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ATAS/437/2010 • CJ GE ATAS/437/2010 Generato dall'IA

Insurer Reverses Coverage Suspension, Appeal Declared Moot

Numero d'incarto ATAS/437/2010
Autorità giudiziaria
Giurisdizione Svizzera · Canton Ginevra (CH-GE)
Data della decisione
Esito del giudizio struck_off
Spese processuali senza spese
Apri la fonte ufficiale Archivio Entscheidsuche Versione Markdown leggibile dalle macchine (.md)

Sintesi Legislator

Generato dall'IA

An insured party appealed a decision by the insurer that suspended the coverage of healthcare costs, alleging arbitrary and discriminatory treatment, but before the court could rule, the insurer issued a subsequent decision on March 3, 2010, which canceled the prior opposition decision and lifted the suspension of benefits because the competent cantonal authorities had covered the insured's premium arrears and co-payments. The court recognized that under the relevant procedural law, the insurer was permitted to reconsider its decision until the appeal was forwarded, and given the insurer's subsequent action resolving the underlying issue, the court declared the appeal moot, compensated costs, and closed the case.

Regesto Legislator

Generato dall'IA

art. 64a de la loi fédérale sur l’assurance-maladie (LAMal, Art. 64a LAMal; Insurer Reverses Coverage Suspension, Appeal Declared Moot: The court recognized that under the relevant procedural law, the insurer was permitted to reconsider its decision until the appeal was forwarded, and given the insurer's subsequent action resolving the underlying issue, the court declared the appeal moot, compensated costs, and closed the case.

Parole chiave

Generato dall'IA
assicuratore sospensione della prestazione d'assicurazione riduzione dei premi dell'assicurazione malattie spese per malattia prese in carico riesame da parte dell'assicuratore cessazione dei pagamenti

Disposizioni normative citate

Generato dall'IA
art. 64a de la loi fédérale sur l’assurance-maladie (LAMal
Art. 64a LAMal
This article relates to the suspension of benefits which was the subject of the initial dispute resolved by the insurer's later decision.
Generato dall'IA
A/4395/2007
Mootness of Appeal Due to Insurer's Reversal of Denial
A/3337/2021
Appeal Moot Due to Insurer's Reconsideration of Benefit Suspension
A/1954/2010
Insured v. Health Insurance Organization (Mootness and Costs)
A/4530/2015
Insured Reimbursement Appeal Moot Due to Subsequent Insurer Decision
A/4391/2010
Insured Appeal of Coverage Suspension for Unpaid Premiums Upheld

Questioni giuridiche chiave estratte da Legislator

Generato dall'IA
art. 64a de la loi fédérale sur l’assurance-maladie (LAMal)

Mentioned in the background of the insurer's decision which was accepted by the court, leading to the appeal becoming moot.

art. 53 al. 3 de la loi fédérale sur la partie générale du droit des assurances sociales, du 6 octobre 2000 (LPGA ; RS 830.1)

Cited as the legal basis allowing the insurer to reconsider its decision before the appeal authority rules.

Art. 64a LAMal

This article relates to the suspension of benefits which was the subject of the initial dispute resolved by the insurer's later decision.

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Testo completo

A/585/2010

### [ATAS/437/2010](/apps/decis/fr/atas/show/1964348) du 28.04.2010 ( LAMAL ) , SANS OBJET

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[Par ces motifs](#PCM)

RÉPUBLIQUE ET CANTON DE GENÈVE

POUVOIR JUDICIAIRE

A/585/2010 ATAS/437/2010 ARRET DU TRIBUNAL CANTONAL DES ASSURANCES SOCIALES

Chambre 4 du 28 avril 2010

En la cause

Madame M___________, domiciliée au LIGNON, représentée par GROUPE SIDA GENEVE · recourante

contre

MUTUEL ASSURANCES, sise rue du Nord 5, MARTIGNY · intimée

Vu la décision sur opposition de MUTUEL ASSURANCES du 19 janvier 2010 confirmant sa décision du 22 septembre 2009 de suspension de la prise en charge des coûts des prestations à l’encontre de Madame M___________ ;

Vu le recours interjeté le 17 février 2010 par l’assurée par l’intermédiaire de son conseil, GROUPE SIDA GENEVE, concluant à la condamnation de MUTUEL ASSURANCES pour traitement arbitraire et discriminatoire et à ce que la décision de suspension soit déclarée nulle ;

Vu la décision du 3 mars 2010 notifiée à la recourante et communiquée au Tribunal de céans par laquelle MUTUELLE ASSURANCES annule et remplace la décision sur opposition du 19 janvier 2010 et lève toute suspension de prestations au sens de l’art. 64a de la loi fédérale sur l’assurance-maladie (LAMal), au motif que les institutions cantonales genevoises compétentes ont pris en charge la totalité des arriérés de primes et participations de l’assurée ;

Vu la réponse du 18 mars 2010 de l’intimée ;

Considérant en droit que conformément à l’art. 53 al. 3 de la loi fédérale sur la partie générale du droit des assurances sociales, du 6 octobre 2000 (LPGA ; RS 830.1), jusqu’à l’envoi de son préavis à l’autorité de recours, l’assureur peut reconsidérer une décision ou une décision sur opposition contre laquelle un recours a été formé ;

Que tel est le cas en l’espèce ;

Qu’au regard des circonstances et de l’issue du litige, les dépens seront compensés ;

PAR CES MOTIFS,

LE TRIBUNAL CANTONAL DES ASSURANCES SOCIALES

Prend acte de la décision de MUTUEL ASSURANCES du 3 mars 2010.

Dit que le recours est sans objet.

Compense les dépens.

Dit que la procédure est gratuite.

Raye la cause du rôle.

La greffière Isabelle CASTILLO · La présidente Juliana BALDE

Une copie conforme du présent arrêt est notifiée aux par le greffe le