Rs 830.1 Federal Act Of 6 October 2000 On The General Part Of The Law Of Social Insurance (Lpga)

Original Language Title: RS 830.1 Loi fédérale du 6 octobre 2000 sur la partie générale du droit des assurances sociales (LPGA)

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830.1 Federal law on the general part of the law of social insurance (LPGA) on 6 October 2000 (Status January 1, 2012) the Federal Assembly of the Swiss Confederation, view the art. 112, al. 1, 114, al. 1, and 117, al. 1, of the Constitution, saw the report of a commission of the Council of States of 27 September 1990, given the opinion of the federal Council on 17 April 1991, 17 August 1994 and 26 May 1999, saw the report of the Committee on social security and public health of the national Council of 26 March 1999, quit: Chapter 1 scope of application art. 1 purpose and object of the Act coordinates the federal social insurance law: a. defining the principles, concepts and institutions of the social insurance law; b. by setting standards for a uniform procedure and adjusting the judicial organization in the field social insurance; c. by harmonizing social insurance benefits; d. regulating the right of appeal of social insurance to third parties.

Art. 2 scope and reports with the special laws on social insurance provisions of this Act are applicable to social insurance governed by federal legislation, if and to the extent where the Special on social insurance statutes.

Chapter 2 Definitions of general terms art. 3 disease is deemed disease all harmful to the physical, mental or psychological health which is not due to an accident and requires an examination or medical treatment, or causes an inability to work.
Is deemed congenital disease has accomplished the child birth.

New content according to point 2 of the annex to the Federal Act of 21 March 2003 (4 revision have), in force since Jan. 1. 2004 (RO 2003 3837; FF 2001 3045).

Art. 4Accident is deemed to be any breach accident damaging, sudden and involuntary, brought to the human body by an external cause extraordinary which jeopardizes the physical, mental or psychological health or that results in death.

New content according to point 2 of the annex to the Federal Act of 21 March 2003 (4 revision have), in force since Jan. 1. 2004 (RO 2003 3837; FF 2001 3045).

Art. 5 maternity maternity includes pregnancy and childbirth as well as recovery time following the latter.

Art. 6 incapacity for work is deemed unable to work any loss, total or partial, of the ability of the insured to perform in his profession or his area of activity work that may reasonably be required of him, if this loss is the result of an infringement to his physical, mental or psychological health. Long-term work incapacity, the activity which may be required of him can also take up another profession or another field of activity.

New content according to point 2 of the annex to the Federal Act of 21 March 2003 (4 revision have), in force since Jan. 1. 2004 (RO 2003 3837; FF 2001 3045).

Art. Gain 7incapacite is deemed to be unable to gain any reduction of the whole or a part of the earning opportunities of the insured on a labour market balanced in its field of activity, if this reduction is the result of an infringement to his physical, mental or psychological health and that it persists after treatment and rehabilitation measures due.
Only the consequences of the damage to health are taken into account to judge the presence of a disability. In addition, there is inability to work if it is not objectively surmountable.

New content according to point 2 of the annex to the Federal Act of 21 March 2003 (4 revision have), in force since Jan. 1. 2004 (RO 2003 3837; FF 2001 3045).
Introduced by section 2 of the schedule to the Federal Act of 6 October. 2006 (have 5 review), in force since Jan. 1. 2008 (2007 5129 RO; FF 2005-4215).

Art. 8 disability is deemed disabled the total or partial incapacity which is presumed to be permanent or of long duration.
Minor policyholders without gainful activity are deemed disabled if they have damage to their physical, mental or psychological health that will likely result in a partial or total incapacity.
Major holders who were not lucrative performing before be achieved in their physical, mental or psychological health and which it may be required that they exercise a are deemed invalid if the breach prevents them to do their usual work. Art. 7, al. 2, shall apply by analogy.

New content according to point 2 of the annex to the Federal Act of 21 March 2003 (4 revision have), in force since Jan. 1. 2004 (RO 2003 3837; FF 2001 3045).
Sentence introduced by section 2 of the schedule to the Federal Act of 6 October. 2006 (have 5 review), in force since Jan. 1. 2008 (2007 5129 RO; FF 2005-4215).
New content according to point 2 of the annex to the Federal Act of 21 March 2003 (4 revision have), in force since Jan. 1. 2004 (RO 2003 3837; FF 2001 3045).

Art. 9 impotence is deemed impotent anyone who, because of damage to his health, needs permanently help others or personal supervision to perform basic daily acts.

