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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 (State 1 Er January 2012)

The Swiss Federal Assembly,

Having regard to art. 112, para. 1, 114, para. 1, and 117, para. 1, of the Constitution 1 , having regard to the report of a committee of the Council of States of 27 September 1990 2 , having regard to the opinions of the Federal Council of 17 April 1991 3 , 17 August 1994 4 And 26 May 1999 5 , having regard to the report of the Social Security and Public Health Commission of the National Council of 26 March 1999 6 ,

Stops:

Chapter 1 Scope of application

Art. 1 Purpose and Purpose

This Law shall coordinate the Federal Law on Social Insurance:

A.
Defining the principles, concepts and institutions of social insurance law;
B.
Setting the standards for a uniform procedure and setting up the judicial organisation in the field of social insurance;
C.
By harmonizing social insurance benefits;
D.
By regulating the right of social insurance to third parties.
Art. 2 Scope and relationships with special social insurance laws

The provisions of this Law shall apply to social insurances governed by federal law, if and to the extent that the special laws on social insurance provide for it.

Chapter 2 Definitions of General Concepts

Art. 3 Sickness

1 Any impairment of physical, mental or mental health which is not due to an accident and which requires medical examination or treatment or causes incapacity for work is deemed to be sickness. 1

2 A congenital infirmity of any illness occurs at the child's complete birth.


1 New content according to the c. 2 of the Annex to the PMQ of 21 March 2003 (4 E Revision AI), effective from 1 Er Jan 2004 ( RO 2003 3837 ; FF 2001 3045 ).

Art. 4 1 Accident

Any harmful, sudden and unintentional injury to the human body by an extraordinary external cause that compromises physical, mental or mental health or causes death is considered an accident.


1 New content according to the c. 2 of the Annex to the PMQ of 21 March 2003 (4 E Revision AI), effective from 1 Er Jan 2004 ( RO 2003 3837 ; FF 2001 3045 ).

Art. 5 Maternity

Motherhood includes pregnancy and childbirth, as well as convalescence following the pregnancy.

Art. 6 Incapacity of work

Any loss, total or partial, of the ability of the insured person to perform in his or her occupation or field of activity the work that may reasonably be required of him, if that loss results from an injury to his or her health, shall be deemed to be incapacity for work Physical, mental or psychic. 1 In the case of long-term incapacity for work, the activity which may be required of him may also be carried out by another profession or another area of activity.


1 New content according to the c. 2 of the Annex to the PMQ of 21 March 2003 (4 E Revision AI), effective from 1 Er Jan 2004 ( RO 2003 3837 ; FF 2001 3045 ).

Art. 7 1 Gain Inability

1 A reduction of all or part of the gain of the insured person in a balanced labour market in his or her field of activity is deemed to be an inability to gain all or part of the gain of the insured person as a result of impairment of his or her physical, mental or physical health And that it persists after treatment and rehabilitation measures are required.

2 Only the consequences of the harm to health are taken into account in judging the presence of an inability to gain. Moreover, there is an inability to gain any gain only if it is not objectively surmountable. 2


1 New content according to the c. 2 of the Annex to the PMQ of 21 March 2003 (4 E Revision AI), effective from 1 Er Jan 2004 ( RO 2003 3837 ; FF 2001 3045 ).
2 Introduced by ch. 2 of the annex to the LF 6 Oct. 2006 (5 E Revision AI), effective from 1 Er Jan 2008 ( RO 2007 5129 ; FF 2005 4215 ).

Art. 8 Invalidity

1 Deemed disability is the incapacity for total or partial gain that is presumed to be permanent or long-term.

2 Minors without gainful employment are deemed to be disabled if they have an impairment of their physical, mental or psychological health, which will likely result in a total or partial incapacity for gain. 1

3 Major insured persons who did not engage in a gainful occupation prior to being reached in their physical, mental or mental health and who cannot be required to exercise a gainful occupation are deemed to be disabled if the impairment prevents them from performing their Usual work. Art. 7, para. 2, shall apply mutatis mutandis. 2 3


1 New content according to the c. 2 of the Annex to the PMQ of 21 March 2003 (4 E Revision AI), effective from 1 Er Jan 2004 ( RO 2003 3837 ; FF 2001 3045 ).
2 Phrase introduced by ch. 2 of the annex to the LF 6 Oct. 2006 (5 E Revision AI), effective from 1 Er Jan 2008 ( RO 2007 5129 ; FF 2005 4215 ).
3 New content according to the c. 2 of the Annex to the PMQ of 21 March 2003 (4 E Revision AI), effective from 1 Er Jan 2004 ( RO 2003 3837 ; FF 2001 3045 ).

Art. Impotence

Any person who, by reason of an attack on his or her health, needs the help of others or personal supervision to perform basic acts of daily life is deemed to be impotent.

Art. 10 Salariate

An employee is considered to be an employee who provides dependent work and who receives for that work a determinative salary within the meaning of special laws.

