An insured found himself on sick leave during a period of change of insurance contract. What to do in such a situation? If the date of the work stoppage is a major factor, the insured must fulfill all the conditions of the contract that he is terminating before requesting the payment of compensatory benefits.
If your insurance contract is in the termination phase, until when must your insurer cover you in the event of a claim. Asked about this point, the Insurance mediator explains the procedure to follow in his Annual Report published at the end of the summer. Thus, an insured person had taken out a collective insurance contract whose purpose was to provide him with benefits in the event of sick leave. This insurance contract has been cancelled. The insured then added a new equivalent insurance contract with another insurer. Having been off work, he requested reimbursement from the insurer of the second contract. The latter refused to grant his request, on the grounds that the origin of the work stoppage dated back to the period during which the insured was covered by the first insurer.
How to know who is wrong and who is right in such an in-between? On the basis of the Evin law of 1989, the mediator recalls that the termination or non-renewal of the contract or agreement has no effect on the payment of benefits immediate or deferred, acquired or born during its execution. In addition, the Court of Cassation, also quoted by the mediator, stipulates that if the concept of deferred service does not imply that a service has necessarily been in progress on the day of the termination of the contract, it nevertheless imposes that a service is due during the period of validity of the contract.
An obligation of the insured to respect
Consequently, the insurer of the terminated contract must, despite the departure of the insured, pay the benefits that he had begun to pay during the course of the contract, if all the conditions of the contract are met. In this case, the first insurance contract conditioned the management of the sick leave, its recognition by the insurer’s medical adviser and a drop in income. However, this recognition by the medical advisor had not taken place when the first contract was in progress. Thus, the service was not due or in the process of being paid when this contract expired. The mediator therefore invited the second insurer to pay for the work stoppage of the insured.
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The mediator recalls that it is up to the insured to declare his claim as soon as possible so that the insurer can assess whether the conditions of cover have been met before the termination of the contract.