Appeal inadmissible without insurer's opposition decision

ATA/204/1996Tribunal de Justiça / Câmara Administrativa16 de abr. de 1996Inadmissible

Extraído pela Omnilex

Resumo Omnilex

A social insurance appeal was filed before the health insurer had decided the objection. The court held that judicial review was premature under LAMal art. 86 para. 1, declared the appeal inadmissible, and transmitted the file to the insurer so that it could rule on the objection first.

Sumário Omnilex

LAMal art. 86 al. 1; recevabilité du recours en l'absence de décision sur opposition: le recours n'est recevable qu'après une décision sur opposition rendue par l'assureur-maladie. À défaut d'une telle décision, le juge ne peut pas entrer en matière; il doit constater l'irrecevabilité du recours et transmettre le dossier à l'assureur compétent pour qu'il statue d'abord sur l'opposition (consid. non précisé).

Texto completo

Descripteurs

ASSURANCE SOCIALE; AM; OPPOSITION(PROCEDURE); ASSU

Normes

LAMAL.86 al.1

Résumé

Recours irrecevable, la caisse-maladie ne s'étant pas prononcée sur l'opposition. Transmission du recours à la caisse-maladie.

Palavras-chave

social insurancehealth insuranceobjection procedureadmissibilitypremature appealtransmission

Extraído pela Omnilex

Questões jurídicas principais extraídas pela Omnilex

Questão jurídica principal

Whether the appeal was admissible despite the health insurer not having decided the objection.

Decisão extraída

The appeal was inadmissible because the insurer had not issued an objection decision; the file had to be transmitted to the health insurer.

Fundamentação extraída

Under the applicable procedural rule, judicial review presupposed a prior objection decision by the insurer. Since that step was missing, the court could not examine the merits and had to forward the matter to the insurer.

Appeal inadmissible without insurer's opposition decisionGerado por IA