The fight is on: Protect your disability pension or death benefit against your insurer!

What is a provident institution?

According to its 2023 statistical report, the French Technical Centre for Provident Institutions (CTIP) estimates that provident institutions cover 14 million employees, providing benefits through 2 million companies.

Operating within the field of supplementary social protection, a provident institution is a private legal entity that manages collective personal insurance schemes covering, in particular, the risks of illness, incapacity for work, dependency and death.

However, although these organisations are officially non-profit (Article L.931-1 of the French Social Security Code), it is unfortunately common for them to remain silent when policyholders seek to enforce their rights under these contracts, particularly when requesting information about the general terms and conditions of the group insurance policy taken out by their employer.

What benefits do provident institutions provide?

Provident institutions mainly offer two types of benefits: disability pensions and death benefits.

On the one hand, where an employer has taken out a group insurance policy including disability cover, an employee may receive a disability pension to compensate for the loss of income resulting from their disability until retirement. The amount depends on the policy subscribed to by the employer.

On the other hand, a death benefit is intended to protect the deceased employee's family by compensating for the loss of income. It may be paid either as a lump sum or in the form of survivor's pensions for the spouse and children.

This death benefit may also include additional guarantees, such as funeral expense insurance, a doubled benefit in the event of accidental death, or an increased payment where both spouses die simultaneously. These additional guarantees can represent substantial sums.

When can the death benefit be paid in advance due to disability?

A state of total and permanent disability may entitle the insured person to receive the death benefit in advance.

When an insured person is classified by the French Social Security system as being in Category 3 disability, they are considered to be permanently and irreversibly incapable of carrying out any professional activity. This status may entitle them to receive their own death benefit before death.

In addition, the death benefit may be increased where the disability results from a sudden, unforeseeable and external accident, depending on the terms of the policy.

How can I obtain the benefits to which I am entitled?

In theory, simply submitting a claim should be sufficient to obtain payment of these benefits.

Unfortunately, the experience of LEXSTONE AVOCATS, based in Puget-sur-Argens and Rocbaron, shows that this is often not the case.

Provident institutions frequently reject claims outright, relying on numerous arguments that are presented as legally complex but are often unfounded.

However, Article 1103 of the French Civil Code provides that:

"Lawfully formed contracts have the force of law for those who have entered into them."

Furthermore, Article 1104 of the same Code states that:

"Contracts must be negotiated, formed and performed in good faith."

It should also be noted that provident institutions have a legal duty to inform their members.

In this respect, the French Supreme Court (Cour de cassation) has held that:

"...provident institutions are required to fulfil their duty to inform members by sending the information notice provided for under Article L.932-6 of the French Social Security Code..."
(Cour de cassation, Second Civil Chamber, 8 December 2016, No. 15-19.685).

The Supreme Court has gone even further by recognising a duty to advise, holding that a provident institution:

"...has an even greater obligation than an ordinary insurer to inform the policyholder and draw attention to any shortcomings resulting from the type of scheme chosen. Failure to do so constitutes negligence for which it is liable."

Maximise your chances of recovering the benefits owed to you

The LEXSTONE AVOCATS law firm, based in Puget-sur-Argens and Rocbaron, will assist you throughout the process of recovering the benefits to which you are entitled, from amicable negotiations through to litigation where necessary, with the aim of making the process as efficient and cost-effective as possible.

Your fight is our fight.

Do not hesitate to contact us.