For a British pensioner living in France, an S1 can be the document that keeps healthcare funded by the United Kingdom while French institutions organise access to treatment. It is not, however, a carte Vitale, a residence permit or a promise that every invoice will be paid in full. The difficult situation is common after Brexit: the pensioner has an S1, the French caisse primaire d’assurance maladie (CPAM, the local primary health-insurance fund) has not finished registering it, and medical costs have already been paid personally. The immediate questions are whether the treatment falls within the French scheme, from which date the entitlement can be proved, which documents should be sent, and how a refusal or silence must be challenged.

This article focuses on that narrow, practical dispute. It explains the difference between the underlying right to healthcare and the administrative operation that produces an attestation de droits (certificate of entitlement), a temporary social-security number or a carte Vitale. It also sets out the evidence needed for a reimbursement request and the procedure for a written CPAM refusal. The analysis is for a British reader settling in France after Brexit and distinguishes an S1 holder from a visitor using a GHIC or EHIC, a worker affiliated in France and a person relying on residence-based cover. The legal position must always be matched to the pensioner’s dates, benefit, residence and family circumstances.

I. Can a British pensioner use an S1 to obtain healthcare in France before CPAM registration?

A. What does the S1 establish, and why does registration matter?

An S1 is a portable healthcare document. It is issued by the institution responsible for the person’s healthcare costs and is presented to the institution in the country of residence. The official CLEISS explanation of the S1 describes it as a document that allows an insured person, and where relevant family members, who live in a state other than the competent state to register with the health-insurance institution in the state of residence. CLEISS is the French Centre for European and International Social Security Liaison. The document therefore answers a coordination question: which state must bear the cost while the person receives healthcare under the rules of the state where the person lives?

For a British national, the United Kingdom may issue an S1 to a person receiving a UK State Pension or another qualifying exportable benefit. It can also arise in some posting or cross-border work situations. Eligibility is not created by British nationality alone. The GOV.UK guidance on healthcare for UK nationals living in France says that a resident receiving a UK State Pension or an exportable benefit may be entitled to UK-funded healthcare and must register the S1 with the local CPAM. The issuing authority must be able to confirm the category, the effective date and the person covered.

The starting French rule is found in Article L. 160-1 of the French Social Security Code. It states: « Toute personne travaillant ou, lorsqu’elle n’exerce pas d’activité professionnelle, résidant en France de manière stable et régulière bénéficie, en cas de maladie ou de maternité, de la prise en charge de ses frais de santé dans les conditions fixées au présent livre. » In practical terms, the French system recognises healthcare cover for a person working in France or, subject to the legal conditions, living there stably and regularly. An S1 is a specific coordination route that must be placed on the person’s file; the general wording of Article L. 160-1 does not remove the need to prove the correct route.

Article L. 160-6 is particularly relevant to a pensioner whose healthcare costs are borne by another state. That provision excludes Article L. 160-1 for certain people, including « les personnes titulaires d’une pension étrangère […] lorsque, en application d’un règlement européen ou d’un accord international, la prise en charge de leurs frais de santé […] relève du régime étranger qui sert la pension ». The wording does not mean that the pensioner is left without healthcare. It means that the foreign pension state can remain the financially responsible state under the applicable international coordination rules. The S1 is the administrative proof used to make that coordination operational in France.

A British pensioner must also distinguish a protected residence position from the S1 itself. The French implementation of the EU–UK Withdrawal Agreement is addressed, among other provisions, by Article 30 of Decree no. 2020-1417 of 19 November 2020. It states that the qualifying Withdrawal Agreement residence documents « ouvrent droit à son titulaire à l’affiliation et au bénéfice des prestations ou allocations sociales », subject to the conditions of the decree and the particular benefit. That provision supports the social-rights position of the protected person; it does not replace the UK authority’s decision about whether an S1 is issued, nor does it turn a later mover into a Withdrawal Agreement beneficiary.

Family members require an individual analysis. Article L. 161-1 of the Social Security Code defines family members, including « le conjoint de l’assuré social, son concubin ou la personne à laquelle il est lié par un pacte civil de solidarité ». The definition is important but is not a universal rule that one pensioner’s S1 automatically covers every relative. The full text of Article L. 161-1 contains further categories and the applicable healthcare coordination rules may require a separate certificate for a spouse or dependant. The official CLEISS page confirms that an S1 is individual and nominative and that a separate document may be needed for each family member.