Art. 11 Employer

The employer is deemed to employ employees.

Art. 12 Persons engaged in an independent gainful occupation

1 It is considered to be engaged in a gainful occupation independent of the person whose income does not come from the exercise of an activity as an employee.

2 A person engaged in an independent gainful occupation may simultaneously have the status of an employee if he or she receives a corresponding salary.

Art. 13 Home and habitual residence

1 A person's place of residence is determined by s. 23 to 26 of the Civil Code 1 .

2 A person is deemed to have his or her habitual residence at the place of residence 2 A certain amount of time even if the length of the stay is limited from the outset.


1 RS 210
2 Rectified by the drafting committee of the Ass. Fed. (art. 33 LREC; 1974 1051).

Art. 13 A 1 Registered partnership

1 Throughout its duration, the registered partnership is equated with marriage in the law of social insurance.

2 The surviving registered partner is a widower.

3 The judicial dissolution of the registered partnership is treated as a divorce.


1 Introduced by ch. 28 of the annex to the law of 18 June 2004 on partnership, in force since 1 Er Jan 2007 ( RO 2005 5685 ; FF 2003 1192 ).

Chapter 3 General provisions on benefits and contributions

Section 1 Benefits in kind

Art. 14

Benefits in kind include treatment or care, auxiliary means, individual prevention and rehabilitation measures, transportation costs and similar benefits that are provided or reimbursed by the Different social insurance.

Section 2 Cash benefits

Art. 15 General information

Cash benefits include, in particular, per diems, annuities, annual supplementary benefits, allowances for impotents and their supplements; they do not include the replacement of a benefit in Nature of insurance coverage.

Art. 16 Disability Rate

In assessing the disability rate, the income that the insured could have obtained if he was not disabled is compared with that which he could obtain by carrying out the activity that may reasonably be required of him after the treatment and the measures taken by him. Rehabilitation, in a balanced labour market.

Art. 17 Revision of the disability pension and other sustainable benefits

1 If the invalidity rate of the beneficiary of the pension undergoes a significant change, the annuity is, ex officio or upon request, revised for the future, i.e. increased or reduced accordingly, or deleted.

2 Similarly, any sustainable benefit granted by virtue of a decision entered into force is, ex officio or upon request, increased or reduced accordingly, or deleted if the circumstances on which its award depends significantly change.

Art. 18 Maximum Insured Gain Amount

For the social insurances which allocate cash benefits fixed in % of the gain, the Federal Council fixes the maximum amount of the insured gain.

Art. 19 Payment of benefits in cash

1 In general, periodic cash benefits are paid monthly.

2 Per diems and similar benefits are paid to the employer as long as he continues to pay the insured despite his entitlement to per diems.

3 Impotent annuities and allowances are always paid in advance for the entire calendar month. A benefit that replaces another benefit is paid only for the following month.

4 If entitlement to benefits appears to be proven and payment is delayed, advances may be made.

Art. Warranty for use consistent with purpose

1 The Insurer may pay all or part of the benefits in cash to a qualified third party or an authority having a legal or legal obligation to maintain or assist the beneficiary on an ongoing basis when:

A.
The beneficiary does not use those benefits for his or her maintenance or that of the persons under the care of the beneficiary, or if it is established that he is not in a position to use them for that purpose, and that
B.
He or the persons he or she is responsible for depend on that fact of public or private assistance.

2 Benefits paid to a third party or to an authority may not be offset by that third party or authority with claims against the person entitled to it. An exception is in the case of retroactive payment of benefits within the meaning of s. 22, para. 2.

Section 3 Reduction and denial of benefits

Art.

1 If the insured has aggravated the insured risk or caused it to be carried out intentionally or by intentionally committing a crime or crime, the cash benefits 1 May be temporarily or permanently reduced or, in particularly serious cases, refused.

2 Cash benefits payable to relatives or survivors of the insured person shall be reduced or refused only if they have caused the risk to be carried out intentionally or by intentionally committing a crime or a crime.

3 To the extent that social insurances having the character of loss-of-gain insurance do not provide for a cash benefit for relatives, the cash benefits cannot be reduced under para. 1 half. For the other half, the reduction provided for in para. 2 is reserved.

4 Benefits may be reduced or refused temporarily or definitively if the insured person subtracts or opposes, or does not participate spontaneously, within the limits of what may be required of him, a treatment or a measure of Reintegration that is reasonably due and likely to significantly improve its work capacity or offer a new earning potential. A written notice setting out the legal consequences and providing it with a reasonable period of reflection must be sent to it. Treatment and rehabilitation measures that present a life or health hazard may not be required.

5 If the insured undergoes a measure or a penalty of deprivation of liberty, the payment of benefits for loss of gain may be partially or totally suspended with the exception of benefits for the care of the relatives referred to in para. 3.


