Territoriality principle bars daily allowance abroad

ATA/133/1995Court of Justice / Administrative ChamberMar 14, 1995Dismissed

Extracted by Omnilex

Omnilex summary

An insured person became ill while on holiday in Spain and claimed daily allowances. The benefit was refused, and the refusal was upheld on the basis that the territoriality principle precluded payment abroad under Art. 12 LAMA.

Omnilex headnote

LAMA art. 12; territoriality principle and daily allowances abroad: sickness occurring while the insured is staying abroad does not, absent a statutory exception, give rise to entitlement to daily allowances. The place of stay may be decisive for coverage where the scheme is territorially limited; holidays abroad do not in themselves suspend the territorial requirement. Refusal of benefits is therefore upheld when the claim falls outside the territorial scope of the insurance coverage.

Full text

Descripteurs

ASSURANCE SOCIALE; AM; PRINCIPE DE LA TERRITORIALITE; INDEMNITE JOURNALIERE

Normes

LAMA.12

Résumé

Assuré tombé malade en vacances en Espagne. Indemnités journalières refusées en vertu du principe de la territorialité.

Keywords

social insuranceterritorialitydaily allowancesabroadholidaycoverage

Extracted by Omnilex

Key legal questions extracted by Omnilex

Key legal question

Whether daily allowances are payable when the insured falls ill while abroad on holiday.

Extracted holding

The claim was rejected because the territoriality principle excludes payment of daily allowances in the foreign situation at issue.

Extracted reasoning

The court upheld the refusal based on the territorial scope of the insurance scheme under the applicable statutory rule.

Territoriality principle bars daily allowance abroadAI generated