Entitlement to benefits begins upon receipt of affiliation application

ATA/320/1997Tribunal de Justiça / Câmara Administrativa27 de mai. de 1997Other

Extraído pela Omnilex

Resumo 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.

Sumário 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.

Texto completo

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.

Palavras-chave

social insuranceinsurance coveragebenefit entitlementaffiliationwaiting periodreimbursement of expenses

Extraído pela Omnilex

Questões jurídicas principais extraídas pela Omnilex

Questão jurídica principal

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

Decisão extraída

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.

Fundamentação extraída

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 applicationGerado por IA