Facts
The Valais Mutual Health Insurance Fund terminated the payment of daily allowances to [S.] on August 5, 1996, on the grounds that from that date, he was no longer incapable of working. [S.] had two medical certificates sent on August 28 and September 4, 1996, showing that he was still unable to work. On September 9, 1996, [S.] filed a written and reasoned opposition. The Valais Mutual Health Insurance Fund considered the opposition to be late and refused to issue a decision on the opposition.
The Cantonal Insurance Court of the Canton of Valais upheld S.'s appeal and referred the case back to the Valais Mutual Health Insurance Fund for possible further investigation and a decision on the opposition. The Valais Mutual Health Insurance Fund filed an administrative law appeal against this judgment.
Considerations
The Federal Tribunal considered that the 30-day deadline provided for in Art. 85 para. 1 of the Health Insurance Act (LAMal) for filing an opposition cannot be suspended. However, the written form is not a condition for the validity of the opposition. The legislative history and doctrine show that the opposition procedure does not impose any formal requirements, and the opposition can be made orally or through discussion with the insurer.
The Federal Tribunal applied by analogy the principles developed in the field of accident insurance, according to which the opposition must be reasoned. However, the formal requirements cannot be more stringent than those relating to the…