Registration is the bridge between the certificate and day-to-day treatment. The CPAM checks identity, address, the relevant residence or immigration status, the issuing institution, the S1 category and any dependants. Once the file is processed, the pensioner may receive an attestation de droits showing the French social-security identifier. The carte Vitale is a later healthcare card used to transmit treatment information electronically. It is not the source of the entitlement. The GOV.UK operational guidance states that registration can first lead to a temporary number, that the attestation confirms the right and number, and that the card may take longer.

This distinction matters when a CPAM file is delayed. A missing plastic card does not necessarily mean that the S1 is invalid. Conversely, possession of an S1 does not mean that the CPAM already has enough information to pay a particular invoice. The pensioner should ask the CPAM to confirm, in writing, three separate points: whether the S1 has been received, whether it has been registered against the correct person and address, and the date from which the French institution can process treatment claims. If the answer is only that the file is “in progress”, request the missing-document list and a reference number.

An S1 must not be confused with a GHIC or EHIC. A GHIC is a Global Health Insurance Card and an EHIC is a European Health Insurance Card. They are generally used for medically necessary state healthcare during a temporary stay, not as a replacement for residence registration. The French Service-Public page for a UK national on a short stay sets out the visitor route and the documents for a claim made with a GHIC or a provisional replacement certificate. A British pensioner who has made France the ordinary place of residence should tell the CPAM that the request concerns an S1, rather than allowing the file to be treated as a tourist claim.

There is a similar distinction with PUMa, meaning protection universelle maladie, the French universal health-protection scheme. A person working in France or relying on stable and regular residence may be assessed under French affiliation rules. That route should not be mixed with an S1 route without an explanation. If the CPAM asks an S1 pensioner for evidence normally requested from a person applying solely under residence-based cover, the pensioner should answer the request but also state that the UK-issued S1 is the primary legal basis being submitted. The factual alternatives should be analysed separately: UK responsibility under the S1, French affiliation through work, or French affiliation through residence.

In a real file, the effective date is often more important than the date on which the card is delivered. The S1 may show a starting date, while the CPAM may register it weeks later. A claim for treatment during that interval should therefore identify the date of the treatment, the S1 effective date, the date the document was sent to France and the date of each CPAM submission. The pensioner should not assert automatic retrospective cover without checking those dates. The stronger argument is specific: the person was eligible, the S1 was valid for the treatment period, the treatment was delivered in France under the public system, and the administrative delay prevented normal electronic processing.

B. Which medical costs and documents can support a reimbursement claim?

An S1 does not promise a full refund of every amount paid to a doctor, pharmacist, hospital or private clinic. Once registered, the person generally receives healthcare in France on the same basis as a person covered by the relevant French rules. The patient may still have a co-payment, a deductible, a regulated contribution, an excess charge or a cost outside the public tariff. Article L. 160-8 of the Social Security Code describes the scope of protection by stating: « La protection sociale contre le risque et les conséquences de la maladie […] comporte : » It then lists categories such as general and specialist medicine, dental care, medicines, examinations, hospital treatment and related care. The claim must still satisfy the conditions for the particular treatment and tariff.

The first question is whether the invoice concerns care received in France during a period covered by the S1. A routine consultation, prescribed medicine or hospital treatment may be considered under the ordinary French reimbursement rules. A private convenience charge, a treatment outside the public scheme, a non-prescribed item or an amount above the accepted tariff may not be recoverable in full. A planned treatment requiring prior approval can raise a separate issue. The CPAM should be asked to identify the exact reason for any reduction: no entitlement on the date, missing form, wrong institution, treatment outside the covered category, tariff limit or patient share.

The second question is whether the claim can be processed even though the S1 was not yet visible in the CPAM system. The GOV.UK guidance explains that a person who needs care before receiving the carte Vitale should use the available social-security number, ask the provider for a feuille de soins (paper treatment form) and send it to the CPAM for treatment paid personally. An S1 claimant who has no number yet should ask the CPAM what identifier must appear on the paper form and should attach the S1 registration reference. The administrative workaround is not a guarantee of entitlement; it is the method for putting a traceable claim in front of the fund.

