Refusal of the health insurance fund to grant hospital benefits to the insured

Facts

R., born in 1933, is insured with the SUPRA Health Insurance Fund. Suffering from Alzheimer's disease, she has been staying in a medical-social institution since November 1, 1996. The fund has covered a daily flat rate of 60 francs. The insured's husband requested the fund to pay the benefits provided for in the event of hospitalization, which the fund refused in a decision of October 6, 1997. The husband then filed an objection on October 13, 1997. Due to the lack of a decision by the fund on the objection, the insured brought the matter before the Insurance Tribunal of the Canton of Vaud, which dismissed the appeal on the grounds that it could not be seized before the fund had ruled on the objection.

Considerations

The law does not impose a time limit on the insurer to rule on an objection. Although the objection constitutes a request by the insured for a decision on his rights, it is distinct from the initial decision-making procedure provided for in Art. 80 para. 1 HIA, for which a 30-day time limit is provided. Therefore, this time limit cannot be applied by analogy to the objection procedure.

However, the objection procedure is subject to the procedural guarantees of Art. 4 para. 1 Cst., which requires that a procedure…