Art. 10 employee is deemed an employee who provides a job dependent and who receives a salary key to the meaning of the special laws for this work.

Art. 11 employer is deemed employer who employs workers.

Art. 12 persons engaged in gainful self-employment is considered as operating lucrative independent one whose income does not come from the exercise of an activity as an employee.
A person exercising an independent gainful activity may simultaneously the quality of employee if she receives a salary.

Art. 13 domicile and habitual residence a person's home is determined according to the art. 23 to 26 of the civil code.
A person is deemed have habitual residence to the place where she is staying some time even if the duration of the stay is limited from the outset.

SR 210 changed by Commission for the drafting of the SSA. fed. (art. 33 LREC;) 1974 1051 RO).

Art. 13aPartenariat recorded during its lifetime, the registered partnership is assimilated to marriage in the social insurance law.
The surviving registered partner is considered to be a widower.
The legal dissolution of the registered partnership is assimilated to the divorce.

Introduced by section 28 of the annex to the Act of 18 June 2004 on the partnership, in effect since Jan. 1. 2007 (RO 2005 5685; FF 2003-1192).

Chapter 3 General provisions concerning benefits and Section 1 benefits contributions in-kind art. 14 constitute in-kind benefits including treatment or care, AIDS, the individual measures of prevention and rehabilitation, transportation costs and similar benefits that are provided or reimbursed by various social insurance.

Section 2 benefits cash art. 15 General cash benefits include, in particular, daily allowances, annuities, annual complementary benefits, allowances for disabled and their supplements; they do not include the replacement of a benefit in kind to the charge of insurance.

Art. 16 disability rates to assess the rate of disability, the income that the insured person could have obtained if he was not disabled is compared with the one he could get by exercising the activity that may reasonably be required of him after treatment and rehabilitation measures, on a balanced labour market.

Art. 17 revision of disability pension and other long-term benefits if the rate of the pension beneficiary undergoes a significant change, the pension is automatically or on request, revised for the future, namely increased or decreased accordingly, or even deleted.
Similarly, any sustainable benefits granted under a decision entered into force is, officio or on request, augmented or reduced accordingly or even deleted if circumstances which depended its granting change significantly.

Art. 18 maximum amount of the insured income for social insurance who allocate cash benefits laid down as a percentage of the gain, the federal Council sets the maximum amount of the insured income.

Art. 19 payments in cash as a general rule, periodic cash benefits are paid monthly.
Daily allowances and similar benefits are paid to the employer where he continues to pay to the insured person despite his entitlement to daily allowances.
The pensions and allowances for disabled is always paid in advance for the full calendar month. A benefit which replaces another is paid only for the following month.
If the right to benefits seems proven and their payment is delayed, advances may be paid.

Art. 20 warranty the use consistent with the purpose of the insurer may pay all or part of the cash benefits to a third party qualified or authority having a legal obligation or moral of maintenance with respect to the beneficiary, or who assists him permanently when: a. the recipient does not use these benefits to its maintenance or that of people he charge , or if it is established that it is not able to use them for this purpose, and Frenchie. himself or people whom he is responsible that's dependent on public or private assistance.


Benefits paid to a third party or authority cannot be compensated by such third party or this authority with claims against the beneficiary. Fact exception compensation in case of retroactive payment of benefits in the sense of art. 22, al. 2 section 3 Reduction and denial of benefits article 21. If the insured has compounded the insured risk or in caused the realization intentionally or intentionally committing a crime or misdemeanour, cash benefits may be temporarily or permanently reduced or, in particularly serious cases refused.
Cash benefits owed to relatives or survivors of the insured are reduced or denied if they resulted in the realisation of the risk intentionally or intentionally committing a crime or misdemeanour.
Insofar as social insurance in the nature of loss of earnings insurance provide no benefit in cash to relatives, cash benefits cannot be reduced under para. 1 half. For the other half, the reduction provided for in para. 2 is reserved.
The benefits may be reduced or denied temporarily or permanently if the insured is avoiding or opposing, or does not spontaneously participate within the limits of what may be required of him, a measure of vocational rehabilitation or treatment reasonably required and likely to significantly improve its ability to work or offer a new opportunity to gain. A formal written notice warning him of the legal consequences and outsourcing it a suitable cooling period should have been addressed to him. Treatment and rehabilitation measures that pose a danger to life or health may be required.
If the insured suffers a measure or a custodial sentence, the payment of benefits for loss of earnings may be partially or totally suspended with the exception of benefits intended for the maintenance of the family referred to in para. 3. rectified by Commission for the drafting of the SSA. fed. (art. 33 LREC;) 1974 1051 RO).