The reimbursement bundle should be easy to audit. Include a cover letter and an index, followed by:

• a copy of the S1, including every page, and any letter from the UK issuing authority confirming its category and effective date;
• the British passport and the French residence document or other status evidence requested by the CPAM;
• the French address evidence and, where the file concerns a disputed period, a dated residence chronology;
• the temporary social-security number or attestation de droits, if one has already been issued;
• the dated, signed feuille de soins or electronic claim reference for each treatment;
• itemised invoices, proof of payment, prescriptions, hospital discharge papers and referrals where relevant;
• bank details in the format requested by the CPAM, with an explanation of the account holder if it differs from the patient; and
• the original CPAM submission receipt, upload confirmation, postal delivery record and every answer received.

Do not send a bundle that hides the central issue. Put the treatment invoices in chronological order and make a table showing the provider, date of care, amount paid, amount requested and document proving payment. If several family members are involved, create a separate section for each person. If the CPAM has already paid part of the claim, state the amount and ask for the balance to be assessed rather than asking for a second payment of the same invoice.

The pensioner should also distinguish the French public share from private cover. A mutuelle is supplementary health insurance. It may pay some of the patient contribution or tariff gap, but it does not determine whether the CPAM must register the S1. Send the CPAM claim first, then provide the reimbursement statement to the mutuelle under its contract. If the private policy was purchased as interim cover, check whether it requires notification of public healthcare registration or whether it excludes costs that the public scheme should have handled.

Timing is a separate legal risk. Article L. 332-1 of the Social Security Code provides that the action for payment of sickness benefits is subject to a two-year period running from the first day of the quarter following the benefits concerned. The text says: « L’action de l’assuré pour le paiement des prestations en espèces de l’assurance maladie se prescrit par deux ans ». The wording of the provision and the classification of a claim should be examined carefully, but a person seeking reimbursement of paper treatment forms should never leave the file dormant. Submit each claim promptly and preserve proof of receipt.

In Cass. 2e civ., 8 November 2012, no. 11-30.270, the Court of Cassation dealt with a healthcare reimbursement dispute where treatment forms had been sent but payment had been made to the wrong recipient. The Court held that the two-year prescription did not bar an action to recover sums that were already due and had not been validly paid to the insured. Its wording is precise: « ne concerne que l’action de l’assuré pour le paiement des prestations de l’assurance maladie ». The decision does not create automatic S1 retroactivity, but it shows why a pensioner should prove the original submission of the treatment forms and the exact payment history.

The result will depend on the date from which the person was entitled and the French reimbursement rules for the treatment. There are at least four different scenarios:

• The S1 was valid, the person was resident in France, the care was delivered after the effective date and the claim was sent with the required treatment form. This is the clearest request for manual processing.
• The S1 was valid but the CPAM had not issued a number. The claim should still identify the person and certificate, with a request for a manual link to the eventual social-security record.
• The person applied for an S1 only after treatment, or the issuing authority refuses to confirm cover for the treatment date. The claim may require a determination of the competent state before reimbursement can be decided.
• The person was only visiting France and had no residence S1. The GHIC, EHIC or provisional replacement route may apply, but it is a different claim with different documents and limits.

Do not describe an unregistered S1 as a private insurance policy. Do not send only a bank statement and a prescription, because the CPAM may be unable to identify the patient’s entitlement or the amount paid. Do not submit an English document with a French summary that changes “State Pension” into a different benefit. If translation is needed, keep the original, the French translation and a note identifying the translator. The goal is to let the CPAM resolve the entitlement date and the invoice without guessing.

When a provider refuses to issue a treatment form because there is no carte Vitale, ask for an itemised paid invoice and contact the CPAM in writing. The provider’s billing practice and the CPAM’s reimbursement decision are not the same thing. A hospital may also have a social-work or international-patient service that can record the S1 reference. Keep a copy of the request and the response. If the treatment is urgent, address continuity of care immediately rather than waiting for the reimbursement dispute to finish.

II. How can you challenge a CPAM delay or refusal to reimburse?

A. What should you send before the two-month CRA deadline?

Start by identifying whether there is a formal decision. A CPAM message can be a request for a missing document, a notification that the S1 cannot be registered, a refusal of a specific reimbursement, a contribution assessment, or an explanation that the file is still being examined. A telephone agent’s statement is not a reliable substitute for the written decision that gives reasons and appeal instructions. Ask the CPAM to state the legal and factual basis, the date of notification, the period concerned, the documents considered and the body to which an appeal must be sent.

