Reimbursement of hospital costs after treatment at a clinic

ATA/76/1998Cour de justice / Chambre administrative10 févr. 1998Granted

Extrait par Omnilex

Résumé Omnilex

The insured person, after an intervention, sought reimbursement for hospital costs incurred at the Clinique de la Lignière. The court held that these hospitalization expenses were reimbursable and granted the claim. The only identified legal basis is Art. 23 LAMA.

Regeste Omnilex

Art. 23 LAMA; reimbursement of hospitalization costs after treatment in a clinic: where an insured person, following an intervention, undergoes medically justified inpatient care, the related hospital expenses are to be borne by the insurer if they fall within the reimbursable treatment costs. The decisive point is the medical necessity and the functional connection between the intervention and the subsequent stay; the mere fact that treatment took place in a clinic does not exclude coverage, unless a statutory exclusion applies.

Texte intégral

Descripteurs

ASSURANCE SOCIALE; AM; ASSURANCE COMPLEMENTAIRE; SEJOUR A L'HOPITAL; ECONOMIE DU TRAITEMENT; ASSU

Normes

LAMA.23

Résumé

L'assuré qui a subi des traitements médicaux à la clinique de la Lignière après une intervention a droit au remboursement des frais d'hospitalisation.

Mots-clés

social insurancehealth insurancesupplementary insurancehospitalizationmedical treatmentreimbursement

Extrait par Omnilex

Questions juridiques clés extraites par Omnilex

Question juridique clé

Whether the insured person is entitled to reimbursement of hospital expenses incurred at the Clinique de la Lignière after the intervention.

Solution extraite

The insured person is entitled to reimbursement of the hospitalization costs.

Motifs extraits

The decision accepts that the post-operative hospital stay at the clinic falls within the reimbursable treatment expenses under the applicable social insurance rules.

Reimbursement of hospital costs after treatment at a clinicGénéré par IA