Understanding the social security courts and the appeals process

There are various means of appeal open to people who feel they have been wronged by a decision handed down by one of the institutions in the social security system. In most cases, before commencing a procedure in a specialised social security court, a person who disagrees with a decision must file a written objection with the relevant institution, asking the institution to review its position.

By way of example, the following decisions may be contested:

  •     a decision to deny or withdraw the services of the National Health Fund (Caisse nationale de santé);
  •     a refusal to award family allowances by the Children's Future Fund (Caisse pour l'avenir des enfants);
  •     the withdrawal of a pension by the National Pension Insurance Fund (Caisse nationale d'assurance pension), etc.

Written objection (non-contentious procedure)

The person affected by an individual decision handed down by the President of the relevant social security institution – or their representative – may contest that decision by means of a written objection. That objection must be sent by registered letter with acknowledgement of receipt to the governing body of the institution that issued the decision.

The areas in which it is possible to lodge an objection are those relating to:

  • health insurance;
  • pension insurance
  • accident insurance;
  • dependency insurance and family benefits.

The objection must be brought before the governing body (which is a collegial body) of the competent institution within 40 days of notice of the decision. 

There are no particular restrictions on the form in which the letter is written. It may be written on plain paper. There is no need for the services of a lawyer.

Only the decision of the governing body handed down in response to the affected person's objection may later be appealed in court. Only if this first attempt to resolve the dispute fails may a judicial appeal be lodged with the social security courts set up for that purpose.

Specific procedure for objecting to a decision about an amount charged

In the event of a dispute regarding an amount charged in connection with health and maternity insurance, the Supervisory Commission ( Commission de surveillance) (which, among other matters, is competent with respect to healthcare pricing) has the power to compel the necessary redress. Its decisions may be appealed before the social security courts.

Appeals to the competent social security courts 

The Social Security Arbitration Tribunal (Conseil arbitral de la sécurité sociale – CASS) is a court of first instance before which any decision by the governing body of a social security institution may be appealed.

The appeal must be filed within 40 days of notice of the decision handed down in response to the concerned party's objection. The procedure is free of charge and does not require the involvement of a lawyer. An appeal before the CASS is not suspensory.

The appeal is made by simply filing a petition – on paper – at the CASS headquarters. The petition must be filed in as many copies as there are parties involved.

The petition must mention:

  • the surname(s) and first name(s) of the applicant;
  • the numbers of their identifying documents;
  • their occupation;
  • the applicant's address;
  • the capacity in which they are acting;
  • the purpose of the petition;
  • a summary of the grounds (i.e. the arguments on which the petition is founded).

The petition must be signed by:

  • the applicant;
  • their legal representative; or
  • their representative, who may be the representative of their professional organisation or trade union.

If the petition is filed by proxy, they must show special power of attorney, unless they are a licenced lawyer.

The CASS rules in the first and last instance if the amount in dispute is less than EUR 1,250. Where the dispute pertains to an amount greater than EUR 1,250, an appeal may be lodged against the verdict handed down by the CASS. That appeal must be filed with the High Council of Social Security (CSSS), the court of appeal for social security matters.

The appeal is free of charge and does not require the involvement of a lawyer. It is made by simply filing a letter (a petition) with the CSSS. The appeal must be filed within 40 days of notice of the decision of the Social Security Arbitration Tribunal. The petition must mention:

  • the surname(s) and first name(s) of the applicant;
  • the numbers of the applicant's identifying documents;
  • the applicant's occupation;
  • the applicant's address;
  • the capacity in which they are acting (legal representative, guardian, etc.).

It must also mention the purpose of the petition and a summary of the grounds (the arguments on which the appeal is based).

The petition must be signed by the applicant; or

  • by their legal representative; or
  • their representative, who may be the representative of their professional organisation or trade union; or
  • a lawyer.

If the petition is filed by proxy, they must show special power of attorney, unless they are a licenced lawyer.

Decisions made in the last instance by the CASS and decrees of the CSSS may be contested by appeal before the Court of Cassation. This procedure requires the involvement of a lawyer admitted to practise before the Court.

Where applicable, the insured party may also turn to other bodies that are not part of the judicial apparatus, such as:

  • the Ombudsman: this body exists to find amicable solutions to disputes between citizens and government authorities;
  • the non-profit Patientevertriedung: this body provides patients and insured parties with information and guidance on their rights and responsibilities. In the event of a specific problem, the patient/insured party may seek advice from the Patientevertriedung;
  • the Medical Board (Collège médical): the Medical Board is tasked with ensuring that the ethical rules applicable to the exercise of the medical professions are complied with.
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