Appeal procedures

In social security matters, a distinction is made between the Luxembourg administrations' internal appeal procedures – i.e. administrative appeals – and contentious appeal procedures (for contentious appeals).

Before bringing a dispute before a social security tribunal, the insured person must have lodged an appeal with the relevant administration's internal appeals tribunal; this procedure is still sometimes referred to as an out-of-court settlement.

Administrative appeals

Appeals brought before a social security institution

For each branch of insurance, there is a procedure for appealing against individual decisions concerning the insured person. Where long-term care insurance is concerned, the following options exist:

Official decisions by the President of the National Health Fund (also applicable in matters concerning long-term care insurance)

Any insured person who is not satisfied with a decision handed down by the National Health Fund can seek an official decision from the president of that institution.

Following that decision, the insured person can lodge an objection before the Executive Committee within 40 days.

Objections lodged before the Board of Directors of the National Health Fund

The Board of Directors of the National Health Fund also has competence in matters concerning long-term care insurance.

Decisions handed down by the Board of Directors can be appealed either before the Supervisory Commission or before the social security tribunals.

The Supervisory Commission

The Supervisory Commission falls under the authority of the Ministry of Social Security (Ministère de la Sécurité sociale).

It has authority in matters concerning sickness and maternity insurance, accident insurance and long-term care insurance. However, unlike sickness and maternity insurance, the insured person cannot appeal to the Supervisory Commission, since the latter does not pay the costs of long-term care insurance benefits. As such, it is not involved in such disputes. The right of initiative lies with the National Health Fund or with the care and assistance providers.

The Supervisory Commission therefore has competence in matters concerning:

• the invoicing of benefits covered by long-term care insurance;
• violations of legal, regulatory, statutory or contractual provisions by care and assistance providers.

Invoicing of benefits covered by long-term care insurance

The Supervisory Commission will rule on disputes between the State Office for Assessment and Monitoring of the long-term care insurance (AEC), or the National Health Fund, and care and assistance providers, relating to the invoicing of benefits covered by long-term care insurance. Since the insured person does not advance the cost of long-term care insurance benefits, they are not involved in these disputes.

Violations of legal, regulatory, statutory or contractual provisions by care and assistance providers

As is the case in matters concerning sickness insurance and accident insurance, the Supervisory Commission has competence to assess violations of legal, regulatory, statutory and contractual provisions by care and assistance providers.

Contentious appeals

If the competent institution does not reverse its decision following an internal appeal, the case is then brought before the social security system's special tribunals:

• the Social Security Arbitration Tribunal (Conseil arbitral de la sécurité sociale), which has competence to settle disputes in the first instance;
• the High Council of Social Security (Conseil supérieur de la sécurité sociale), which rules on appeals against decisions handed down by the Social Security Arbitration Tribunal.

The final option is to lodge an appeal with the Final Court of Appeal (Cour de cassation) to have the decisions and judgements quashed.

The Social Security Arbitration Tribunal

The Social Security Arbitration Tribunal is the first-instance jurisdiction. It rule on matters in the first and final instance in disputes involving amounts up to EUR 1,250, and on appeals in matters relating to larger amounts. Appeals before the Arbitration Tribunal must be lodged within 40 days of the notification of the decision handed down by the Executive Committee of the social security institution in question, or the Supervisory Commission's decision. Appeals submitted after that deadline will not be considered.

The High Council of Social Security

The High Council of Social Security is the appellate jurisdiction. The appeal must be lodged within 40 days of the notification of the Social Security Arbitration Tribunal's decision, or will be inadmissible.

The High Council's decision is final.

Appeals before the Final Court of Appeal

Insured persons can lodge an appeal to have final-instance decisions handed down by the Arbitration Tribunal and the High Council of Social Security quashed, but only if the law has been broken or if the procedural requirements before the social security tribunals have been violated.