ATA/222/1995•Restitution of undue benefits time-barred under Art. 47 LAVS by analogy
ATA/222/1995Tribunal de Justiça / Câmara Administrativa28 de abr. de 1995Dismissed
Extraído pela Omnilex
A sickness insurance fund sought repayment of an undue insurance benefit. The court held that the restitution rule of Art. 47 LAVS applies by analogy in health insurance, but concluded that the action had been filed after the one-year deadline. The fund's claim was therefore time-barred and dismissed.
Art. 47 LAVS; restitution of undue benefits by analogy in health insurance; limitation/peremption of the recovery action. The rules on restitution of undue payments under Art. 47 LAVS are applicable mutatis mutandis in health insurance. A restitution claim is forfeited when it is not asserted within the one-year period. If the action is brought after expiry of that period, the claim must be dismissed as time-barred, without need for further examination of the substantive entitlement.
Descripteurs
ASSURANCE SOCIALE; REMBOURSEMENT DE FRAIS(ASSURANCE); PRESTATION D'ASSURANCE INDUE; PEREMPTION; PRESCRIPTION
Normes
LAVS.47
Résumé
L'art.47 LAVS lequel régit la restitution de l'indû est appliqué par analogie en assurance-maladie. Action de la caisse périmée car intentée en dehors du délai d'une année.
Whether Art. 47 LAVS on restitution of undue payments applies by analogy in health insurance.
Yes. The restitution regime of Art. 47 LAVS applies by analogy to health insurance.
The court treated the undue-benefit recovery rules of old-age and survivors' insurance as applicable mutatis mutandis in health insurance.
Whether the fund's action for repayment was brought within the limitation period.
No. The action was time-barred because it was filed after the one-year period.
The claim was filed outside the one-year deadline governing restitution claims, so the right to recover was forfeited.
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