For a non-medical administrative dispute such as refusal to reimburse treatment or refusal to process the entitlement file, the usual preliminary appeal is the commission de recours amiable (CRA), the amicable-appeal commission within the social-security organisation. Article L. 142-4 of the Social Security Code provides: « Les recours contentieux formés dans les matières mentionnées aux articles L. 142-1, à l’exception du 7°, et L. 142-3 sont précédés d’un recours préalable ». The same article contains exceptions and different rules for certain matters. The notification must be read before assuming that every dispute follows the ordinary CRA path.

The filing period is set out in Article R. 142-1 of the Social Security Code, which states: « Cette commission doit être saisie dans le délai de deux mois à compter de la notification de la décision ». Calculate from the notification of the disputed CPAM decision, not from the date on which the pensioner first became unhappy with the delay. If the letter has no clear date or the appeal instructions are incomplete, send the CRA appeal promptly and explain the uncertainty. Waiting for a second telephone answer can sacrifice the deadline.

Address the appeal to the CRA at the CPAM identified in the notification. Use the channel specified by the fund and retain proof of delivery. A short letter can be sufficient if it clearly states that it is a “recours préalable devant la commission de recours amiable”, identifies the CPAM decision, gives the S1 number or reference, lists the treatment dates and requests the exact remedy. The remedy may be registration of the S1, correction of the affiliation basis, reconsideration of the reimbursement, recognition of a specific effective date or a written decision identifying the missing condition.

A useful CRA letter has five sections:

1. Identity and contact details, including the French social-security number if available and the CPAM reference.
2. The decision challenged, its date, the date received and the appeal deadline.
3. The legal route: UK-issued S1, French employment, French residence or temporary visitor cover.
4. The facts in chronological order, including the S1 issue date, CPAM submissions, treatment dates, invoices and payments.
5. The precise request and an indexed list of exhibits.

Explain the error rather than repeating nationality. A British pensioner may have been treated as a visitor using a GHIC, as a person applying under PUMa, or as someone with no evidence of a competent foreign institution. The letter should say why that classification is wrong and which document proves the correct classification. If the issue is a missing transmission between the UK authority and the CPAM, attach the UK confirmation and ask both institutions to match the certificate to the same identity and address.

For a reimbursement claim, identify each invoice. State: “I request assessment of the attached treatment claims under the S1 effective from [date].” Then list the date of care, provider, amount paid, amount requested and form attached. Ask the CPAM to state, for each unpaid item, whether the obstacle is eligibility, timing, missing evidence, tariff, patient contribution or treatment category. This prevents a general refusal from concealing several different decisions that should be addressed separately.

Do not confuse a complaint, a mediation request and a CRA appeal. An ordinary service complaint may be helpful for chasing a file, and the official ameli guidance on challenging a decision explains that a refusal of reimbursement is an administrative decision for which the CRA is normally the first route. A mediator may help with communication, but a mediation request should not be assumed to replace the required preliminary appeal or to stop a deadline unless the applicable rules say so. Label the document clearly as a CRA appeal and send it within time.

Medical decisions can follow another route. If the CPAM refusal concerns medical necessity, incapacity, consolidation or a medical assessment rather than the administrative recording of an S1 or the tariff processing of an invoice, the notification may direct the claimant to the commission médicale de recours amiable (CMRA). The pensioner should separate a medical challenge from an administrative one. A claim that the CPAM failed to connect an S1 is not transformed into a medical appeal merely because the unpaid invoice concerns a medical appointment.

Silence must be calculated. Article R. 142-6 of the Social Security Code states: « Lorsque la décision du conseil, du conseil d’administration ou de l’instance régionale ou de la commission n’a pas été portée à la connaissance du requérant dans le délai de deux mois, l’intéressé peut considérer sa demande comme rejetée. » The provision adds that the period runs from receipt of the complaint and, where documents are produced later, from receipt of those documents. Keep the delivery receipt and proof of any later submission. A pensioner who sends a new bundle may need to record whether it supplements the original appeal or is a new request.

Use the two-month period to improve the record, not to create a new dispute. Send the certificate, the CPAM refusal, the UK authority’s confirmation, the treatment forms, invoices, payment evidence and residence chronology. If the CPAM has requested a document that cannot exist, say why and provide an alternative. If an address or name differs across documents, explain the difference. If a dependant’s S1 is separate, do not rely on the principal pensioner’s certificate alone.

