ATA/546/1998•Accident-related dental treatment not covered by health insurer
ATA/546/1998Tribunal de Justiça / Câmara Administrativa1 de set. de 1998Dismissed
Extraído pela Omnilex
The case concerns whether a health insurer must reimburse dental treatment made necessary by an accident. The answer is negative: the insurer is not required to bear the costs of the treatment. The only cited legal basis is Art. 31 para. 1 LAMal.
Art. 31 al. 1 LAMal; accident-related dental treatment and allocation of costs; when dental treatment is necessitated by an accident, the health insurer is not liable for the expenses claimed under compulsory health insurance. The decisive criterion is the causal link to the accident; the costs are not shifted to the caisse-maladie on that basis alone.
Descripteurs
ASSURANCE SOCIALE; AM; AFFECTION DENTAIRE; TRAITEMENT DENTAIRE; ECONOMIE DU TRAITEMENT; ASSU
Normes
LAMAL.31 al.1
Résumé
Le traitement dentaire étant nécessaire en raison d'un accident, la caisse-maladie n'a pas à en supporter les coûts.
Extraído pela Omnilex
Whether the health insurer must bear the costs of dental treatment necessitated by an accident.
The health insurer does not have to bear those costs.
The treatment was required because of an accident, so the claimed costs do not fall on the health insurer under the invoked statutory framework.
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