My Cpam is incompetent and inefficient – who can help?
I find my local Cpam office to be inefficient and incompetent. Is there an ombudsman to whom one can address grievances? N.C.
There is a service called the conciliateur, which aims to resolve problems between patients and Cpams (local state health insurance bodies).
This is as opposed to the similarly named médiateur de la Cpam, who intervenes in disputes between patients and health professionals.
At first, you should address your complaint with a réclamation (claim) directly to the Cpam, whether by phone, in writing, in person, or via your account on ameli.com.
If you are dissatisfied with the reply or do not obtain one within three weeks, you may apply to the conciliateur by sending a letter to the Cpam, addressed to him/her.
Their role is to give their opinion and try to find an amicable solution. Another avenue for those with a grievance against a public body is the Défenseur des droits (defenseurdesdroits.fr), an official whose role is to investigate disputes between the public and bodies, and defend people’s rights. To apply (free of charge) you need to at least have made a written complaint to the Cpam as a previous step.
Note, however, that if you want to contest a specific decision (eg. the Cpam refused to refund a treatment), whether or not you are seeking help such as mentioned above, you should lodge an appeal with the Commission de recours amiable (CRA) at the Cpam within two months of the decision.
If turned down after this, there are possible legal avenues to fight the decision, including the tribunal des affaires de sécurité sociale, or if the problem relates to an incorrect (in your view) assessment of your category of disability, the tribunal du contentieux de l’incapacité.
You can also obtain advice on these issues from the Cpam English-speaking helpline on 08 11 36 36 46 or international social security advice body CLEISS on 01 45 26 33 41.