Section 4 provisions specific art. 22 benefits guarantee entitlement to benefits is not transferable; It can be given in pledge. Any assignment or pawned sucks.
Benefits granted retroactively by the social insurer may however be transferred: a. the employer or institution of public welfare or private insofar as these have made advances; (b) the insurer who has provisionally taken over benefits.

Rectified by Commission for the drafting of the SSA. fed. (art. 33 LREC;) 1974 1051 RO).

Art. 23 waiver to benefits having it right may waive benefits owed to him. The waiver may be revoked at any time for the future. The waiver and revocation are a written statement.
Waiver and revocation are null when they are detrimental to the interests of other people, institutions of insurance or assistance or they tend to evade legal provisions.
The insurer confirms in writing to the person entitled the waiver and revocation. The object, scope, and the suites of the waiver and the revocation must be mentioned in the confirmation.

Art. 24 expiry of the right the right to benefits or contributions backward died five years after the end of the month for which the benefit was due and five years after the end of the calendar year for which the fee was to be paid.
If the contributor is exempted from the obligation to pay contributions by a punishable act for which the criminal law provides for a longer limitation period, it is one that determines where turns off the claim.

Art. 25 return benefits unduly received must be returned. Restitution may be required when the person concerned was in good faith and that she would put him in a difficult situation.
The right to request the return off one year after the time which the insurance institution became aware of the fact, but no later than five years after payment of the benefit. If the claim is of a punishable act for which the criminal law provides for a longer limitation period, it is crucial.
The refund of overpaid contributions can be requested. The right shall expire one year after the contributor had knowledge of its payments too high, but at the latest five years after the end of the calendar year in which the contributions have been paid.

Art. 26 interest on arrears and remunerative interest receivables due contributions are subject to the collection of interest on arrears and receivables due in restitution of unduly paid contributions are subject to the payment of remunerative interest. The federal Council may provide for exceptions to claims modest or expired recently.
Default interest are payable for any claim of social insurance benefits for a period of 24 months from the birth of the right, but no earlier than twelve months from the moment where the insured asserted this right, as long as he is fully complied with their obligation to cooperate that is responsible.
No interest is due where foreign insurers are responsible for the delays.
Not be entitled to interest on arrears: a. the person entitled to benefits or his heirs, when benefits are paid retroactively to a third party; (b) third parties who have made loans or provisionally supported benefits within the meaning of art. 22, al. 2, and that benefits retroactively were transferred; c. other social insurance who have temporarily taken care benefits within the meaning of art. 70. introduced by section 2 of the annex to the Federal Act of 6 October. 2006 (have 5 review), in force since Jan. 1. 2008 (2007 5129 RO; FF 2005-4215).
Introduced by section 2 of the schedule to the Federal Act of 6 October. 2006 (have 5 review), in force since Jan. 1. 2008 (2007 5129 RO; FF 2005-4215).

Chapter 4 General provisions on procedure Section 1 Information, administrative assistance, obligation to maintain secrecy art. 27 information and advice within their area of competence, insurers and the delivery of various social insurance agencies are required to inform stakeholders on their rights and obligations.
Everyone has the right to be advised, in principle free of charge, on their rights and obligations. Are competent for that insurers for which interested parties must assert their rights or obligations. The federal Council may provide for the collection of fees and fix the rate for consultations requiring expensive research.
If an insurer finds that an insured person or his relatives are entitled to other social insurance benefits, he informs them without delay.

Art. 28 collaboration when implementing the insured and employers must work for free execution of the various laws on social insurance.
Who asserted his right to benefits must provide all the information necessary to establish this right and set the benefits due.
The applicant is required to authorize in special cases all persons and institutions, including employers, physicians, insurance and official bodies to provide information, as far as these are necessary to establish the right to benefits. These people and institutions are required to provide the required information.

Art. 29 the right to benefits who asserted his right to benefits must report to the competent insurer, in the prescribed form for the concerned social insurance.
Social insurers provide free formulas designed to assert and establish the right to benefits; These forms must be forwarded to the competent insurer, filled with complete and accurate way by the applicant or his employer and, where applicable, by the attending physician.
If a request does not meet the formal requirements, or if it is delivered to an incompetent body, the date given to the post office or filed with this body is decisive in meeting the time limits and the legal effects of demand.

Art. 30 mandatory transfer all the implementation of social insurance bodies to accept requests, motions or other documents that arrive by mistake. They to record the date of receipt and forward to the competent body.

