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ATA/83/1996•Daily allowance: end of 100% incapacity and mitigation duty
ATA/83/1996Cour de justice / Chambre administrative13 févr. 1996Modified
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In a social insurance dispute over daily allowances, the court held that a 100% work incapacity was no longer justifiable. It granted a six-month transition period at 50% incapacity, starting when the claimant personally realized that he could no longer work full time in his profession, in order to allow time to find suitable employment. The decision thus adjusted the extent and timing of the entitlement rather than maintaining total incapacity.
LAMA 12 bis al. 1; daily allowances and work incapacity: total incapacity is not maintained where the insured person can reasonably be expected to resume work at a reduced capacity. Under the duty to mitigate damage, the transition to a lower incapacity may be accompanied by an adaptation period, starting from the moment the insured person recognizes the impossibility of continuing full-time work in the former occupation. The duration of such a period depends on the circumstances, including the need to seek suitable alternative employment.
Descripteurs
ASSURANCE SOCIALE; AM; INDEMNITE JOURNALIERE; INCAPACITE DE TRAVAIL; NOTION; DELAI; REPRISE; ACTIVITE HYPOTHETIQUE; OBLIGATION DE REDUIRE LE DOMMAGE; EXPERTISE; ASSU
Normes
LAMA.12 bis al.1
Résumé
Constat que l'incapacité de travail à 100 % n'est plus admissible. Délai de 6 mois pour une incapacité de travail à 50 %, accordé dès la date à laquelle le recourant a lui-même constaté qu'il ne pouvait plus travailler à 100 % dans sa profession, pour lui permettre de trouver un travail adéquat.
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Whether a 100% work incapacity remained admissible for entitlement to daily allowances.
A full incapacity was no longer admissible; the claimant had to be assessed on a reduced incapacity basis.
The court held that the medical and practical situation no longer justified continued total incapacity.
From when the claimant could be required to accept a 50% incapacity and seek suitable work.
A six-month transition period at 50% incapacity was granted, starting from the date on which the claimant himself realized that he could no longer work 100% in his profession.
To respect the duty to mitigate damage, the claimant was given time to find appropriate work after acknowledging the inability to continue full-time work.
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