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We all have certain basic rights to medical care. Especially people with a chronic illness, who have the right to ‘AVBZ’ care. On the ‘SVB’s’ website you can find all the information related to this right in the General Insurance Act for Special Medical Expense (‘AVBZ’), better known as the ‘Lei di Labizjan’. For your easy reference or you can just click on the link to read the description of the law. So now you know what the AVBZ entails and how you can request it but what happens when you are rejected for the ‘AVBZ’ care by the ‘SVB’?

This is where it gets tricky. Most people don’t realize that they can appeal a rejection or how to go about appealing the decision. The process is somewhat complicated and based on very technical legalese. For someone with a chronic illness or disability it is probably even more daunting; they already have to deal with the daily struggles of their disability and to top it off, they must practically be legal experts to understand the procedure and write the objection letter.


The Process
The Alton Paas Foundation talked to Mrs. Sandra Smith and she was kind enough to explain the process in laymen’s terms and give us some pointers on what to do when the ‘SVB’ rejects a petition for ‘AVBZ’ care.

According to Sandra, basically people with a chronic affliction with no chance of recovery are entitled to the ‘AVBZ’ care. There is a ‘LAR’, the Ordinance Administrative Jurisprudence that regulates the ‘AVBZ’ as well as all other regulations of the ‘SVB’. The ‘LAR’ lists two different ways you can appeal rejections by the ‘SVB’.

  1. You can file an objection with the director of the ‘SVB’
  2. You can file an appeal with the court


The First Option
In the case of an objection, you have to submit your objection to the director of the ‘SVB’ within six weeks from the date you received the rejection letter. The ‘SVB’ has an Advice Committee that reviews these objections. They collect information of the department in question that was involved in the decision making and once they have received all information, they invite the client (with his representative if he has one) as well as the staff members of the ‘SVB’ to a formal hearing to discuss the objection. Both parties get the chance to present their complaint or defense and with this additional information the Advice Committee evaluates the case and advices the ‘SVB’ director accordingly. The director is not obligated to follow the advice but in most cases he does.

If the board agrees with the Committee’s advice to approve the client’s appeal for ‘AVBZ’ they notify the client accordingly in writing and if it is a negative advice, or the ‘SVB’ director decides to go against the Committee’s advice, he notifies the client of his decision in a letter, motivating the basis of the decision. This letter also serves as the final ruling of the ‘SVB’.


Second Option
When a client receives this letter, he will again have six weeks to make use of his second option which is to file an appeal with the court, leaving the decision in the judges’ hands. The ‘LAR’ fully describes the procedures for filing an objection or an appeal. You could opt to file an appeal with the court directly instead of filing an objection with the director of the ‘SVB’ or you could file an objection with the director of the ‘SVB’ first and eventually file an appeal with the court afterwards. The court is your last resort to appeal your case and you can’t go back to objecting to the ‘SVB’ director once you’ve filed an appeal with the court.


Some Suggestions

This was a brief explanation of how it works. But it was just the basics. Actually submitting an objection or appeal is not as easy as it sounds. The objection letter must comply with various requirements as stated in the ‘LAR’ and there is a certain procedure to be followed. This process can be quite technical and complicated and a simple error could mean the difference between an approval or a rejection of your request. That is why Sandra suggests the following:

  1. Always submit objections to the ‘SVB’ director first, since you might be able to resolve the matter internally without having to go to court, which could be a costly and time consuming affair.
  2. Make sure you submit your objection or appeal within the required timeframe and in accordance with the requirements.
  3. If possible, have a lawyer, a legal expert or an experienced advisor represent you when filing either an objection or appeal to ensure that it is done correctly and that the proper procedure is followed.
  4. If you can’t afford a lawyer, look into the possibility of obtaining pro-deo council (paid by the government) at the SOAW department or ask for assistance at the ‘Tienda di Lei’ (Law Store); an entity consisting of a group of law-students that give free advice and assistance in legal matters to those with no income or with a low income.

We hope the information above is helpful to anyone who has recently been rejected for ‘AVBZ’ care by the SVB. For more information please feel free to contact the Alton Paas Foundation.

Click here to read the AVBZ Description 

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