Social insurer may exclude insolvent insured from complementary coverage

ATA/688/1997Tribunal de Justiça / Câmara Administrativa11 de nov. de 1997Dismissed

Extraído pela Omnilex

Resumo Omnilex

The fund initiated debt enforcement for unpaid complementary-insurance premiums and obtained a certificate of unpaid debts. Since the insured's basic health-insurance premiums were covered by the Hospice général, the court held that the fund could treat him as insolvent and exclude him from complementary insurance. The challenge was dismissed.

Sumário Omnilex

LAMA 1 ss; complementary insurance; insolvency and exclusion: where enforcement for complementary-insurance premiums results in a certificate of unpaid debts, and the insured's basic-insurance contributions are borne by public assistance, the insurer may infer insolvency and lawfully exclude the insured from complementary coverage.

Texto completo

Descripteurs

ASSURANCE SOCIALE; AM; ASSURANCE COMPLEMENTAIRE; EXCLUSION(EN GENERAL); ASSU

Normes

LAMA.1 ss

Résumé

La caisse qui a procédé à une poursuite débouchant sur un acte de défaut de biens, pour le paiement des cotisations d'une assurance complémentaire, et dont l'assuré voit ses cotisations d'assurance de base prises en charge par l'Hospice général, est fondée à considérer son assuré, comme insolvable et comme tel à l'exclure de l'assurance complémentaire.

Palavras-chave

social insurancecomplementary insuranceinsolvencyexclusiondebt enforcementpublic assistance

Extraído pela Omnilex

Questões jurídicas principais extraídas pela Omnilex

Questão jurídica principal

Whether an insurer may treat an insured as insolvent and exclude him from complementary insurance after debt enforcement produced a certificate of unpaid debts.

Decisão extraída

Yes. A certificate of unpaid debts in relation to complementary-insurance premiums, together with public assistance covering the basic-insurance premiums, allowed the insurer to regard the insured as insolvent and exclude him from complementary coverage.

Fundamentação extraída

The enforcement outcome demonstrated the insured's inability to pay the complementary-insurance premiums. The fact that his basic-insurance premiums were assumed by the public welfare authority reinforced the conclusion of insolvency.

Social insurer may exclude insolvent insured from complementary coverageGerado por IA