Reduction of daily sickness benefits at retirement age

ATA/316/1997Court of Justice / Administrative ChamberMay 27, 1997Confirmed

Extracted by Omnilex

Omnilex summary

The case concerns daily sickness allowances under health insurance law. The insured had already reached retirement age but remained active. The court states that insurers may reduce the daily allowance to the statutory minimum once retirement age is reached, and that this is also permissible if the reduction takes place during a period of sickness. The continued professional activity of the insured does not prevent the reduction.

Omnilex headnote

LAMal art. 9; daily allowance benefits after attainment of retirement age may be reduced to the statutory minimum, even if the insured continues gainful activity. The decisive criterion is the insured's having reached old-age insurance age; a reduction during an ongoing sickness period is not precluded on that account (ATF 97 V 130/131).

Full text

Descripteurs

ASSURANCE SOCIALE; AM; INDEMNITE JOURNALIERE; ASSU

Normes

LAMAL.9

Résumé

Les caisses sont autorisées à réduire au minimum légal le montant versé à titre d'indemnités journalières à un assuré ayant atteint l'âge de l'assurance vieillesse, et ce quand bien même il continuerait à être actif; il importe peu que cette réduction ait lieu pendant une période de maladie (ATF 97 V 130/131).

Keywords

social insurancedaily allowanceretirement agebenefit reductionsickness insurance

Extracted by Omnilex

Key legal questions extracted by Omnilex

Key legal question

Whether daily sickness benefits may be reduced to the statutory minimum once the insured has reached retirement age, even if still gainfully active.

Extracted holding

Yes. The insurers may reduce daily allowance benefits to the statutory minimum for an insured person who has reached retirement age, even if the person continues to work; the timing of the reduction during a sickness period does not matter.

Extracted reasoning

The headnote states that reaching the age of old-age insurance is sufficient to justify the reduction to the legal minimum, irrespective of continued activity and irrespective of whether the reduction occurs while sickness benefits are being paid.

Reduction of daily sickness benefits at retirement ageAI generated