Art. 31 required notice in case of a change in circumstances the person entitled, relatives or third parties to whom a benefit is paid are required to communicate to the insurer or, where appropriate, to the competent body any material change in the circumstances determining for the granting of a benefit.
Any person or institution participating in the implementation of social insurance has the obligation to inform the insurer if it finds that the circumstances determining for the provision of benefits are changed.

Art. 32 administrative assistance


The administrative and judicial authorities of the Confederation, cantons, districts, constituencies and Commons provide free social insurance bodies, in specific cases and on written and motivated request, the data which are necessary for: a. set or change benefits, or to claim restitution; b. prevent payments indus; c. establish and collect contributions; d. make a claim of recovery against the third party liable.

The social insurance bodies lend each other assistance on the same conditions.

Art. 33 obligation to keep secret the people participating in the application of laws on social insurance as well as its control or supervision are required to maintain secrecy with respect to others.

Section 2: Procedure for social insurance art. 34 parties have quality of parts those whose rights or obligations result from social insurance, as well as the people, organizations, or authorities that have a legal remedy against the decision of an insurer or a similarly executing agency level.

Art. 35 jurisdiction the insurer examines Office whether it is competent.
The insurer, which stands for competent noted in a decision if a party disputes its jurisdiction.
The insurer, which stands for incompetent decision of inadmissibility if a party claims he is competent.

Art. 36 disqualification individuals called to make or prepare decisions on rights or obligations must recuse themselves if they have a personal interest in the case or if, for other reasons, they seem to be prevented.
If the recusation is challenged, the decision is made by the supervisory authority. If it comes to the disqualification of a member of a college, the decision is made by the college in the absence of this member.

Art. 37 representation and assistance a party may, at any time, be represented, unless she to act personally or be assisted, as far as the urgency of an investigation not the excluded not.
The insurer may require the agent that he justifies his powers by a written proxy.
As long as the party does not revoke the power of Attorney, the insurer address its communications to the agent.
When the circumstances so require, free legal assistance is granted to the applicant.

Art. 38 calculation and suspension of deadlines if time, counted by days or months, must be communicated to the parties, it starts the day after the communication.
If it doesn't have to be communicated to the parties, he begins the day after the event that triggers the.
A communication which is delivered to that against the signature of the recipient or a third ability is deemed to be received no later than seven days after the first unsuccessful delivery attempt.
When the deadline falls on a Saturday, a Sunday or a holiday under federal or cantonal law, its term is extended to the first working day that follows. The law is that of the canton where the party or its representative has his domicile or seat.
Delays in days or months set by the law or by the authority do not run: a. 7 day before Easter to the 7th day after Easter inclusive; b. from July 15 to August 15 inclusive; c. from December 18 to January 2 inclusively.

Introduced by section 106 of the annex to the Act of 17 June 2005 on the TAF, in force since Jan. 1. 2007 (RO 2006 2197; FF 2001-4000).
New content according to section 106 of the annex to the Act of 17 June 2005 on the TAF, in force since Jan. 1. 2007 (RO 2006 2197; FF 2001-4000).
New content according to section 106 of the annex to the Act of 17 June 2005 on the TAF, in force since Jan. 1. 2007 (RO 2006 2197; FF 2001-4000).

Art. 39 observation of deadlines the writings must be handed in no later than the last day of the period to the insurer or to his address, to the Swiss Post or a representation diplomatic or consular Switzerland.
When a part is addressed to an incompetent insurer in good time, the delay is deemed observed.

Art. 40 extensions of time and delay the deadline cannot be extended.
If the insurer sets a deadline for action, it at the same time indicates the consequences of a delay. It can have other consequences than those mentioned in the warning.
The deadline set by the insurer may be extended for relevant reasons if the part request before it expires.

Art. 41Restitution of the time limit if the applicant or his agent has been prevented, without his fault, to act within the time limit, it is rendered so that, within 30 days from the one which the impediment ceased, the applicant or his agent has filed a motivated request for restitution and had completed the omitted Act.

New content according to section 106 of the annex to the Act of 17 June 2005 on the TAF, in force since Jan. 1. 2007 (RO 2006 2197; FF 2001-4000).

Art. 42 right to be heard the parties have the right to be heard. It is not necessary to hear before a decision subject to opposition.

