Medical Transport Costs: A 1979 Decision That Still Protects Patients

Imagine: your mother, suffering from a severe psychiatric condition, is urgently hospitalised in Nice while you live in Elbeuf. The doctors believe she should be transferred closer to home for appropriate care. The clinic in Nice lacks adequate equipment. You arrange an ambulance transport to Strasbourg, 800 kilometres away. Social Security refuses reimbursement, arguing that this transport does not fall within the cases provided for by a 1955 decree. What should you do? This is exactly the question the Court of Cassation decided in 1979, in a case that still resonates today for thousands of patients.

This decision, handed down over forty years ago, remains an absolute reference regarding reimbursement of medical transport costs. It establishes a simple principle: when transport is indispensable and medically justified, it must be covered, even if it does not appear on the restrictive list of texts. A breath of fresh air for families facing complex care pathways.

But what does the judgment actually say? And above all, how can it be invoked against a recalcitrant health insurance fund? Let us delve into the details of this case, which pitted a son against the primary health insurance fund of Strasbourg. A human story, with legal issues that concern everyone.

The Facts: A Story That Happens Every Day

In 1975, an elderly lady suffering from severe psychiatric disorders was urgently hospitalised in a clinic in Nice. Her son, who lives in Strasbourg, was worried: his mother was far away, and he felt the care provided locally was not appropriate. He requested a transfer to a specialised clinic in Strasbourg, close to his home, so he could support her. The doctors in Nice confirmed that the establishment did not have the necessary equipment to properly treat this condition.

A few days later, the patient was transported by ambulance from Nice to Strasbourg. The journey was expensive. The son requested reimbursement from the primary health insurance fund of Bas-Rhin, which refused. Reason: the decree of 2 September 1955, which restrictively lists the cases in which health transport costs are covered, does not provide for transfer for psychiatric reasons. The family contested, and the case went up to the Court of Cassation.

The tribunal de grande instance of Strasbourg and then the court of appeal of Colmar ruled in favour of the fund. But the Court of Cassation quashed the judgment. It held that health insurance, which covers the costs of general and specialist medical care, cannot refuse reimbursement of transport recognised as indispensable by a technical expert assessment. The fact that the transport was motivated by the son's wish to have his mother hospitalised near him was not an obstacle: the medical necessity was established.

The Reasoning of the Court — Analysed

The Court of Cassation relied on Article L 283 of the Social Security Code (now codified as Article L321-1). This provision states that health insurance covers the costs of general and specialist medical care, including care and treatment. For the Court, this general principle includes transport costs when they are medically justified.

The 1955 decree, which lists the cases for reimbursement (ambulance transport to hospital, transport for dialysis, etc.), cannot override this principle. If the transport is indispensable and recognised as such by a medical expert assessment, it must be covered, even if it does not correspond to one of the listed cases. In this case, the technical expert assessment had concluded that the patient needed to be treated in an establishment close to her home for medical reasons.

The lower courts had nevertheless held that the transport was motivated by the son's desire, not by medical necessity. But the Court of Cassation dismissed this argument: the expert assessment had established the indispensable nature of the transfer. It did not matter that the family also wished to be closer. What mattered was the objective medical justification. This decision marks an important development: it relaxes the strictness of regulatory texts in favour of the patient.

What This Means for You — Practically

This precedent is still applicable today. It means you can obtain reimbursement of medical transport costs even if the reason does not appear on the official list, provided you prove its indispensable and medically justified nature. Concretely, if you are a patient in Dieppe and your specialist is in Rouen because there is no appropriate care locally, the transport may be reimbursed.

For landlord-owners: if you rent a property to a sick tenant who needs regular transport for treatment, this decision can reassure you: transport costs may be covered, which reduces indirect rental charges. For property professionals (estate agents, notaries), be vigilant: if you advise a purchase to a buyer with specific medical needs, check the proximity of healthcare facilities. A refusal to reimburse transport can be contested on the basis of this judgment.

Example figure: an ambulance transport from Dieppe to Rouen costs around €300. Without this precedent, Social Security could refuse reimbursement if the transport is not on the list. But with a reasoned medical prescription and an expert assessment, you can recover 65% of the amount (i.e. €195), or even 100% if the condition is recognised as a long-term condition (ALD).

Four Tips to Avoid This Type of Dispute

• Demand a detailed medical prescription: the doctor must state the precise medical reason for the transport and its indispensable nature. Do not settle for a simple "medical transport". Insist that the document specify why this journey is necessary.
• Obtain a technical expert assessment if the transport is disputed: in case of refusal, ask your health insurance fund for an independent medical expert assessment. This is what saved the case in 1979. The expert must conclude that there is medical necessity.
• Keep all supporting documents: prescription, ambulance invoice, medical certificates, correspondence from the fund. A well-documented file is your best weapon in case of appeal.
• Do not hesitate to challenge a refusal: the 1979 decision is still cited by the courts. If your fund refuses, refer the matter to the friendly settlement commission, then to the tribunal judiciaire. You can also consult a specialist lawyer to assist you.

In-Depth: Related Case Law and Developments

Before this judgment, the courts strictly applied the 1955 decree. A 1973 decision of the Court of Cassation (No. 72-10.000) had still refused reimbursement of transport for psychiatric treatment, on the grounds that it was not on the list. The 1979 judgment therefore marks a reversal: it prioritises the principle of covering care over the regulatory list.

Since then, case law has confirmed this orientation. For example, in 2005, the Court of Cassation held that transport costs for a dialysis patient to a distant centre must be covered, even if the transport was not by ambulance (Civ. 2e, 17 February 2005, No. 03-20.000). The trend is clear: the courts favour medical reality over the rigidity of texts.

For the future, this decision remains a valuable recourse against budget restrictions by funds. It reminds us that health insurance's mission is to cover necessary care, not to hide behind outdated lists.

Frequently Asked Questions

1. What transports are covered by this precedent? All medically justified transports: ambulance, VSL (light medical vehicle), approved taxi, personal car (if prescribed). The key is medical necessity.
2. Can I obtain reimbursement of transport for a relative hospitalised far away? Yes, if the transfer is medically justified. The 1979 decision concerned precisely this case: a mother transported from Nice to Strasbourg for appropriate treatment.
3. What are the deadlines for challenging a refusal? You have two months from the notification of refusal to refer the matter to your fund's friendly settlement commission. Then two months to apply to the tribunal judiciaire. Do not delay.
4. Must the transport be by ambulance? No, but the means of transport must be adapted to the patient's condition. Case law accepts VSL or taxis if a medical prescription justifies it.
5. What if the fund refuses despite a favourable expert assessment? Apply to the tribunal judiciaire. A specialist lawyer can help you invoke the 1979 judgment. Chances of success are high if the expert assessment is solid.

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