Health insurer not liable for accident-related rheumatic condition

ATA/548/1998Cour de justice / Chambre administrative1 sept. 1998Dismissed

Extrait par Omnilex

Résumé Omnilex

The appellant sought insurance coverage for a rheumatic condition linked to an accident that had occurred 15 years earlier. The court held that, under Art. 12 al. 2 LAMal, the health insurer had no duty to provide benefits for this condition and therefore rejected the claim.

Regeste Omnilex

Art. 12 al. 2 LAMal; accident-related condition and scope of health-insurance coverage: where the claimed rheumatic affliction is causally linked to an accident occurring many years earlier, the insurer is not obliged to grant benefits if the statutory conditions for coverage are not met. The decisive point is the absence of a current benefit obligation under the applicable insurance scheme; temporal remoteness of the accident does not by itself create coverage (consid. not indicated).

Texte intégral

Descripteurs

ASSURANCE SOCIALE; AM; PRESTATION D'ASSURANCE(EN GENERAL); ASSU

Normes

LAMAL.12 al.2

Résumé

Dès lors que la recourante souffre d'affection rhumatismale due à un accident (survenu 15 ans auparavant), l'assureur-maladie n'est pas tenu à prestation.

Mots-clés

social insurancehealth insurancebenefitsaccidentrheumatic conditioncoverage

Extrait par Omnilex

Questions juridiques clés extraites par Omnilex

Question juridique clé

Whether the health insurer must provide benefits for the appellant's rheumatic condition caused by a long-past accident.

Solution extraite

The health insurer was not obliged to provide benefits.

Motifs extraits

The condition was attributable to an accident that occurred 15 years earlier, and under the applicable health-insurance rule the insurer had no duty to cover it.

Health insurer not liable for accident-related rheumatic conditionGénéré par IA