Art. 43 statement demand the insurer reviews applications, takes office the necessary investigative measures and collects the information he needs. The information given orally must be recorded in writing.
The insured must submit to medical or technical examinations if these are necessary for the assessment of the case and that they may be reasonably required.
If the insured or other applicants refuse to inexcusable way to comply with their obligation to inform or to contribute to the statement, the insurer can pronounce to the State of the file or close the investigation and decide not to enter into matter. It must have addressed a formal written notice to them warning them of the legal consequences and their outsourcing time for proper reflection.

Rectified by Commission for the drafting of the SSA. fed. (art. 33 LREC;) 1974 1051 RO).

Art. 44 expertise if the insurer has to resort to the services of an independent expert to clarify the facts, it gives knowledge of the name of it to the parties. They can challenge the expert for relevant reasons and present some counter-proposals.

Art. 45 education the cost of education fees are supported by the insurer who ordered the measures. Otherwise, the insurer will pay the costs of the measures essential to the assessment of the case or included in benefits later.
The insurer indemnifies the parties and the persons required to provide information if they suffer a loss of income or incur costs.
Fees may be paid by the party who prevents or hinders the statement of inexcusable way after warning and indication of the consequences.

Art. 46 records during each procedure under social insurance, the insurer management record systematically all documents that may be decisive.

Art. 47 consultation of the file have the right to consult the file, where the predominant private interests are safeguarded: a. the insured, for the data concerning them; b. the parties, regarding the data that is required to exercise a right or an obligation resulting from a law on social insurance or to assert a right way against a decision based on this Act; (c) the authorities responsible for deciding on appeals against decisions based on a law on social insurance, for the data necessary for the accomplishment of this task; d. the party responsible and its insurer, for data that they need to settle on a recourse claim to the insurance concerned.

If it comes to health information whose disclosure could result in damage to the health of the person authorized to consult the file, it may be required to designate a doctor who will provide them.

Art. 48 taking into account parts kept secret a piece which the consultation was denied to a party cannot be used to his disadvantage if the insurer in communicated, orally or in writing, the essential content pertaining to the case and also gave him the opportunity to express themselves and to provide the counter-evidence.

Art. 49 decision the insurer must make decisions regarding benefits, claims, or important injunctions or with which the person concerned is not agree in writing.
If the applicant makes likely an interest worthy of protection, the insurer makes a decision in finding.
The decisions indicate the remedies. They must be motivated if they are not entirely right to the requests of the parties. The irregular notification of a decision should cause no harm to the person concerned.
The insurer who makes a decision affecting the obligation of another insurer to allocate benefits is required to provide him with a copy. This another insurer has the same remedies that the insured.

Art. 50 transaction disputes on social insurance benefits may be paid per transaction.
The insurer is required to notify the transaction in the form of a decision subject to appeal.
The al. 1 and 2 apply by analogy to the opposition procedure as well as to the appeal procedure.

Art. 51 simplified procedure


Benefits, claims and injunctions which are not referred to in art. 49, al. 1, can be dealt with under a simplified procedure.
The interested party may request that a decision be made.

Art. 52 opposition decisions may be attacked within 30 days by way of opposition the insurer who made them, with the exception of the procedure scheduling decisions.
The decisions on opposition must be made within a reasonable period. They are motivated and indicate remedies.
The opposition procedure is free of charge. As a general rule, it can be allocated to costs.

Art. 53 review and reconsideration and the decisions on opposition formally placed in force are subject to revision if the insured or the insurer subsequently discovered important new facts or find new means of evidence which could not be produced before.
The insurer may revisit the decisions or the decisions on opposition formally placed in force when they are clearly wrong and their correction is of significant importance.
To the mailing of the notice to the appeal authority, the insurer may reconsider a decision or a decision on opposition against which an appeal has been filed.

Art. 54 execution decisions and the decisions on opposition are enforceable when: a. they cannot be attacked by an opposition or an appeal; b. the opposition or the appeal has no suspensive effect; c. the suspensive effect attributed to an opposition or an appeal has been withdrawn.

Decisions and decisions on binding opposition which carry conviction to pay a sum of money or to provide collateral includes enforceable judgments within the meaning of art. 80 of the Federal law of April 11, 1889, on debt collection and bankruptcy.

RS 281.1 art. 55 special rules of procedure procedural points which are not addressed comprehensively in the art. 27 to 54 of this Act or by the provisions of the special acts are governed by the Federal Act of 20 December 1968 on administrative procedure.
The federal Council may declare applicable to proceedings governed by this Act, the provisions of the Federal Act of 20 December 1968 on administrative procedure on electronic communication with the authorities.
The proceedings before a federal authority is governed by the Federal Act of 20 December 1968 on administrative procedure, except when it comes to benefits, claims and injunctions under the social insurance law.

