Background
M. [Z], a medical adviser with the Provence-Alpes-Côte d’Azur regional medical service, filed an occupational-disease claim on April 23, 2019, with the Bouches-du-Rhône health insurance fund, to which he was affiliated. A May 15, 2019 delegation agreement among that fund, the Doubs health insurance fund, and two regional medical services assigned investigation of the claim to the Doubs fund.
After the Doubs fund rejected the claim on January 24, 2020, M. [Z] brought proceedings before a court responsible for social-security disputes. The Aix-en-Provence Court of Appeal accepted the funds’ jurisdictional objection, reasoning that the challenged delegation agreement was an administrative act whose legality could be reviewed only by the administrative courts. M. [Z] appealed to the Court of Cassation.
The Court’s Holding
The Court of Cassation quashed the appellate judgment in its entirety. Raising the issue on its own motion under Article 620(2) of the Code of Civil Procedure, it held under Articles L. 142-1 and L. 142-8 of the Social Security Code that jurisdiction depends on the nature of the dispute. Because M. [Z] sought recognition of his illness as occupational, the dispute fell within the social-security jurisdiction of the ordinary judiciary.
The Court further held that the delegation agreement concerned the processing of an occupational-disease claim and did not involve the health insurance funds’ exercise of public-authority powers. The Court of Appeal therefore erred in treating the agreement’s legality as a matter reserved exclusively to the administrative courts. The case was remanded to a differently constituted panel of the Aix-en-Provence Court of Appeal; the Doubs fund was ordered to pay costs, and both funds were ordered jointly to pay M. [Z] €3,000.
Key Takeaways
- Jurisdiction in French social-security litigation turns on the nature of the underlying dispute, not merely on whether a contested instrument may be characterized as administrative.
- A claim seeking recognition of an occupational disease falls within the jurisdiction of the ordinary judiciary under Articles L. 142-1 and L. 142-8 of the Social Security Code.
- A delegation agreement governing investigation of an occupational-disease claim does not shift the dispute to the administrative courts when it does not reflect the exercise of public-authority powers.
Why It Matters
The ruling prevents procedural arrangements among health insurance bodies from diverting an occupational-disease dispute away from the specialized judicial system designated for social-security matters. It also clarifies that courts must examine both the dispute’s substance and whether the challenged conduct actually involves public-authority prerogatives before declining jurisdiction in favor of the administrative courts.