1 Rectified by the drafting committee of the Ass. Fed. (art. 33 LREC; 1974 1051).

Section 4 Special provisions

Art. Benefit Security

1 The right to benefits is not transferable; it cannot be pledged. Any assignment or pledge is void.

2 Benefits granted retroactively by the social insurer may, on the other hand, be transferred:

A.
To the employer or to a public or private social assistance institution to the extent that they have made advances;
B.
To the insurer who has temporarily paid benefits 1 .

1 Rectified by the drafting committee of the Ass. Fed. (art. 33 LREC; 1974 1051).

Art. Waiver of benefits

1 The entitlement to benefits may be waived. Renunciation may be revoked at any time for the future. Renunciation and revocation shall be the subject of a written declaration.

2 Renunciation and revocation shall be null and void where they are detrimental to the interests of other persons, insurance or assistance institutions or when they tend to evade legal provisions.

3 The Insurer confirms in writing the waiver and revocation. The purpose, scope and suites of the renunciation and revocation must be stated in the confirmation.

Art. 24 Extinguishing the law

1 The entitlement to benefits or arrears ceases 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 contribution was to be paid.

2 If the contributor has withdrawn from the obligation to contribute by a punishable act for which the criminal law provides for a longer limitation period, it shall determine the time when the claim is extinguished.

Art. 25 Check-in

1 Benefits unduly affected must be returned. Restitution may not be required where the person concerned was in good faith and would put it in a difficult situation.

2 The right to claim restitution shall lapse one year after the day on which the insurance institution became aware of the fact, but not later than five years after the payment of the benefit. If the debt arises out of a punishable act for which the criminal law provides for a longer limitation period, it is decisive.

3 The refund of overpaid contributions may be claimed. The entitlement ceases one year after the contributor became aware of his or her overpayments, but no later than five years after the end of the calendar year in which the contributions were paid.

Art. 26 Moratoria Interest and Pay Interest

1 The claims of matured contributions are subject to the levying of moratoria interests and the claims due in return of unduly paid contributions are subject to the payment of remunerative interest. The Federal Council may provide for exceptions for low-and low-debt claims.

2 Moral interest shall be payable for any claim for social insurance benefits at the expiry of a period of 24 months from the date of the birth of the right, but at the earliest twelve months from the date on which the insured person claims that right, They have fully complied with their obligation to cooperate.

3 There is no interest in a moratorium when foreign insurers are responsible for delays. 1

4 Not entitled to moratoria interests:

A.
The person entitled to benefits or his heirs when the benefits are paid retroactively to third parties;
B.
Third parties who have made advances or are temporarily in charge of benefits within the meaning of s. 22, para. 2, and to whom the retroactive benefits have been transferred;
C.
The other social insurance undertakings which have temporarily taken care of benefits within the meaning of s. 70. 2

1 Introduced by ch. 2 of the annex to the LF 6 Oct. 2006 (5 E Revision AI), effective from 1 Er Jan 2008 ( RO 2007 5129 ; FF 2005 4215 ).
2 Introduced by ch. 2 of the annex to the LF 6 Oct. 2006 (5 E Revision AI), effective from 1 Er Jan 2008 ( RO 2007 5129 ; FF 2005 4215 ).

Chapter 4 General provisions of procedure

Section 1 Information, administrative assistance, obligation to keep secrecy

Art. 27 Information and Advice

1 Within the limits of their field of competence, insurers and the implementing bodies of the various social insurance companies are obliged to inform interested persons about their rights and obligations.

2 Everyone has the right to be advised, in principle, free of charge, of his rights and obligations. Insurers in respect of which the persons concerned must assert their rights or fulfil their obligations are competent to do so. The Federal Council may provide for the collection of fees and set the tariff for consultations that require costly research.

3 If an insurer finds that an insured person or his or her family members are entitled to benefits from other social insurance, he or she shall inform them without delay.

Art. 28 Collaboration at implementation

1 Insured persons and employers must cooperate free of charge in the implementation of the various social insurance laws.

2 He who claims his right to benefits must provide free of charge all the information necessary to establish that right and fix the benefits payable.

3 The applicant is required to authorize in special cases all persons and institutions, including employers, doctors, insurance and official bodies, to provide information, provided that information is required To establish entitlement to benefits. These individuals and institutions are required to provide the required information.

Art. Exercise of entitlement to benefits

1 The person who claims his right to benefits must declare himself to the competent insurer in the prescribed form for the social insurance concerned.

2 Social insurers provide free forms to claim and establish entitlement to benefits; these forms must be provided to the relevant insurer, completed in a complete and accurate manner by the applicant or his employer And, where applicable, by the attending physician.

3 If an application does not comply with the formal requirements or if it is given to an incompetent body, the date on which it was mailed or filed with that body is decisive for the observance of time limits and effects Legal of the application.

Art. Forwarding required

All social insurance implementation bodies have an obligation to accept requests, requests or other documents which are received in error. They shall record the date of receipt and transmit them to the competent body.

