Reimbursement of hospital costs after treatment at a clinic

ATA/76/1998Tribunal de Justiça / Câmara Administrativa10 de fev. de 1998Granted

Extraído pela Omnilex

Resumo 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.

Sumário 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.

Texto completo

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.

Palavras-chave

social insurancehealth insurancesupplementary insurancehospitalizationmedical treatmentreimbursement

Extraído pela Omnilex

Questões jurídicas principais extraídas pela Omnilex

Questão jurídica principal

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

Decisão extraída

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

Fundamentação extraída

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 clinicGerado por IA