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Daily allowance insurance for undocumented and black-market workers

ATA/473/1997Cour de justice / Chambre administrative6 août 1997Modified

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Extrait par Omnilex

Résumé Omnilex

A worker without a residence permit and a black-market worker sought daily allowance insurance benefits after becoming incapable of work. The decision holds that such a person may receive daily allowance benefits if contributions were made, as if he had been regularly authorized to work. Entitlement is assessed according to the last status attained, namely seasonal worker status, but that status does not extend coverage into the inter-season. The outcome is thus to recognize the insured entitlement while excluding payment for the off-season.

Regeste Omnilex

Art. 67 LAMal; daily allowance insurance and the effect of irregular residence or employment status. A person who has contributed to daily allowance insurance cannot be denied benefits solely because he lacked a residence permit or worked without authorization; the decisive factor is the insured relationship actually created by the contributions. For seasonal workers, entitlement is assessed according to the last acquired status, but that status does not confer coverage for the inter-season absent a corresponding insured risk. Illegal work does not, in itself, negate entitlement to benefits funded by contributions made as if lawful employment existed.

Texte intégral

Descripteurs

ASSURANCE SOCIALE; AM; INDEMNITE JOURNALIERE; TRAVAIL AU NOIR; SAISONNIER; ASSU

Normes

LAMAL.67

Résumé

Un travailleur sans autorisation de séjour doit pouvoir bénéficier de l'assurance indemnité journalière lorsqu'il tombe en incapacité de travail. Son indemnisation doit être admise en fonction du dernier statut qu'il a obtenu, soit celui d'un travailleur saisonnier. Il n'a ainsi pas droit à l'obtention d'indemnité pendant l'entre-saison. Le travailleur au noir doit pouvoir bénéficier des prestations de l'assurance d'indemnités journalières à laquelle il a cotisé comme s'il avait obtenu une autorisation régulière de travailler.

Mots-clés

social insurancedaily allowanceincapacity for workundocumented workerblack-market employmentseasonal workerinsured statuscontributions

Extrait par Omnilex

Questions juridiques clés extraites par Omnilex

Question juridique clé

Whether a worker without a valid residence permit can claim daily allowance insurance benefits after incapacity for work.

Solution extraite

Yes, the worker can benefit from daily allowance insurance if he had contributed to it; entitlement must be assessed according to his last attained status as a seasonal worker, not denied outright because of the lack of a residence permit.

Motifs extraits

The summary indicates that incapacity arising during the relevant insured relationship does not justify excluding the worker from daily allowance coverage solely due to immigration status.

Question juridique clé

Whether a seasonal worker is entitled to daily allowance benefits during the off-season.

Solution extraite

No, the indemnity is to be admitted according to the last status obtained, namely seasonal worker status, and this does not confer entitlement during the inter-season.

Motifs extraits

The worker’s insured status is tied to the last lawful working status; however, that status does not extend benefits into the period outside the seasonal employment.

Question juridique clé

Whether a black-market worker who contributed to the daily allowance insurance may receive benefits as if lawfully employed.

Solution extraite

Yes, the worker must be able to receive the daily allowance benefits to which he contributed as though he had obtained regular authorization to work.

Motifs extraits

Contributions made under an unlawful work situation cannot be disregarded when determining entitlement to insured daily allowance benefits.

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