The CRA decides on the documents. The pensioner should therefore include everything that a court would need to understand the file, while keeping the letter readable. Use exhibit numbers, a chronology and a one-page calculation. The appeal should not contain unsupported legal conclusions or a long narrative about Brexit that does not establish the treatment date or the responsible institution. The central question is whether the CPAM applied the correct healthcare route to this person, for this period, with this evidence.

B. What happens after the amicable appeal, and which evidence protects the case?

If the CRA rejects the appeal, the next route is generally the social-security division of the competent tribunal judiciaire, commonly called the pôle social. Article L. 142-8 of the Social Security Code provides that the judicial judge hears disputes relating to the social-security litigation defined by Article L. 142-1. The current ameli procedure guide explains that a rejected administrative appeal can be followed by a claim before the tribunal judiciaire, pôle social, and that the address and time limit should appear in the CRA notification.

Do not wait for an indefinite informal response after the CRA period. Article R. 142-6 treats the absence of a decision within two months as a deemed rejection for the preliminary appeal. Once the relevant rejection exists, read the notification for the court deadline and address. If the CRA decision is notified, the notification normally identifies the time limit and the specially designated court. If the CRA is silent, keep the original appeal receipt and calculate the date on which the two-month silence period ended. Obtain advice promptly if the deadline is close.

The Court of Cassation has repeatedly treated notification as a serious procedural issue. In Cass. 2e civ., 26 January 2023, no. 21-11.414, a social-security case involving a different benefit, the Court held that « ne court qu’à compter de la notification de la décision de la commission de recours amiable ». The case is not an S1 ruling and should not be presented as one. Its practical lesson is narrower: retain the decision, the envelope or electronic notification and evidence of what appeal information was actually provided.

Another procedural safeguard appears in Cass. 2e civ., 14 November 2024, no. 23-16.186. In an incapacity dispute, the Court considered whether the notification properly stated the applicable routes and periods before a time bar could be used against the insured. The Court’s reasoning concerned that specific medical-litigation context, but it reinforces a disciplined approach for an S1 file: do not discard a notification, and do not assume that a vague message has the same procedural effect as a reasoned decision that identifies the appeal body and deadline.

The court file should be built around the legal basis and the effective dates. Include the S1 in full, the issuing authority’s confirmation, the CPAM application and refusal, the CRA appeal and proof of receipt, the CRA decision or silence calculation, the treatment forms, invoices, proof of payment, residence evidence, identity documents, family documents and a schedule of amounts. Add the relevant official guidance and statutory extracts, but avoid attaching a mass of material that does not relate to the person’s category. The judge should be able to answer four questions quickly: who is insured, which state is competent, from when, and what specific cost is claimed?

Evidence of residence can be decisive where the CPAM says that the applicant was only visiting. A British pensioner should prepare a chronology showing the French home, ordinary household life, insurance, utilities, tax correspondence, medical appointments and travel. These documents do not all prove the same thing. A residence permit can prove immigration status; it does not alone prove that the UK issued a valid S1. A pension statement can support the benefit category; it does not alone prove where the person lived on the treatment date. The file should explain the role of each document.

Evidence from the United Kingdom is equally important. Request written confirmation from NHS Overseas Healthcare Services or the relevant issuing authority stating the S1 category, the person covered, the effective date, the French address and whether the certificate was sent to a CPAM. If a certificate was replaced, attach both versions and explain the transition. If the person’s State Pension began after the first S1, provide the dates and ask whether a new certificate was required. If the person’s circumstances changed through work, divorce, a new pension or a move, disclose the change and ask which institution became competent.

The same care is required for a spouse or dependant. List every person separately, with a passport, S1 or other proof, relationship document, address and treatment dates. Article L. 161-1 is a starting definition, not a substitute for the coordination decision. If the CPAM paid the pensioner but rejected the spouse, the court will need the reason for the different treatment. If a child’s certificate was never issued, the child’s position may have to be resolved separately rather than folded into the adult’s appeal.

Cross-border responsibility should be framed as a concrete question. If the CPAM says the United Kingdom must pay, ask the UK authority to confirm the S1 and send the certificate details. If the UK authority says France must pay, ask it to explain whether the person is treated as French-affiliated through employment or residence. If both authorities refer the pensioner to the other, create a written record with dates, names of services and contradictory answers. A court can assess documents; it cannot reliably resolve a dispute based only on recollections of telephone conversations.

