Administrative dispute with the health insurance fund

Verified 28 September 2026 - Public Service / (Prime Minister)

How can you challenge an administrative decision (e.g. refusal to reimburse care, payment of daily allowances) made by a social security organization? We guide you in your approach.

Step-by-step approach

The appeal before the Commission de recours amiable (CRA) of your health insurance fund is mandatory before any contentious proceedings.

What disputes can be referred to the Commission for amicable redress?

The Amicable Appeals Board shall have jurisdiction in the following disputes:

  • Disputes between insured persons and a social security organization
  • Litigation concerning administrative decisions related to membership, contributions and benefits.

Examples:

  • Decision to refuse membership
  • Decision to refuse payment of a benefit
  • Decision on a calculation of contributions
  • Decision to refuse refund
  • Decision to refuse payment of daily allowances.

Who can refer the matter to the Amicable Appeals Board?

Any insured person may refer his health insurance fund to the Amicable Appeals Board.

When to refer the matter to the Amicable Appeals Board?

You must refer to the Amicable Appeals Board in the 2 months delay from the date of notification of the contested decision.

How to refer the matter to the Amicable Appeals Board?

You must contact the Amicable Appeals Board of your health insurance fund preferably by registered letter with : titleContent.

Indeed, this makes it possible to prove, if necessary, that the matter was indeed referred to the Commission within the two-month period.

FYI  

The address of the Amicable Appeals Board is given on the notification of the contested decision.

How is the request to the Amicable Appeals Board handled?

The Amicable Appeals Board of your health insurance fund decides on the documents at its disposal.

The decision is yours notified within the period of 2 months from the receipt of the request.

She is motivated and the time limits and methods of appeal to the court.

After 2 months, the absence of a response from the Amicable Appeals Board means that your request is rejected.

This implied rejection can be challenged in court.

FYI  

The Commission rules on documents: you will not be summoned.

When should your application be submitted to the court?

You must address your query to the judicial tribunal (social pole) within 2 months:

  • From the date of the notification of the Commission decision which you are challenging
  • Orin the absence of a response from the Amicable Appeals Board, from the end of the two-month period available to it to reply to your complaint.

What is the competent court?

The court of competent jurisdiction is the court of your domicile.

His address shall be mentioned, if appropriate, on the acknowledgement of receipt or the decision of the Amicable Appeals Board.

How do I apply to the court?

It is possible to send your request on site or by registered letter.

Please note

You can't fax it or send it electronically.

On site

You can file your request and documents, by 2 copies, at the Single Reception Service (SAUJ) of the court of your domicile.

His address is mentioned:

  • If applicable, on the acknowledgement of receipt or the decision of the CRA
  • And through the crate.

Application to refer the matter to the court - Social security and social assistance litigation

By post (LRAR)

You can send your request by registered letter with : titleContent at the court of your domicile at the address indicated on the notification the decision of the amicable appeal board.

All documents must be submitted in 2 copies.

Application to refer the matter to the court - Social security and social assistance litigation

Can we be assisted or represented before the court?

Yes. You can:

  • Appear alone
  • Be assisted (e.g. by a union representative)
  • Be represented (example: by a lawyer).

FYI  

If you are assisted by a lawyer, you may, under certain conditions, benefit fromlegal aid.

How is the application for judicial review handled?

The court summons you by mail at least 15 days before the hearing.

The court office notifies you of the decision. The notification indicates the time limits and remedies before the court of appeal.

There are several situations:

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The dispute concerns an amount greater than €5,000

Where the dispute concerns an amount greater than €5,000, you can appeal to the social chamber of the court of appeal.

This call takes place in a one month delay from the date of notification of the judgment of the court.

A lawyer is not required before the Court of Appeal.

The court registry notifies you of the decision.

Who shall I contact

The dispute concerns an amount of less than €5,000

If the dispute is for an amount less than €5,000, you can refer the case to the Court of Cassation in a 2 months delay from the date of notification of the judgment of the court.

The dispute concerns an indeterminate amount

If the dispute concerns an indeterminate amount (example: the damage does not give rise to a specific amount), you can appeal to the social chamber of the Court of Appeal.

This call takes place in a one month delay from the date of notification of the judgment of the court.

A lawyer is not required before the Court of Appeal.

The court registry notifies you of the decision.

Who shall I contact

You can benefit from certain conditions of llegal aid.

The approach varies depending on the situation (following a decision of the court of last resort or a decision of the court of appeal):

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Following a decision of the court of last resort (amount less than € 5,000)

If the decision of the court is final (this is the case for disputes involving an amount less than €5,000), you can appeal to the Court of Cassation within a period of time 2 months from the date of notification of the judgment of the court.

Who shall I contact

You must call on a lawyer at the Council of State and the Court of Cassation:

You can benefit from certain conditions to benefit from legal aid.

Following a decision of the Court of Appeal

Where the dispute concerns an amount greater than €5,000 or an indeterminate amount.

Where the dispute concerns an amount greater than €5,000 or an indeterminate amount.

If you are not satisfied with the decision of the Court of Appeal, you can refer the matter to the Court of Cassation within a period of time 2 months from the date of notification of the judgment of the Court of Appeal.

Who shall I contact

You must call on a lawyer at the Council of State and the Court of Cassation:

You can benefit from certain conditions of legal aid.

On the same subject

Who can help me?

Find who can answer your questions in your region

  • Health Info Rights

    Telephone line created by a collective of user associations to provide legal or social information related to health

    By phone

    01 53 62 40 30

    Price of a normal communication

    Open service:

    • Monday, Wednesday and Friday from 2pm to 6pm
    • Tuesday and Thursday from 2pm to 8pm.

    By email

    https://www.france-assos-sante.org/sante-info-droits/

    The maximum response time by email is 15 days.