Art. Notifiable when changing circumstances

1 The person entitled, his or her relatives or the third parties to whom a benefit is paid shall be required to communicate to the insurer or, as the case may be, to the competent body any significant change in the circumstances determining the grant of a benefit.

2 Any person or institution involved in the implementation of social insurance shall have the obligation to inform the insurer if it learns that the determining circumstances for the granting of benefits have changed.

Art. 32 Administrative assistance

1 The administrative and judicial authorities of the Confederation, the cantons, the districts, the districts and the municipalities shall provide, free of charge, social insurance bodies, in special cases and on written and reasoned request, The data required to:

A.
Fixing or amending benefits, or claiming restitution;
B.
Prevent undue payments;
C.
Fixing and collecting contributions;
D.
Claim a claim against the responsible third party.

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

Art. 33 Obligation to keep secrecy

Persons involved in the enforcement of social insurance laws, as well as in their control or supervision, are required to maintain secrecy with respect to third parties.

Section 2 Social insurance procedure

Art. 34 Parties

The persons whose rights or obligations are the result of social insurance, as well as persons, organizations or authorities who have a means of law against the decision of an insurer or an implementing body, are parties Same level.

Art. 35 Jurisdiction

1 The Insurer examines ex officio if it is competent.

2 The insurer holding the competent authority finds it in a decision if a party disputes its jurisdiction.

3 The incompetent insurer makes a decision of inadmissibility if a party claims that it is competent.

Art. 36 Recusal

1 Persons who are required 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 appear to have been prevented.

2 If the objection is challenged, the decision shall be rendered by the supervisory authority. If the objection is to a member of a college, the decision is rendered by the college in the absence of that member.

Art. Representation and assistance

1 A party may, at any time, be represented, unless it is required to act personally, or be assisted, provided that the urgency of an investigation does not exclude it.

2 The insurer may require the agent to justify its powers by a written power of attorney.

3 As long as the party does not revoke the power of attorney, the insurer sends its communications to the agent.

4 Where circumstances so require, free legal advice shall be given to the applicant.

Art. 38 Calculating and Suspending Delays

1 If the period, counted by days or months, is to be communicated to the parties, it starts to run the day after the communication.

2 If it is not to be communicated to the parties, it begins to run the day after the event that triggers it.

2bis A communication which is delivered only against the signature of the addressee or a qualified third party shall be deemed to have been received no later than seven days after the first unsuccessful attempt at distribution. 1

3 When the period falls on a Saturday, a Sunday or a holiday under federal or cantonal law, its term shall be carried forward to the next working day. The decisive cantonal law is that of the canton where the party or its representative has its domicile or its seat. 2

4 The time limits in days or months fixed by law or authority do not run:

A.
Of 7 E Day before Easter at 7 E Day after Easter inclusive;
B.
July 15 to August 15 inclusive;
C. 3
From December 18 to January 2 inclusive.

1 Introduced by ch. 106 of the Annex to the Law of 17 June 2005 on the TAF, in force since 1 Er Jan 2007 ( RO 2006 2197 ; FF 2001 4000 ).
2 New content according to the c. 106 of the Annex to the Law of 17 June 2005 on the TAF, in force since 1 Er Jan 2007 ( RO 2006 2197 ; FF 2001 4000 ).
3 New content according to the c. 106 of the Annex to the Law of 17 June 2005 on the TAF, in force since 1 Er Jan 2007 ( RO 2006 2197 ; FF 2001 4000 ).

Art. 39 Timeliness Observation

1 Written submissions must be submitted no later than the last day of the period to the Insurer or, at his/her address, to the Swiss Post Office or to a Swiss diplomatic or consular representation.

2 Where a party addresses an incompetent insurer in a timely manner, the time limit shall be deemed to be observed.

Art. 40 Extension of time and delay

1 The legal deadline cannot be extended.

2 If the insurer sets a time limit for a given action, it also indicates the consequences of a delay. This may have other consequences other than those mentioned in the warning.

3 The time limit set by the insurer may be extended for relevant reasons if the party so requests before it expires.

Art. 1 Check-in time

If the applicant or his representative has been prevented, without his fault, from acting within the time limit fixed, the latter shall be returned in so far as, within 30 days from the date on which the impediment has ceased, the applicant or his representative has filed a reasoned request Of rendition and performed the omitted act.


1 New content according to the c. 106 of the Annex to the Law of 17 June 2005 on the TAF, in force since 1 Er Jan 2007 ( RO 2006 2197 ; FF 2001 4000 ).

Art. Right to be heard

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

Art. 43 Request Statement

1 The Insurer reviews applications, takes the necessary investigative measures ex officio, and collects the information it requires. Oral information must be recorded in writing.

2 The insured person must undergo medical or technical examinations if they are necessary for the assessment of the case and may be reasonably required.