RS 172.021 introduced by section 106 of the annex to the Act of 17 June 2005 on the TAF, in force since Jan. 1. 2007 (RO 2006 2197; FF 2001-4000).

Section 3 litigation art. 56 right to appeal decisions on opposition and those against which the way of the opposition is not open are subject to appeal.
The resort can also be formed when the insurer, despite the request of the interested party, does not make decision or decision on opposition.

Art. 57 cantonal Insurance Court each canton establishes an insurance tribunal, which rules in single instance on appeals in the field of social insurance.

Art. 58 jurisdiction the competent Insurance Court is that of the canton of residence of the insured or of any other party at the time of filing the appeal.
If the insured or any other party are domiciled abroad, the competent court of the insurance is the canton of their last home in Switzerland or that of the canton of residence from their last employer Swiss; If none of these homes can be determined, the Insurance Court is that of the canton where the implementing body is headquartered.
The tribunal which shall decline jurisdiction must without delay the appeal to the competent court.

Art. 59 quality for anyone who is affected by the decision or the decision on opposition and has a legitimate interests to be protected in that it is cancelled or varied shall be entitled to use.

Art. 60 deadline for appeal the appeal must be filed within thirty days of the notification of the decision subject to appeal.
The art. 38 to 41 shall apply by analogy.

Art. 61 procedure subject to art. 1, al. 3, of the Federal Act of 20 December 1968 on administrative procedure, the procedure before the cantonal Insurance Court is governed by cantonal law. It must meet the following requirements: a. it must be simple, fast, generally public, as well as free for the parties; emoluments of justice and the costs of the proceedings may, however, be paid by the party who is reckless way or reflects light; (b) the notice of appeal must contain a brief statement of the facts and the grounds, as well as the conclusions; If the Act is not in accordance with these rules, the court sets a suitable deadline for the using to fill the gaps, warning him that breach the use will be waived; c. the tribunal established with the cooperation of the parties the key facts for the solution of the dispute. It administers the necessary evidence and appreciate them freely; (d) the Court is not bound by the conclusions of the parties; He can reform, at the expense of using, the contested decision or greater that the appellant had requested; It must, however, give the parties the opportunity to comment or to withdraw the appeal; e. If the circumstances warrant, parties may be convened at the debates; (f) the right to be assisted by counsel should be guaranteed; in the circumstances, legal aid is granted to the using; g. the appellant who wins is entitled to the reimbursement of his costs and expenses to the extent fixed by the Court; their amount is determined without regard to the value in dispute according to the importance and the complexity of the litigation; h. judgments contain selected reasons, an indication of the remedies as well as the names of the members of the tribunal and are notified in writing; i. judgments are subject to review if facts or means new evidence are discovered or if a crime or misdemeanour has influenced the judgment.

RS 172.021 art. Federal 62Tribunal the judgments rendered by the District Court of insurance can be appealed to the federal Tribunal, in accordance with the law of 17 June 2005 on the federal court.
The federal Council sets the quality to appeal to the federal court of the implementing bodies of social insurance.
Art. 54 applies by analogy to the execution of the judgments rendered by the authorities of recourse before the federal court.

New content according to section 106 of the annex to the Act of 17 June 2005 on the TAF, in force since Jan. 1. 2007 (RO 2006 2197; FF 2001-4000).
RS 173.110 Chapter 5 coordination rules Section 1 Coordination of benefits art. 63 general coordination rules in this section apply to several social insurance benefits.
The AVS and AI are considered a single social insurance.
The coordination of a social insurance benefits is governed by the relevant special law.

Art. 64 treatment treatment is the sole responsibility of a single social insurance insofar as it's benefits prescribed by law.
If the conditions of the relevant special law are met, the treatment, within the legal limits, is in sequence according to the load to: a. military insurance; (b) accident insurance; c. got it; d. Medicare.

The social insurer to pay benefits supports single and unlimited costs of hospital treatment, even if the damage to health is not entirely due to the event that it is required to cover.
Moreover, the social insurer to pay benefits supports the treatment of damage to health which he did not respond when violations occur during hospital treatment and cannot be dealt with separately.

Art. 65. other benefits in kind other benefits in kind such as AIDS or rehabilitation measures are, within the limits of the relevant special law and in the following order, taken in charge by: a. military insurance or accident insurance; b. the AVS or have it; c. Medicare.

