Retroactive effect of new tariff convention requires express clause

ATA/526/1997Cour de justice / Chambre administrative2 sept. 1997

Extrait par Omnilex

Résumé Omnilex

In a dispute concerning reimbursement of ambulatory treatment costs under social insurance tariff coverage, the tribunal held that the conclusion of a new tariff convention does not have retroactive effect for insured persons unless retroactivity is expressly stipulated. The decision emphasizes that coverage and reimbursement conditions under a tariff agreement are governed prospectively by the new convention, and that retroactive application cannot be inferred from the mere conclusion of the agreement.

Regeste Omnilex

Art. 22bis al. 2 LAMA; new tariff convention and retroactivity: a later tariff agreement cannot be applied retroactively to insured persons unless the agreement expressly provides for such effect. In the absence of an explicit retroactive clause, the convention governs only for the future. The principle follows from the need for clarity and legal certainty in tariff-based reimbursement schemes and from the protection of good faith in the determination of insurance coverage (consid. not specified).

Texte intégral

Descripteurs

ASSURANCE SOCIALE; AM; TARIF-CADRE; TRAITEMENT AMBULATOIRE; TRIBUNAL ARBITRAL; REMBOURSEMENT DE FRAIS(ASSURANCE); PRESTATION D'ASSURANCE(EN GENERAL); COUVERTURE; JURIDICTION ARBITRALE; PRINCIPE DE LA BONNE FOI; RETROACTIVITE; ASSU

Normes

LAMA.22 bis al.2

Résumé

La conclusion d'une nouvelle convention tarifaire ne saurait déployer des effets rétroactifs pour les assurés, à moins qu'elle ne le prévoie expressément.

Mots-clés

social insurancetariff agreementambulatory treatmentreimbursement of costsretroactivitygood faithjurisdictioncoverage

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Questions juridiques clés extraites par Omnilex

Question juridique clé

Whether a new tariff convention may apply retroactively to insured persons without an express retroactivity clause.

Solution extraite

A new tariff convention cannot produce retroactive effects for insured persons unless retroactivity is expressly provided.

Motifs extraits

The court relied on the requirement of legal certainty and good faith in tariff-based insurance coverage: absent an explicit clause, a later convention governs only prospectively.

Retroactive effect of new tariff convention requires express clauseGénéré par IA