projetos
ATA/316/1997 ΓÇó Reduction of daily sickness benefits at retirement age
ATA/316/1997Tribunal de Justiça / Câmara Administrativa27 de mai. de 1997Confirmed
The case concerns daily sickness allowances under health insurance law. The insured had already reached retirement age but remained active. The court states that insurers may reduce the daily allowance to the statutory minimum once retirement age is reached, and that this is also permissible if the reduction takes place during a period of sickness. The continued professional activity of the insured does not prevent the reduction.
LAMal art. 9; daily allowance benefits after attainment of retirement age may be reduced to the statutory minimum, even if the insured continues gainful activity. The decisive criterion is the insured's having reached old-age insurance age; a reduction during an ongoing sickness period is not precluded on that account (ATF 97 V 130/131).
Descripteurs
ASSURANCE SOCIALE; AM; INDEMNITE JOURNALIERE; ASSU
Normes
LAMAL.9
Résumé
Les caisses sont autorisées à réduire au minimum légal le montant versé à titre d'indemnités journalières à un assuré ayant atteint l'âge de l'assurance vieillesse, et ce quand bien même il continuerait à être actif; il importe peu que cette réduction ait lieu pendant une période de maladie (ATF 97 V 130/131).