How to appeal – and complain – to CPAM

There are established procedures in place should you have a grievance concerning the CPAM. They fall into two categories:

– complaints and;

– appealing a medical or administrative decision.

Before entering any formal procedure it is always better to try and resolve your problem amicably with your local CPAM staff. If you live in a rural area a CPAM representative will visit a local village for half a day a week – your mairie will have details. It is usually the same person each week so a degree of continuity can be maintained.

There is an English speaking helpine: 08 11 36 36 46

However, there will be occasions when routine communication with the CPAM does not resolve a problem and it is necessary to take more formal steps.

COMPLAINTS

There are potentially many types of complaint that need to be resolved. Examples include obstructive staff, unacceptable delays in processing a case file etc

The first step is to contact, in writing, the conciliateur in your CPAM office. There are an increasing number of CPAM offices that will accept your complaint by e-mail, however, if the matter is serious a letter is still the best option. The conciliateur should reply within three weeks with a proposed course of action.

CHALLENGES/ APPEALS

With a complaint the concilateur acts as a mediator. He or she does not have decision making powers. So when actually challenging a decision made by the CPAM office, such as having affiliation of your healthcare cover refused, then a different procedure must be followed.

Initially you should contact the Commission de recourse aimable (CRA) at your local CPAM office.

Should the CRA reject your appeal then the next step is to contact the Tribunal des affaires des sécurité sociale (TASS). This should be submitted within two months. You cannot approach a TASS without having a rejection from the CRA.

The TASS will probably only be located in the capital of the département.

If it is still rejected then one can make final appeal to the court of appeal (la cour d’appel).