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Daily indemnity during rehabilitation and six-month job-search period

ATA/709/1998Cour de justice / Chambre administrative10 nov. 1998Modified

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Résumé Omnilex

The court held that an insured person's entitlement to rehabilitation measures under invalidity insurance does not exclude concurrent sickness-insurance daily allowances. However, where the AI delays the implementation of the observation stage, the sickness insurer is liable only for the period during which that stage could reasonably have been conducted. In this case, the court fixed that period at six months, starting when the observation stage ordered by the AI ended.

Regeste Omnilex

LAMA art. 12bis paras. 1 and 3; coordination between invalidity-insurance rehabilitation and sickness-insurance daily allowances. The priority of rehabilitation measures does not eliminate the insured person's duty to mitigate loss, but it modifies its temporal application. If the AI delays an observation stage, the sickness insurer's obligation to pay daily allowances is limited to the reasonable period in which such a stage should have taken place. The period may be fixed ex officio by the court on the basis of the concrete circumstances; consid. 6.

Texte intégral

Descripteurs

ASSURANCE SOCIALE; AM; INCAPACITE DE TRAVAIL; HERNIE DISCALE; SYNDROME CERVICAL; ASSURANCE COLLECTIVE; CAPACITE DE TRAVAIL PARTIELLE; INVALIDITE(INFIRMITE); INDEMNITE JOURNALIERE; MESURE DE READAPTATION(ASSURANCE SOCIALE); ASSU

Normes

LAMA.12bis al.1 et 3

Résumé

Le TA a fixé à 6 mois le laps de temps durant lequel un chauffagiste atteint d'une hernie discale et de cervicolombalgies devait pouvoir retrouver un nouvel emploi impliquant une activité légère; ce délai devait commencer à courir dès la fin du stage d'observation professionnelle ordonné par l'AI. Le droit au reclassement aux frais de l'AI n'exclut pas la possibilité de bénéficier simultanément de l'indemnité journalière d'une caisse-maladie; le droit à la réadaptation a la priorité sur l'obligation de l'assuré de diminuer le dommage. Or si l'AI tarde à mettre en place un tel stage d'observation, la caisse-maladie n'est alors tenue à prestations que durant la période à laquelle ce stage aurait pu raisonnablement avoir lieu, soit en l'espèce dans un délai de six mois.

Mots-clés

social insurancedaily allowancerehabilitation measureinvalidity insurancework incapacitypartial work capacitymitigation of damageobservation stagedisc herniationcollective sickness insurance

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Questions juridiques clés extraites par Omnilex

Question juridique clé

Whether entitlement to AI rehabilitation/daily benefits prevented concurrent sickness-insurance daily allowances.

Solution extraite

The right to rehabilitation at the expense of invalidity insurance did not exclude concurrent entitlement to sickness daily allowances.

Motifs extraits

Rehabilitation took priority over the insured person's duty to mitigate damage; the sickness insurer's duty to pay was limited only to the period in which the AI observation stage could reasonably have taken place.

Question juridique clé

What period should be allowed for the insured person to find suitable light work after the AI observation stage.

Solution extraite

A period of six months was fixed, starting at the end of the observation stage ordered by the AI.

Motifs extraits

Because the AI had delayed the observation stage, the insurer remained liable only for the period corresponding to the reasonable time in which that stage should have been completed.

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