Entitlement to benefits begins upon receipt of affiliation application

ATA/320/1997Cour de justice / Chambre administrative27 mai 1997Other

Extrait par Omnilex

Résumé Omnilex

The decision clarifies the temporal relationship between affiliation and benefit entitlement in social insurance. It holds that the right to benefits begins on the day an approved fund receives the request for affiliation. The court distinguishes this from the start of insurance coverage; the two moments coincide only where the statutory scheme does not provide for a probationary period or waiting time.

Regeste Omnilex

LAMO art. 19; affiliation to an approved fund and commencement of entitlement to benefits. The start of insurance coverage must be distinguished from the start of the right to benefits. Entitlement begins upon receipt of the affiliation application by the approved fund; the two dates coincide only where the statutory provisions do not establish a qualifying period or waiting time.

Texte intégral

Descripteurs

ASSURANCE SOCIALE; AM; AFFILIATION; COUVERTURE; PRESTATION D'ASSURANCE(EN GENERAL); REMBOURSEMENT DE FRAIS(ASSURANCE); ASSU

Normes

LAMO.19

Résumé

Le droit aux prestations court dès le jour où une caisse agréé reçoit une demande d'affiliation. Il faut distinguer le début de l'assurance du début du droit aux prestations. Ces deux moments ne coïncident que lorsque les dispositions statutaires ne prévoient pas de stage ou de délais d'attente.

Mots-clés

social insuranceinsurance coveragebenefit entitlementaffiliationwaiting periodreimbursement of expenses

Extrait par Omnilex

Questions juridiques clés extraites par Omnilex

Question juridique clé

When do benefits start in relation to an affiliation application to an approved insurance fund?

Solution extraite

The right to benefits begins on the day the approved fund receives the application for affiliation. The start of insurance coverage and the start of the right to benefits must be distinguished; they coincide only if the statutes do not provide for a qualifying period or waiting time.

Motifs extraits

The court distinguishes the commencement of insurance membership from the commencement of the entitlement to benefits. Absent statutory waiting periods or stages, both dates are the same; otherwise, entitlement can start earlier or later depending on the applicable rules.

Entitlement to benefits begins upon receipt of affiliation applicationGénéré par IA