Transport costs and health insurance: when the judges remind the rules

You are in Aix-les-Bains, you slip on a patch of black ice coming out of the market. Fractured wrist. You are taken to the local hospital. But your family lives in Paris, and your father offers you to stay with him for the recovery. You ask to be transferred to a Parisian clinic. Health insurance refuses to cover the transport. Why? Because it is not medically necessary. This 1970 decision of the Cour de cassation says it clearly: transport costs are only reimbursed if they are justified by the needs of the treatment, not by personal reasons.

The question every owner or tenant asks: "Can I get reimbursement of my transport costs if I am hospitalised far from home?" The answer is no, unless the transport is required by the state of health. And this rule also applies to real estate professionals who, for example, have to travel to manage a property.

What this decision says: the first instance commission had granted reimbursement to an insured person who had been transported from La Clusaz to Nancy to be treated near his father. The Cour de cassation quashed this decision, holding that the judges should have checked whether the person could receive appropriate care in the establishment nearest to the place of the accident. In short, personal comfort does not justify coverage.

The facts: a story that happens every day

Mr X, a young man domiciled in Paris, goes on a skiing holiday to La Clusaz (Haute-Savoie). He skis on a blue run when, unfortunately, he falls and is seriously injured. Rushed to the Annecy hospital, he is treated. But his father, worried, lives in Nancy. Mr X asks to be transferred to a Nancy clinic, closer to his father. The ambulance transport is carried out. Then, he asks the health insurance fund to reimburse the transport costs.

The fund refuses: according to it, the transport was not medically justified. Mr X refers the matter to the first instance commission (the predecessor of the social security tribunal). This commission rules in his favour, considering that the transport was "likely to shorten the duration of his hospitalisation and avoid the costs of a nurse". In other words, because his father could take care of him, this justified the transport.

The fund appeals to the Cour de cassation. The Cour de cassation, in its judgment of 22 July 1970, quashes the commission's decision. It criticises the lower court judges for not having investigated whether the person could receive appropriate care in the establishment nearest to the place of the accident. In this case, was the Annecy hospital able to treat him properly? If so, the transport to Nancy was not justified.

This case illustrates a classic conflict between the patient's freedom to choose their place of treatment and the budgetary rigour of the Social Security.

The reasoning of the court — analysed

The Cour de cassation relies on the Order of 2 September 1965, which sets out the list of cases where transport costs are covered by health insurance. Outside these cases (emergency transport, transport linked to a planned hospitalisation, etc.), reimbursement is only possible if the transport is "recognised as medically justified by the necessities of a treatment".

The judges recall that the first instance commission had based its decision on non-medical grounds: family proximity, saving on a nurse. However, these considerations are unrelated to the purpose of health insurance. The Court therefore requires the judge to actually verify whether the initial establishment (the nearest) was capable of providing suitable care. If so, transport to a more distant establishment is not justified.

This decision is not a reversal but a confirmation of the rigour of the system. It is part of a logic of controlling health expenditure. For non-lawyers, remember this: Social Security does not pay for transport simply because it is more convenient for you or your family. A medical prescription is required certifying that the transport is essential to receive appropriate care.

Mr X's arguments (shortening hospitalisation, avoiding a nurse) were dismissed. The Court held that these personal benefits are not a matter for health insurance. It is harsh, but logical: otherwise, anyone could ask to be transported to a relative's home for comfort reasons.

What this changes for you — concretely

If you are a landlord in Albertville and you injure yourself while inspecting a property, you may want to be treated near your home or your family. But beware: if the local hospital can treat you, health insurance will not reimburse your transport to another establishment, even if it is more comfortable.

For a tenant who is a victim of a domestic accident in their flat in Aix-les-Bains: if you are taken to the emergency room, the ambulance costs are covered (this is a case provided for by the Order). But if you request a transfer to a clinic in Chambéry because your mother lives there, it will not be reimbursed without medical justification.

Real estate professionals (agents, notaries, developers) are not directly affected by this decision, but they may encounter clients who are unaware of these rules. For example, a client injured in a property they were visiting may want to be treated in their hometown. Explain to them that they must obtain a precise medical certificate.

Example figure: an ambulance transport from La Clusaz to Nancy costs around €1,200. Without coverage, it is the patient's responsibility. A sum that can be significant.

Four tips to avoid this type of dispute

• Insist on a detailed medical prescription: Before any non-urgent transport, ask your doctor to write a prescription stating precisely why the transport is medically necessary (e.g., "patient requires specialised rehabilitation not available locally").
• Check the list of reimbursable transports: Consult the Order of 2 September 1965 (easily found online) or ask your fund. Emergency transport, serial transport for dialysis or chemotherapy, etc., are covered. For others, be cautious.
• Do not rely on personal reasons: Family proximity, savings on care, convenience are not valid grounds. If you want to be treated near your home, do so at your own expense.
• If refused, challenge with medical arguments: If the fund refuses, you can refer the matter to the amicable appeals commission, then to the tribunal. But to win, you must provide solid medical evidence (certificates, opinion of a medical adviser).

Further reading: related case law and developments

This 1970 decision has been confirmed subsequently. For example, in a judgment of 13 January 1972 (n° 70-12.456), the Cour de cassation held that the transport of a patient to a more distant establishment was not reimbursable if the nearby establishment offered the same care. The trend is constant: judges strictly control the medical necessity of transport.

Since then, the texts have evolved. The Social Security Code (articles L.321-1 and R.321-1) restates these principles. The list of reimbursable transports has been expanded (transport in a light medical vehicle, professional seated transport), but the requirement for medical justification remains. Courts continue to sanction abusive requests.

For the future, the digitalisation of prescriptions could strengthen controls: electronic medical certificates will be directly verified by the funds. It is therefore better to be rigorous from the outset.

In practice: what to do

FAQ:

• Can I be transported to the hospital of my choice? Yes, but at your own expense unless the transport is medically justified.
• What if the fund refuses reimbursement? Challenge it by registered letter with acknowledgement of receipt to your fund's amicable appeals commission. Attach all medical evidence.
• What are the deadlines for challenging? You have two months from the notification of the refusal.
• Is transport for family reasons ever reimbursed? No, unless it is an emergency transport or a treatment that can only be carried out in a specific establishment.
• What if I am injured far from home? Get treatment on site. If you want to return, ask your doctor if transport is medically necessary. Otherwise, arrange private transport.

Are you in a similar situation? A first 30-minute consultation with Maître Zakine (€45) can save you months of proceedings — and often much more. Book an appointment →