Contesting a CPAM decision in France: amicable appeals commission, 2-month deadline and letter template
Refused reimbursement, daily allowances, disability: how to contest a CPAM (health insurance) decision — mandatory amicable appeal to the commission de recours amiable within 2 months, administrative vs medical disputes, referral to the social division of the judicial court. Letter template for registered mail.
Quick answer
A CPAM decision (refused reimbursement, daily allowances, affiliation…) is contested within 2 months of its notification. For an administrative dispute, the first step is mandatory: refer the matter to your fund's amicable appeals commission (CRA) by registered mail with proof of receipt. No reply within 2 months = implicit rejection; you then refer the matter to the social division of the judicial court. For a medical dispute (incapacity rate, disability), the route is a medical assessment or the medical commission. The procedure is free, with no compulsory lawyer.
| Who it's for | Insured people disagreeing with a CPAM decision |
| Deadline | 2 months from notification |
| Mandatory step | Amicable appeals commission (administrative dispute) |
| Then | Social division of the judicial court |
| Medical dispute | Medical assessment / medical amicable appeals commission |
| Cost | Free, no compulsory lawyer |
| Common mistakes | Missing the 2 months, going straight to court, confusing the routes |
1. Identify the nature of the dispute
- Administrative dispute: refused coverage, calculation or payment of daily allowances, affiliation, overpayment, base pension. → Amicable appeals commission (CRA), then the social division of the judicial court.
- Medical dispute: contesting an incapacity rate, a consolidation date, a disability or unfitness decision. → medical assessment (art. L141-1) or the medical amicable appeals commission.
The CPAM's notification letter should state the route and deadline for appeal: read it carefully.
2. The amicable appeals commission (CRA)
- Deadline: refer within 2 months of notification, by registered mail with proof of receipt — proof of the date is decisive.
- Composition: members of the fund's board; it re-examines your file.
- Reply: the CRA decides; no reply within 2 months counts as an implicit rejection.
- Free: no advance of costs, no compulsory lawyer.
3. Letter template to the amicable appeals commission
Subject: Amicable appeal — decision of [date], file no. [X]
Dear Sir or Madam,
By decision notified on [date], you [refuse / reduce / claim] [subject: reimbursement, daily allowances, overpayment…]. I contest this decision on the following grounds: [factual account and supporting documents].
In accordance with the provisions of the Social Security Code, I refer the matter to your fund's amicable appeals commission so that it re-examines my file and revises this decision.
Enclosed are a copy of the contested decision and the supporting documents. Please notify me of your decision within the two-month deadline.
Yours faithfully,
[Date — Signature]
The appeal stands or falls on the 2-month deadline: MaisonMail can print and dispatch your letter through an available registered service. Origin market, delivery times, tracking and the proof-of-receipt slip are confirmed before payment. See also: contesting a CAF overpayment.
4. Referring to the social division of the judicial court
- When: after a rejection by the CRA (explicit or implicit), within 2 months.
- How: an application to the social division of the competent judicial court; free procedure, no compulsory lawyer, with the option to be assisted or represented.
- Medical dispute: the judge relies on an assessment; contest first through the medical route provided.
5. Special cases
- Overpayment: you can contest the principle (CRA) and/or request a debt remission (also the amicable appeals commission), depending on your situation.
- Payment deadlines: financial hardship can justify an instalment plan — request it in parallel.
- Health Insurance Ombudsman: a complementary route that does not suspend the litigation deadlines.
6. Common mistakes
- Letting the 2 months lapse: the decision becomes final.
- Going straight to court without the CRA (administrative dispute): inadmissible.
- Confusing administrative and medical disputes, and taking the wrong route.
- Not enclosing the contested decision and the documents.
- Sending by simple post: without proof of the date, meeting the deadline is fragile.
In short: 2 months to contest, the amicable appeals commission as a mandatory first step for an administrative dispute (registered mail), then the court's social division; a separate medical route for rates and disability. Everything is free with no compulsory lawyer — but meeting the 2-month deadline and having proof of dispatch make all the difference.
Official sources
References used and links to the rules currently in force.
- Contester une décision de la CPAM (F2500)Service-Public.fr
- Code de la sécurité socialeLégifrance
Information current as of the last verification date. This guide is informational and is not legal advice — for a complex situation, consult a qualified professional.
Frequently asked questions
What is the deadline to contest a CPAM decision?
2 months from notification of the decision. After that, the decision becomes final. Referring the matter to the amicable appeals commission (CRA) by registered mail is a mandatory prerequisite before court, except for strictly medical disputes.
What is the difference between an administrative and a medical dispute?
An administrative dispute (refused reimbursement, allowance calculation, affiliation) goes to the amicable appeals commission, then the social division of the judicial court. A medical dispute (incapacity rate, consolidation date, disability) goes through a medical assessment or the medical amicable appeals commission.
The CPAM does not reply to my appeal — what do I do?
No reply from the amicable appeals commission within 2 months counts as an implicit rejection. You can then refer the matter to the social division of the judicial court within 2 months of that rejection (or of the explicit rejection notice if one is issued).
Do I need a lawyer to contest?
No, the procedure before the amicable appeals commission and the social division is free with no compulsory lawyer. You may be assisted or represented (a relative, a union representative, an association). A lawyer remains useful for complex or high-stakes cases.
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