ATA/499/1995•Hospital stay requires overnight stay for family-help reimbursement
ATA/499/1995Court of Justice / Administrative ChamberOct 3, 1995Dismissed
Extracted by Omnilex
The insured sought reimbursement for family-help expenses following wrist surgery for a fracture. The court denied the claim because she was discharged home the same evening and therefore had not undergone a hospital stay within the meaning of the applicable rule. The notion of staying in a hospital requires an overnight stay.
LAMA Art. 30; reimbursement of family-help expenses after hospital treatment presupposes a stay in an establishment hospitalier; the concept of hospital stay requires that the insured remain overnight. Same-day discharge after surgery is insufficient and excludes the claim.
Descripteurs
ASSURANCE SOCIALE; ACCIDENT; AA; ASSISTANCE(EN GENERAL); MENAGERE; SEJOUR A L'HOPITAL; ASSU
Normes
LAMA.30
Résumé
Le remboursement des frais d'une aide familiale prévu par la caisse après un séjour dans un établissement hospitalier, est refusé à bon droit à l'assurée qui a subi une intervention chirurgicale pour une fracture du poi- gnet et est rentrée chez elle le soir même. La notion de séjour dans un établissement hospitalier implique que l'assuré soit resté une nuit dans l'établissement en question.
Extracted by Omnilex
Whether reimbursement of family-help expenses after hospital treatment is owed when the insured did not stay overnight in the hospital.
No. A hospital stay, for this reimbursement rule, requires that the insured remain in the hospital overnight.
The court held that the ordinary meaning of a stay in an establishment hospitalier presupposes at least one overnight stay; a same-day discharge does not satisfy the condition.
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