3 If the insured or other applicants inexcusably refuse to comply with their obligation to inform or cooperate in the investigation, the insurer may rule on the case or terminate the investigation and 1 Decide not to enter. They must have sent them a written notice advising them of the legal consequences and providing them with a reasonable period of reflection.


1 Rectified by the drafting committee of the Ass. Fed. (art. 33 LREC; 1974 1051).

Art. 44 Expertise

If the insurer is required to use the services of an independent expert to elucidate the facts, the insurer gives notice of the facts to the parties. They may challenge the expert for relevant reasons and submit counterproposals.

Art. 45 Instruction Charge

1 The costs of the appraisal are borne by the insurer who ordered the measures. Failing that, the Insurer shall reimburse the costs incurred by the measures necessary for the assessment of the case or included in the benefits granted at a later date.

2 The insurer compensates the parties and the persons required to provide information if they incur a loss of gain or incur costs.

3 The costs may be borne by the party who prevents or obstructs the investigation in an inexcusable manner after warning of the consequences.

Art. Document Management

In each social insurance procedure, the insurer systematically registers all documents that can be decisive.

Art. Browse the folder

1 Have the right to consult the file, insofar as the overriding private interests are safeguarded:

A.
The insured, for the data concerning him;
B.
The parties, with regard to the data necessary for them to exercise a right or fulfil an obligation arising out of a law on social insurance or to assert a plea of law against a decision based on that same law;
C.
The authorities empowered to rule on appeals against decisions based on a law on social insurance, for the data necessary for the performance of this task;
D.
The responsible third party and its insurer, for the data necessary for them to determine on a claim of the social insurance concerned.

2 In the case of health data, the disclosure of which could result in an injury to the health of the person who is authorized to consult the record, the person may be required to appoint a physician who will communicate them to the person.

Art. 48 Consideration of secret parts

A part whose consultation has been refused to a party may be used to its disadvantage only if the insurer has communicated to it orally or in writing the essential content relating to the case and has also given it the opportunity to Express and provide counter-evidence.

Art. Decision

1 The Insurer must make in writing decisions that deal with significant benefits, claims, or injunctions, or with which the individual does not agree.

2 If the applicant makes a reasonable interest to be protected, the insurer makes a finding.

3 Decisions indicate legal remedies. They must be reasoned if they are not fully entitled to the parties' requests. Irregular notification of a decision shall not cause any prejudice to the person concerned.

4 An insurer who makes a decision on the obligation of another insurer to allocate benefits is required to provide a copy of the decision. This other insurer has the same legal remedies as the insured.

Art. 50 Transaction

1 Disputes over social insurance benefits can be settled by transaction.

2 The insurer is required to notify the transaction in the form of a decision subject to appeal.

3 The s. 1 and 2 shall apply mutatis mutandis to the opposition procedure and to the appeal procedure.

Art. Simplified procedure

1 Benefits, claims and injunctions that are not covered by s. 49, para. 1, may be processed in a simplified procedure.

2 The person concerned may require that a decision be rendered.

Art. Opposition

1 Decisions may be challenged within 30 days by opposition to the insurer who made the decisions, with the exception of the decisions to order the proceedings.

2 Decisions on opposition must be made within an appropriate time frame. They shall be reasoned and shall indicate the remedies.

3 The opposition procedure is free. As a general rule, costs cannot be awarded.

Art. Revision and reconsideration

1 Decisions and decisions on formally opposing opposition are subject to review if the insured person or insurer subsequently discovers significant new facts or finds new evidence that could not be produced Before.

2 The Insurer may refer to decisions or decisions on opposition formally taken in force when they are manifestly incorrect and their rectification is of significant importance.

3 Until the notice is sent to the appeal authority, the insurer may reconsider a decision or decision on opposition against which an appeal has been lodged.

Art. Executing

1 Decisions and decisions on opposition are enforceable when:

A.
They can no longer be attacked by an opposition or an appeal;
B.
The opposition or appeal has no suspensive effect;
C.
The suspensive effect attributed to an opposition or an appeal has been withdrawn.

2 Decisions and decisions on binding opposition to pay a sum of money or to provide security rights shall be treated as binding judgments within the meaning of s. 80 of the Federal Act of April 11, 1889 on the Prosecution of Debts and Bankruptcy 1 .


Art. Specific Rules of Procedure

1 Points of procedure which are not dealt with exhaustively in art. 27 to 54 of this Law or by the provisions of special laws shall be governed by the Federal Act of 20 December 1968 on Administrative Procedure 1 .

1bis The Federal Council may declare applicable to the procedures governed by this Law the provisions of the Federal Act of 20 December 1968 on the administrative procedure relating to electronic communication with the authorities. 2

2 The procedure before a federal authority is governed by the Federal Act of 20 December 1968 on administrative procedure, except in the case of benefits, claims and injunctions under the right of social insurance.


1 RS 172.021
2 Introduced by ch. 106 of the Annex to the Law of 17 June 2005 on the TAF, in force since 1 Er Jan 2007 ( RO 2006 2197 ; FF 2001 4000 ).