Art. 66 annuities and allowances for disabled subject to over-compensation, pensions and allowances in different social insurance capital are cumulative.
Annuities and allowances in capital are, according to the provisions of the special law concerned and in the following order, paid by: a. AHV or have it; b. military insurance or accident insurance; c. the occupational old-age, survivors and disability within the meaning of the Federal Act of 25 June 1982 on occupational old age, survivors and disability insurance (LPP).

Allowances for disabled are, according to the provisions of the special law concerned and in the following order, paid exclusively by: a. military insurance or accident insurance; b. the AVS or AI.

RS 831.40 art. 67 treatment and cash benefits


When the per diem or a pension beneficiary staying at the expense of social insurance in a hospital, the social insurer held to support the treatment can, in view of the responsibilities of the insured, deduct a fixed amount for Board in the hospital. This deduction may be made on the daily allowance or pension.
If the recipient of an allowance for helpless stays in a hospital at the expense of social insurance, the right to the allowance is removed for each full calendar month spent at the facility.

New content according to point 2 of the annex to the Federal Act of 6 October. 2006 (have 5 review), in force since Jan. 1. 2008 (2007 5129 RO; FF 2005-4215).

Art. 68 daily allowances and annuities subject of over-compensation, daily allowances and various social insurance pensions are cumulative.

Art. 69 over-compensation contest of different social insurance benefits should not lead to an over-compensation of the right. Not are taken into account in the calculation of the over-compensation that the identical nature and purpose benefits which are granted to the insured because of the damaging event.
There are over-compensation insofar as legally due social benefits exceed, as a result of the realisation of the risk, both the gain which the insured is presumed to have been private, additional costs and possible decreases in revenue suffered by the relatives.
Cash benefits are reduced by the amount of over-compensation. Are excepted from any reduction AHV pension and have him, as well as allowances for disabled and allowances for integrity. For benefits in capital, the value of the corresponding pension is taken into account.

Art. 70 management interim benefits having it right may request interim case management when an insured event entitles him to insurance benefits a social but there is doubt about the debtor of such benefits.
Are required to temporarily take the case their dependants: a. taking Medicare, for daily allowances and benefits in kind covered by health insurance, accident insurance, military insurance or have is disputed; b. unemployment insurance, for which benefits supported by unemployment insurance, health insurance, accident insurance or have it is contested; c. accident insurance, for whose support benefits by accident or military insurance is disputed; d. foresight professional old age survivors and disability within the meaning of the LPP, for annuities which supported it by accident or military insurance or by the occupational old-age, survivors and disability within the meaning of the BVG is disputed.

The right address his request to the social insurance institutions entering into account.

RS 831.40 art. 71 refund the insurer required to temporarily take the case to his office allocates benefits according to the provisions governing its activity. When the case is supported by another insurer, it paid back its advances insofar as they correspond to benefits he should have himself allocate.

Section 2 Subrogation art. 72 principle from the occurrence of the harmful event, the insurer is subrogated, to the extent of statutory benefits, to the rights of the insured and its survivors against any third party responsible.
When there are several officials, they meet jointly and severally against the insurer.
Time limits applicable to the rights of the injured person are also applicable to rights that were passed to the insurer. For contracts the insurer claims, delays don't start however until it had knowledge benefits it must allocate, as well as the Manager.
When the injured person has a direct right against the liability insurer, this right passes to the subrogated insurer. Exceptions based on the insurance contract that cannot be opposed to the injured person can either be obtained claims to the insurer.
The federal Council issues regulations on the exercise of the right of appeal. It can notably order unless action against a manager who is not insured civil liability, several insurers participating in the appeal claim their rights through a single insurer. The federal Council regulates the representation with respect to others if interested insurers fail to agree.

Art. 73 scope of the subrogation of the insurer is subrogated to the rights of the insured and its survivors insofar as benefits allocations, attached to the reparation that is due for the same period by the party responsible, exceed the damage caused by it.
However, if the insurer has reduced its benefits within the meaning of art. 21, al. 1 or 2, the rights of the insured or his survivors spend the insurer insofar as not reduced benefits attached to the reparation that is due for the same period by the third party, exceed the amount of the damage.
Rights that do not pass to the insurer remains to the insured or his survivors. If only a part of the compensation due by the party responsible can be recovered, the insured or his/her survivors have a preferential right over this part.

Art. 74 classification of rights rights pass to the insurer for benefits of the same nature.
Include the benefits of the same nature: a. the costs of treatment and rehabilitation by the insurer and the responsible third party; (b) daily subsistence allowance and compensation for incapacity for work; c. disability pensions or the retirement pensions allocated to their place and compensation for inability to gain d. benefits for impotence, the contribution of assistance and reimbursement of expenses related to care and some other fees due to impotence; e. compensation for damage to the integrity and moral reparation compensation; f. survivors pensions and allowances for loss of breadwinner; g. funeral expenses and other expenses related to the death.

