Decision on the coverage of the costs of diagnosis and treatment of an amalgam intolerance

Facts

The case concerns a fortifications guard insured with the military insurance who was diagnosed with an amalgam intolerance according to the method of auriculotherapy. The Federal Insurance Court must determine whether the costs of diagnosis and treatment (extraction of the amalgam and elimination of mercury) should be covered by the military insurance under Art. 16 para. 2 MilIA.

Considerations

The Federal Court notes that Art. 16 para. 2 MilIA does not expressly require that the examination and treatment methods be scientifically recognized, unlike Art. 32 HIA. However, the evaluation of the effectiveness of a diagnostic or therapeutic method must be done in a general manner and not only based on the results in a particular case. Thus, the judge cannot rely solely on the positive results of the treatment in the insured person, but must examine the effectiveness of the method more broadly.

Regarding the diagnostic method of auriculotherapy used, the Federal Court considers that it cannot be dismissed outright solely on the grounds that it is controversial in conventional medicine. However, its effectiveness must be thoroughly evaluated, using independent medical expert opinions.

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