Section 3 Legal

Art. 56 Right of appeal

1 Decisions on opposition and those against which the opposition is not open are subject to appeal.

2 The appeal may also be lodged where the insurer, despite the request of the person concerned, does not make a decision or decision on opposition.

Art. 57 Cantonal Insurance Tribunal

Each canton establishes a court of insurance, which rules a single instance on appeals in the field of social insurance.

Art. Jurisdiction

1 The competent insurance court shall be that of the home canton of the insured person or of another party at the time of filing of the appeal.

2 If the insured person or another party is domiciled abroad, the competent insurance court shall be that of the canton of their last domicile in Switzerland or that of the canton of domicile of their last Swiss employer; if none of those residences can Be determined, the competent insurance court shall be that of the canton where the implementing body has its seat.

3 The court which declines jurisdiction shall, without delay, transmit the appeal to the competent court.

Art. Quality to use

Anyone who is affected by the decision or decision on opposition and has an interest worthy of being protected from being cancelled or modified has the right to use it.

Art. 60 Time limit for appeal

1 The appeal must be filed within 30 days of the notification of the decision subject to appeal.

2 Art. 38 to 41 are applicable by analogy.

Art. 61 Procedure

Subject to Art. 1, para. 3, of the Federal Act of 20 December 1968 on administrative procedure 1 , the procedure before the cantonal insurance court is governed by the cantonal law. It must meet the following requirements:

A.
It must be simple, fast, as a general rule of law, as well as free for the parties; however, legal fees and procedural costs may be borne by the party who acts in a reckless manner or bears witness to lightness;
B.
The notice of appeal must contain a brief statement of the facts and reasons invoked, as well as the conclusions; if the act is not in conformity with those rules, the court shall specify a suitable time limit for filling the deficiencies, by warning it That in the event of non-compliance the action will be dismissed;
C.
The court establishes with the cooperation of the parties the decisive facts for the resolution of the dispute; it administers the necessary evidence and appreciates them freely;
D.
The court is not bound by the parties' conclusions; it may reform, to the detriment of the appellant, the contested decision or grant more than the appellant has requested; it must, however, give the parties the opportunity to decide or withdraw Recourse;
E.
If the circumstances so warrant, the parties may be called to the proceedings;
F.
The right to be assisted by a council must be guaranteed; where the circumstances justify it, free legal assistance shall be granted;
G.
The successful applicant is entitled to the reimbursement of costs and expenses to the extent determined by the court; their amount is determined without regard to the disputed value based on the size and complexity of the dispute;
H.
The judgments contain the grounds for appeal, the indication of the remedies and the names of the members of the court and shall be notified in writing;
I.
Judgments are subject to review if new facts or evidence are discovered or if a crime or a crime has influenced the judgment.

S. 62 1 Federal Court

1 Judgments handed down by the cantonal courts of insurance may be appealed to the Federal Court, in accordance with the Act of 17 June 2005 on the Federal Court 2 .

1bis The Federal Council regulates the quality of the case before the Federal Court of Social Insurance Administrators.

2 Art. 54 shall apply mutatis mutandis to the enforcement of judgments given by the appeal authorities preceding the Federal Court.


1 New content according to the c. 106 of the Annex to the Law of 17 June 2005 on the TAF, in force since 1 Er Jan 2007 ( RO 2006 2197 ; FF 2001 4000 ).
2 RS 173.110

Chapter 5 Coordination rules

Section 1 Coordination of benefits

S. 63 General information

1 The rules of coordination provided for in this section shall apply to benefits granted by several social insurance undertakings.

2 AVS and DI are considered to be a single social insurance.

3 The coordination of the benefits of the same social insurance is governed by the special law concerned.

Art. 64 Processing

1 Treatment is the exclusive responsibility of a single social insurance to the extent that it is a statutory benefit.

2 If the conditions of the special law concerned are met, the treatment, within the legal limits, shall be in the following order:

A.
Military insurance;
B.
Accidental insurance;
C.
The AI;
D.
Medicare.

3 The social insurer required to pay benefits takes care of the costs of hospital treatment on its own and in an unlimited manner, even if the health impairment is not entirely due to the event it is required to cover.

4 On the other hand, the social insurer required to pay benefits takes care of the treatment of health problems which it does not have to deal with when these attacks occur during hospital treatment and cannot be dealt with separately.

Art. Other benefits in kind

Other benefits in kind, such as auxiliary means or rehabilitation measures, are, within the limits of the special law concerned and in the following order, taken care of by:

A.
Military insurance or accidental insurance;
B.
AVS or AI;
C.
Medicare.
Art. 66 Impotent Rents and Allowances

1 Subject to overcompensation, annuities and capital allowances of the various social insurance schemes are accumulated.

2 Capital annuities and allowances are, in accordance with the provisions of the special law concerned and in the following order, paid by:

A.
AVS or AI;
B.
Military insurance or accidental insurance;
C.
Old-age, survivors and invalidity pension under the Federal Act of 25 June 1982 on old-age pension, survivors and invalidity (LPP) 1 .

