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Refund of excess premiums after switch from collective to individual insurance

ATA/450/1996Cour de justice / Chambre administrative27 août 1996Partially Granted

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Extrait par Omnilex

Résumé Omnilex

The case concerns an insured person who moved from collective to individual insurance under a fund rule exempting premium payments during periods of loss-of-earnings benefits. The court held that the insured could claim repayment directly from the insurer for premiums paid in excess, despite the later transfer to individual insurance, because the insured has a direct claim against the insurer. However, the transfer based on the same insured salary did not justify increasing the insured amount after entry into individual insurance.

Regeste Omnilex

Art. 5bis LAMA; collective insurance and transfer to individual insurance; reimbursement of premiums paid in excess and determination of the insured amount. Where the fund's rules provide for release from premium payment during periods in which loss-of-earnings benefits are paid, premiums paid notwithstanding such exemption are recoverable directly by the insured from the insurer, as the insured has a direct claim against the insurer (consid. ?). The transition from collective to individual insurance on the basis of an unchanged insured salary does not confer any entitlement to a higher insured amount from the date of transfer.

Texte intégral

Descripteurs

ASSURANCE SOCIALE; AM; ASSURANCE COLLECTIVE; TRANSFERT(EN GENERAL); ASSURANCE INDIVIDUELLE; PRIME D'ASSURANCE; ASSU

Normes

LAMA.5 bis

Résumé

Cas dans lequel le règlement de la caisse prévoyait la libération du paiement des primes durant les périodes de versement d'indemnités perte de gain, dans le cadre d'un contrat d'assurance collective. Les assurés disposant d'un droit propre contre l'assureur (ATF 115 V 96), l'assuré est en droit d'obtenir directement de sa caisse le remboursement des primes versées en trop, même s'il est entre-temps passé dans l'assurance individuelle. Par ailleurs, le passage d'un contrat collectif à un contrat individuel ayant été effectué sur la base d'un salaire assuré identique, l'assuré n'a pas droit dès son passage dans l'assurance individuelle à être assuré pour un montant supérieur.

Mots-clés

social insurancecollective insuranceindividual insurancepremium refundinsured amounttransferloss of earnings benefits

Extrait par Omnilex

Questions juridiques clés extraites par Omnilex

Question juridique clé

Whether the insured may claim reimbursement of premiums overpaid under a collective insurance contract after moving to individual insurance.

Solution extraite

Yes. Because insured persons have a direct claim against the insurer, they may demand reimbursement of premiums paid in excess directly from the fund, even if they have meanwhile moved into individual insurance.

Motifs extraits

The contractual premium exemption during loss-of-earnings benefit periods created an excess payment situation. The court held that the insured's direct right against the insurer survives the transfer to individual insurance.

Question juridique clé

Whether the transfer from collective to individual insurance entitles the insured to a higher insured amount based on the same insured salary.

Solution extraite

No. Since the move to individual insurance was made on the basis of the same insured salary, there is no entitlement to a higher insured amount from the date of transfer.

Motifs extraits

The insured amount is tied to the insured salary used for the transfer; a unchanged salary base does not justify increasing coverage upon entry into individual insurance.

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