résumé

- Un traitement hospitalier de rééducation qui suit immédiatement une hospitalisation pour maladie aiguë est obligatoirement à la charge des caisses-maladie (application de la LAMA).

- La caisse-maladie a été condamnée à prendre en charge une hospitalisation de plus de 4 mois à Beau-Séjour, lequel faisait suite à un infarctus.

Mots-clés

social insurancehealth insurancehospital rehabilitationacute illnessmyocardial infarctionmandatory coverage

Extrait par Omnilex

Questions juridiques clés extraites par Omnilex

Question juridique clé

Whether hospital rehabilitation immediately following hospitalization for an acute illness must be covered by the health insurer under LAMA art. 12 para. 2.

Solution extraite

Yes. A hospital rehabilitation treatment that follows immediately after hospitalization for an acute illness is mandatorily covered by the health insurer.

Motifs extraits

The court treated the rehabilitation stay as a continuation of the acute treatment, so it fell within the compulsory benefits regime of the LAMA.

Mandatory coverage of hospital rehabilitation after acute illnessGénéré par IA