3 The allowances for impotents are, in accordance with the provisions of the special law concerned and in the following order, paid exclusively by:

A.
Military insurance or accidental insurance;
B.
AVS or CEW.

Art. 67 Treatment and cash benefits

1 Where the beneficiary of the daily allowance or an annuity stays at the expense of social insurance in a hospital establishment, the social insurer who is required to take charge of the treatment may, taking into account the family expenses of the insured person, Deduct a fixed amount for pension expenses in the hospital setting. This deduction may be made on the daily allowance or on the annuity.

2 If the beneficiary of an allowance for impotent stays in a hospital at the expense of social insurance, the entitlement to the allowance shall be deleted for each calendar month spent in the institution. 1


1 New content according to the c. 2 of the annex to the LF 6 Oct. 2006 (5 E Revision AI), effective from 1 Er Jan 2008 ( RO 2007 5129 ; FF 2005 4215 ).

Art. 68 Daily Allowances and Annuities

Subject to overcompensation, the daily allowances and annuities of various social insurance schemes are accumulated.

Art. 69 Overpayment

1 The social insurance benefit competition must not lead to an overcompensation of the person entitled to it. Only benefits of the same nature and purpose which are granted to the insured as a result of the harmful event shall be taken into account in the calculation of overcompensation.

2 There is overcompensation to the extent that the social benefits legally payable exceed, due to the realization of the risk, both the gain from which the insured person is presumed to have been deprived, the additional costs and the possible reductions of Income from loved ones.

3 Cash benefits are reduced by the amount of overcompensation. The exception is any reduction in AVS and DI annuities, as well as an allowance for impotents and damages for the impairment of integrity. For capital benefits, the value of the corresponding annuity is taken into account.

Art. Interim Support of Benefits

1 The entitled person may apply for the temporary care of his case when an insured event entices him to social insurance benefits, but there is doubt about the debtor of those benefits.

2 The following are required to take the case on an interim basis:

A.
Health insurance, for benefits in kind and per diems for which sickness, accident insurance, military insurance or DI is contested;
B.
Unemployment insurance benefits for which unemployment insurance, sickness insurance, accident insurance or DI is contested;
C.
Accident insurance, for benefits for which accident insurance or military insurance is contested;
D.
Old-age pension, survivors and invalidity in the sense of the LPP 1 , for annuities which are contested by accident insurance or military insurance or by occupational pensions, survivors and invalidity within the meaning of the PPL.

3 The person entitled addresses his request to the social insurance institutions which are included in the account.


Art. Refund

The insurer required to take the case on an interim basis allocates benefits in accordance with the provisions governing its activity. When the case is taken care of by another insurer, the insurer reimburses the insurer for its advances to the extent that it corresponds to the benefits that it should have allocated itself.

Section 2 Subrogation

Art. 72 Principle

1 As soon as the harmful event occurs, the insurer is subrogated to the rights of the insured person and its survivors against any responsible third party, to the extent of the legal benefits.

2 Where there are a number of officials, they are jointly and severally liable for the insurer.

3 The limitation periods applicable to the rights of the injured person are also applicable to the rights which have passed to the insurer. However, for the insurer's claims, the time limits do not start to run until the insurer has been aware of the benefits to be allocated and the person in charge.

4 Where the injured person has a direct right against the insurer in civil liability, this right also goes to the subrogate insurer. The exceptions based on the insurance contract which cannot be opposed to the injured person cannot be the same as the insurer's claims.

5 The Federal Council shall issue provisions on the exercise of the right of appeal. It may, in particular, order that, in the event of an appeal against an official who is not insured in civil liability, several insurers participating in the action claim their reclaims through a single insurer. The Federal Council regulates representation in respect of third parties if interested insurers fail to agree.

Art. Subrogation Scope

1 The insurer is subrogated to the rights of the insured person and its survivors only to the extent that the benefits which it allocates, together with the compensation due for the same period by the responsible third party, exceed the damage caused by it.

2 However, if the insurer has reduced its benefits within the meaning of s. 21, para. 1 or 2, the rights of the insured person or his survivors go to the insurer to the extent that the unreduced benefits, together with the repair due for the same period by the third party, exceed the amount of the damage.

3 Rights that do not pass to the insurer remain vested in the insured or his or her survivors. If only part of the compensation payable by the responsible third party can be recovered, the insured or his survivors shall have a preferential right in that part.

S. 74 Classification of rights

1 Fees go to the insurer for benefits of the same nature.

2 Benefits of the same kind include:

A.
Reimbursement of processing and rehabilitation costs by the Insurer and the responsible third party;
B.
The daily allowance and compensation for incapacity for work;
C.
Disability pensions or old-age pensions allocated to their place and compensation for incapacity for gain;
D. 1
Benefits for impotence, assistance and reimbursement of expenses related to care and other costs due to impotence;
E.
Compensation for damage to integrity and compensation as a moral remedy;
F.
Survivor annuities and loss of support benefits;
G.
Funeral expenses and other costs related to death.