Interim healthcare and reimbursement litigation should proceed together. A pending CRA appeal does not make urgent treatment free, and a pending registration does not necessarily make private cover unnecessary. Tell the provider that the entitlement file is under review, ask for a treatment form and paid invoice, and preserve prescriptions and discharge papers. Check whether private insurance covers the gap, whether it requires prior authorisation and whether it excludes planned treatment. If the patient cannot pay an urgent bill, ask the hospital’s social service about immediate arrangements while the legal file is being processed.

Be precise about what the court is asked to order. The claim might request annulment of a CPAM refusal, recognition of the correct affiliation basis, registration of the S1 from a specified date, reconsideration of named treatment claims, payment of the reimbursable portion or a fresh decision after the CPAM examines the correct documents. A request for “all healthcare costs” without dates and invoices is vulnerable. A schedule stating “consultation, 12 June, €70 paid, treatment form exhibit 8, reimbursement requested under the applicable tariff” gives the court a workable remedy.

A person who has already submitted treatment forms should not assume that a CPAM processing error destroys the claim. The reasoning in no. 11-30.270 shows the importance of distinguishing a late request from a claim that was properly put before the caisse but mishandled afterwards. Keep the original postal receipt, the electronic upload confirmation or the provider’s transmission record. If a claim was sent to the wrong CPAM after an address change, show the date, ask for transfer and explain why the person acted promptly after discovering the error.

Conversely, do not rely on that judgment as a general waiver of time limits. It concerned sums that were treated as due and a payment made to the wrong recipient. It does not decide whether a British pensioner had an S1, whether the United Kingdom was competent for the treatment date, whether a treatment is covered or whether the French tariff allows the amount claimed. Those questions must be proved independently. The safer practice is to file each claim within the applicable period and to appeal every formal refusal within two months.

The following sequence gives the case a defensible shape:

1. Obtain the S1 or written confirmation from the UK authority and check the person, address, benefit and effective date.
2. Send the certificate to the correct CPAM, request registration and keep the submission proof and reference number.
3. For care before the card arrives, request a feuille de soins, retain the invoice and payment proof, and ask the CPAM how to identify the pending S1 claim.
4. Ask for a written decision if the CPAM refuses, delays without explanation or says that another route applies.
5. File a clearly labelled CRA appeal within two months of notification, with the full evidence bundle and a treatment-by-treatment schedule.
6. Record the two-month silence date, read the CRA decision, and consider the pôle social of the tribunal judiciaire within the stated court deadline if the dispute remains unresolved.

That sequence also helps identify when the S1 route is not the right one. A person who works under a French contract may have French affiliation. A person on a short visit may need a GHIC or EHIC. A person without an S1 and without another competent scheme may need a PUMa analysis. A person protected by the Withdrawal Agreement may need to prove the historic residence status and the continuing facts. These alternatives should not be blended into one generic “Brexit healthcare” argument, because the documents and decision-maker can differ.

Finally, legal advice becomes particularly valuable where the unpaid bills are substantial, the patient has an imminent operation, the S1 effective date is disputed, the person has dual pensions, or the CRA deadline is close. The file may involve French social-security law, UK benefit rules, the EU–UK coordination instruments, residence evidence and several family members. A clear chronology and verified documents allow the adviser to identify whether the immediate task is registration, a reimbursement request, a CRA appeal, a court claim or an interim-care solution.

Conclusion

For an eligible British pensioner living in France, the S1 identifies the United Kingdom’s healthcare responsibility while the CPAM administers access under the applicable French rules. Registration, the attestation de droits and the carte Vitale are different stages. A missing card or delayed file should not be treated as proof that the S1 is invalid, but an S1 alone does not guarantee a full refund of every invoice. The effective date, treatment category, French tariff and patient contribution must be assessed separately.

If costs were paid before CPAM registration, submit a complete, traceable claim: S1, UK confirmation, identity and residence evidence, treatment forms, invoices, payment proof and the CPAM reference. If a written refusal arrives, use the CRA route where applicable within two months. If the CRA rejects the appeal or remains silent, preserve the notification and receipt evidence before considering the pôle social of the tribunal judiciaire. The strongest case is factual, dated and precise about the state responsible, the person covered and each amount claimed.

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