ATA/133/1995•Territoriality principle bars daily allowance abroad
ATA/133/1995Tribunal de Justiça / Câmara Administrativa14 de mar. de 1995Dismissed
Extraído pela Omnilex
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.
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.
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.
Extraído pela Omnilex
Whether daily allowances are payable when the insured falls ill while abroad on holiday.
The claim was rejected because the territoriality principle excludes payment of daily allowances in the foreign situation at issue.
The court upheld the refusal based on the territorial scope of the insurance scheme under the applicable statutory rule.
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