1 New content according to the c. 3 of the annex to the LF of 18 March 2011 (6 E Revision AI, first component), in force since 1 Er Jan 2012 ( RO 2011 5659 ; FF 2010 1647 ).

Art. 75 Restriction of the right of appeal

1 The Insurer has a right of appeal against the spouse of the insured, his ascending and descending online parents, or the persons who jointly household with him, unless they have caused the event intentionally or by gross negligence.

2 If the claims are a result of a professional accident, the same limitation applies to the insured's employer, family members and employees of his or her business.

3 There is no limitation of the right of appeal of the insurer to the extent that the person against whom the appeal is lodged is covered by compulsory third party liability insurance. 1


1 Introduced by ch. 2 of the annex to the LF 6 Oct. 2006 (5 E Revision AI), effective from 1 Er Jan 2008 ( RO 2007 5129 ; FF 2005 4215 ).

Chapter 6 Miscellaneous provisions

Art. 76 Supervisory Authority

1 The Federal Council monitors and reports regularly on the implementation of social insurance.

2 In the event of a serious and repeated breach of the legal provisions by an insurer, the Federal Council shall order the measures necessary for the restoration of insurance management 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 monitor their activity and to establish meaningful statistics. They are required to submit a report and annual accounts.

S. 78 Liability

1 The public law corporations, the private founding organisations and the insurers shall, in their capacity as guarantors of the activities of the social insurance bodies, provide for damage caused unlawfully to an insured person or to third parties by Their implementing bodies or their staff.

2 The competent authority shall make a decision on claims for compensation.

3 The subsidiary responsibility of the Confederation for the independent institutions of the ordinary administration of the Confederation is governed by Art. 19 of the Act of 14 March 1958 on Liability 1 .

4 The provisions of this Law shall apply to the procedure provided for in paras. 1 and 3. There is no opposition procedure. Art. 3 to 9, 11, 12, 20, para. 1, 21 and 23 of the Act of 14 March 1958 on liability shall apply mutatis mutandis.

5 Persons acting as organs or agents of an insurer, a review or control body or entrusted with tasks under the special laws are subject to the same criminal responsibility as the members of the authorities And civil servants, according to the provisions of the Penal Code 2 .


Art. Criminal Provisions

1 The General Part of CP 1 As well as art. 6 of the Federal Act of 22 March 1974 on administrative criminal law 2 Are applicable. 3

2 The criminal prosecution is the responsibility of the cantons.


1 RS 311.0
2 RS 313.0
3 New content according to the c. II 28 of Annex 1 to the Code of Criminal Procedure of 5 October. 2007, effective from 1 Er Jan 2011 ( RO 2010 1881 ; FF 2006 1057 ).

Art. 80 Tax Exemption for Insurers

1 Insurers and enforcement bodies are exempt from direct federal, cantonal and communal taxes, as well as cantonal and communal taxes on estates and donations to the extent that their income and capital are used exclusively for Implement social insurance, or to allocate or guarantee social insurance benefits.

2 Documents used in the implementation of social insurance to correspond with insured persons or third parties and other organisations are exempt from public fees and fees. The collection of contributions legally due is not subject to federal stamp duty on bonus payments.

Chapter 7 Final provisions

Art. Executing

The Federal Council shall be responsible for the implementation of this Law. It shall lay down the necessary provisions.

Art. Transitional provisions

1 The substantive provisions of this Law shall not apply to current benefits and claims fixed before it comes into force. On request, invalidity or survivors' pensions reduced or refused due to a fault of the insured will, however, be reviewed and, if necessary, fixed again in accordance with Art. 21, para. 1 and 2, as soon as possible after the entry into force of this Act.

2 ... 1


1 Repealed by c. II 38 of the LF of 20 March 2008 on the formal updating of federal law, with effect from 1 Er August 2008 ( RO 2008 3437 ; FF 2007 5789 ).

Art. 83 Amendment of the law in force

1 The items listed in the Annex are repealed or amended.

2 Before the entry into force of this Act, the Federal Assembly may, by order, amend the schedule in order to adapt it to the changes that would have been made to the laws concerned and which would have entered into force since the adoption of the This Act.

Art. 84 Referendum and entry into force

1 This Act is subject to an optional referendum.

2 The Federal Council shall fix the date of entry into force.

3 Art. 83, para. 2, shall enter into force, in the absence of a referendum, on the first day of the second month following the expiry of the referendum period or, in the case of a referendum, on the day on which this Act is accepted by the people.

Annex

Amendment of the law in force

... 1


1 The mod. Can be viewed at RO 2002 3371 3453 3472 3475.


State 1 Er January 2012