Facts
The applicant, a child with a serious congenital illness (Sanfilippo mucopolysaccharidosis), was placed in a medico-social institution without a hospital service. The compensation fund refused to cover the costs of her stay, considering that the necessary measures were primarily nursing care and not medical treatment. The child's father appealed against this decision.Considerations
The Federal Insurance Court considers that measures aimed at keeping the patient alive, when they are likely to act on the congenital disability or its consequences, must be considered as "necessary medical measures" within the meaning of the law, even if they are carried out by nursing staff and not medical staff. Since the child requires both care and medical treatment, it is sufficient that one of the required medical measures requires a hospital stay for the insured person to be entitled to full hospitalization benefits.
In this case, the child needs measures such as tube feeding, suction of secretions to prevent the risk of suffocation, administration of medication and physiotherapy, which can only be carried out by medical or paramedical staff.…