Facts
Ms. M. was insured with the Valais Mutual Insurance Fund, a health insurance fund, for a daily allowance of 100 francs. After receiving this allowance for a long period, she was granted a full disability pension from the disability insurance, resulting in overcompensation. The fund then informed Ms. M. that it was terminating her daily allowance insurance as of 31 March 1997, but offered her the option to continue receiving a reduced daily allowance of 56.35 francs until the amount of 19,644 francs reimbursed by the disability insurance was exhausted. As Ms. M. did not respond to this proposal within the specified deadline, the fund refused to pay her this reduced allowance. Ms. M. contested this decision.Considerations
According to case law, an insured person who receives a disability pension continues to be entitled to health insurance daily allowances. When the daily allowance is reduced due to overcompensation, particularly in the event of a concurrent disability pension, the person is entitled to the equivalent of 720 full daily allowances, with the periods relating to the granting of the allowances being extended in proportion to the reduction.
In the present case, Ms. M.'s entitlement to daily allowances had not been exhausted as of…