ATA/189/1996•Dental treatment not mandatory under basic insurance
ATA/189/1996Tribunal de Justiça / Câmara Administrativa2 de abr. de 1996Dismissed
Extraído pela Omnilex
The case concerns whether a dental treatment must be covered by mandatory health insurance because an allergy developed after earlier dental treatment. The court held that the intervention remained outside the scope of obligatory benefits. The fact that the allergy was linked to prior dental care did not transform the dental procedure into a compulsory prestation under the basic insurance scheme.
Art. 12 al. 2 LAMal; mandatory health insurance coverage for dental treatment: a dental intervention is not an obligatory benefit merely because it is medically prompted or follows a disease process. The decisive question is whether the treatment falls within the statutory catalogue of compulsory prestations. A causal link between a prior dental treatment and a subsequent allergy does not, by itself, establish coverage for the later dental intervention.
Descripteurs
ASSURANCE SOCIALE; AM; AFFECTION DENTAIRE; COUVERTURE; TRAITEMENT DENTAIRE
Normes
LAMAL.12 al.2
Résumé
Une intervention dentaire n'est pas une prestation obligatoire, même si elle est provoquée par une maladie (allergie). En l'espèce, l'allergie est survenue à la suite d'un traitement dentaire.
Extraído pela Omnilex
Whether the dental intervention had to be covered as a mandatory benefit under basic health insurance because the allergy was related to medical treatment.
The intervention was not an obligatory benefit; even a disease-triggered dental treatment is not covered in this case.
The allergy occurred after dental treatment, but this did not make the dental intervention a mandatory prestation under the basic insurance rules.
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