New content according to Chapter 3 of the annex to the Federal Act of 18 March 2011 (6 revision I, first part), in force since Jan. 1. 2012 (2011 5659 RO; FF 2010 1647).

Art. 75 limitation of the right to appeal the insurer has a right of recourse against the insured's spouse, parents online forward and backward or people who are living together with him unless they caused the insured event intentionally or by serious negligence.
If rights claims arise from an accident at work, the same limitation applies to the employer of the insured, his family members and workers of his company.
There is no limitation of the right of recourse of the insurer insofar as the person against whom the appeal is formed is covered by a compulsory civil liability insurance.

Introduced by section 2 of the schedule to the Federal Act of 6 October. 2006 (have 5 review), in force since Jan. 1. 2008 (2007 5129 RO; FF 2005-4215).

Chapter 6 provisions various art. 76 the Federal Supervisory Authority monitors the implementation of social insurance and regularly reports.
Violations serious and repeated legal provisions by an insurer, the federal Council shall order the measures necessary for the restoration of management of insurance in accordance with the law.

Art. 77 reports and statistics social insurers are required to provide supervisory authorities with all the information they need to control their activity and to produce meaningful statistics. They have the obligation to give them a report and annual accounts.

Art. 78 responsibility corporations under public law, founding organizations and insurers respond, in their capacity as guarantors of the activity of the implementing bodies of social insurance, damage unlawfully caused to an insured or to third parties by their executing agencies or their staff.
The competent authority makes a decision on the applications for compensation.
The subsidiary responsibility of the Confederation for independent institutions of the ordinary administration of the Confederation is governed by art. 19 of the law of 14 March 1958 on the responsibility.
The provisions of this Act apply to the procedure in the al. 1 and 3. There is no opposition procedure. The art. 3 to 9, 11, 12, 20, al. 1, 21 and 23 of the Act of 14 March 1958 on liability shall apply by analogy.
Persons acting as organs or agents of an insurer of a review body or control or to which are assigned tasks under special laws, are subject to the same criminal responsibility as members of the authorities and officials, according to the provisions of the penal code.

RS 170.32 RS 311.0 art. 79 penal provisions of the general part of the CP as well as the art. 6 of the Federal Act of 22 March 1974 on administrative penal law shall apply.
The prosecution is the responsibility of the cantons.

RS 311.0 RS 313.0

New content according to ch. II 28 of annex 1 to the code of criminal procedure of the Oct. 5. 2007, in force since Jan. 1. 2011 (2010 1881 RO; FF 2006 1057).

Art. 80 tax exemption of insurers insurers and the enforcement bodies are exempt from direct taxes federal, cantonal and municipal and cantonal and communal on inheritance and gift taxes insofar as their income and their assets are used exclusively to implement social insurance, or allocate to ensure that social insurance benefits.
Documents used to correspond with the insured or third parties and other organizations in the implementation of social insurance are free of taxes and public fees. The perception of the contributions legally due is not subject to the federal stamp duty on receipts of premiums.

Chapter 7 provisions final art. 81 execution the federal Council is responsible for the execution of this Act. It lays down the necessary provisions.

Art. 82 transitional provisions the provisions of this Act shall not apply to ongoing benefits and claims set before its entry into force. On request, the disability or survivors pension reduced or refused due to misconduct of the insured however will be reviewed and, if necessary, set again in accordance with art. 21, al. 1 and 2, at least early on from the entry into force of this Act.
...

Repealed by no II 38 of the Federal Act of 20 March 2008 relative to the formal update of federal law, with effect from August 1, 2008 (RO 2008 3437; FF 2007 5789).

Art. 83 amendment of existing law items in the schedule are repealed or modified.
Before the entry into force of this Act, the Federal Assembly may, by order, amend Schedule in order to adapt it to the changes that have been made to the laws concerned and who would have entered into force since the adoption of this Act.

Art. 84 referendum and entry into force the present law is subject to optional referendum.
The federal Council shall determine the date of entry into force.
Art. 83, al. 2, comes into force, in the absence of a referendum, the first day of the second month following the due date of the referendum period or, in case of a referendum, the date of acceptance of this Act by the people.

Appendix Modification of the law in force...

Mod. can be found at the RO 2002 3371 3453 3472 3475.

Status as of January 1, 2012

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