›› Medical assessments

This procedure may be initiated either by the insured person or by their attending physician if they contest a decision made by the medical advisor. A simple written request must be submitted to the Medical Control within fifteen days, accompanied by a report from the attending physician, either by registered mail with acknowledgment of receipt, or delivered directly against a receipt of submission.

The expert physicians are those listed on the national register of medical experts, established by the National Commission responsible for verifying the compliance of applications for registration on the list of medical experts.

Eligible for inclusion on this list are specialist physicians who apply, provided they can demonstrate five years of medical practice, are duly registered with the Regional Medical Council, and have not been subject to a dishonorable conviction.

Within eight days from the date of receiving the request for expertise, the Fund shall propose, in writing, three experts from the list of medical experts. The insured person must accept or refuse them within eight days; failing this, they will be required to accept the expert appointed by the Fund.

The Fund provides the medical expert with a file containing:

• The opinion of the attending physician,
• The opinion of the medical advisor,
• A summary of the disputed issues,
• The mission of the medical expert.

The medical expert then summons the insured person, examines them, and prepares a report in two copies (one for the Fund and one for the insured person). This report must be submitted within fifteen days from the date of receipt of the file.

The Fund then notifies the insured person of the results of the expertise within ten days following receipt of the report.

The fee for the medical expert is set at 1,500 Algerian Dinars. The expert’s fee is covered by the Insurance Fund, unless the expert confirms that the insured person’s request is clearly unfounded, in which case the fee is borne by the insured person.