Refusal of supplemental insurance offer after prior treatments

ATA/373/1998Cour de justice / Chambre administrative16 juin 1998Dismissed

Extrait par Omnilex

Résumé Omnilex

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.

Regeste Omnilex

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.

Texte intégral

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.

Mots-clés

social insurancecomplementary insuranceaffiliationrefusalcoverage history

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Questions juridiques clés extraites par Omnilex

Question juridique clé

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

Solution extraite

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

Motifs extraits

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 treatmentsGénéré par IA