Federal Act of 6 October 2000 on the General Part of the Social Insurance Law (LPGA) - Purpose and Objective (ATSG)

This Act coordinates the federal law of social insurance by: a. defining the principles, terms, and institutions of social insurance law; b. establishing the standards for a uniform procedure and regulating judicial organization in the field of social insurance; c. harmonizing the benefits of social insurance; d. regulating the right of recourse of social insurance against third parties.

The provisions of the present law are applicable to social insurances governed by federal legislation, if and to the extent that the special social insurance laws provide for it.

Any impairment to physical, mental, or psychological health that is not caused by an accident and that requires medical examination or treatment, or causes incapacity to work, is considered an illness.

Any illness present at the child's completed birth is considered a congenital infirmity.

An accident is considered to be any damaging, sudden, and involuntary impact on the human body by an extraordinary external cause, which compromises physical, mental, or psychological health, or leads to death.

Maternity includes pregnancy and childbirth as well as the recovery period that follows childbirth.

Incapacity for work is defined as any total or partial loss of the insured's ability to perform the work that can reasonably be expected of them in their profession or field of activity, if this loss results from an impairment of their physical, mental, or psychological health. In the case of long-term incapacity for work, the activity that can be required of them may also pertain to another profession or field of activity.

A loss of earning capacity is considered to be any reduction in the insured's overall or partial earning opportunities in the balanced labor market that are relevant, if this reduction results from an impairment to their physical, mental, or psychological health and persists after reasonable treatments and rehabilitation measures.

Only the consequences of the health impairment are taken into account when determining the presence of a loss of earning capacity. Moreover, there is a loss of earning capacity only if it cannot be objectively overcome.

Disability is considered to be a total or partial incapacity for work that is presumed to be permanent or long-lasting.

Insured minors without gainful employment are considered disabled if they have a physical, mental, or psychological health impairment that will likely result in a total or partial incapacity for work.

Insured adults who were not engaged in gainful employment before suffering from a physical, mental, or psychological health impairment, and who cannot be expected to take up gainful employment, are considered disabled if the impairment prevents them from carrying out their usual work. Art. 7, para. 2, applies by analogy.

A person is considered incapacitated if, due to a health impairment, they require permanent assistance from others or personal supervision to perform basic activities of daily life.

An employee is deemed to be a person who performs dependent work and receives for this work a definitive salary in accordance with special laws.

A person who employs employees is deemed to be an employer.

A person is considered to be self-employed if their income does not come from working as an employee.

A self-employed person can simultaneously have employee status if they receive a corresponding salary.

A person's domicile is determined according to Articles 23 to 26 of the Civil Code.

A person is considered to have their habitual residence where they stay for a certain period, even if the duration of this stay is initially limited.

Throughout its duration, a registered partnership is treated as equivalent to marriage under social insurance law.

The surviving registered partner is treated as a widower.

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

Benefits in kind include, in particular, medical treatments or care, auxiliary means, individual preventive and rehabilitation measures, transportation costs, and similar benefits that are provided or reimbursed by the different social insurances.

Cash benefits include, in particular, daily allowances, pensions, annual supplementary benefits, allowances for those in need of care, and their supplements; they do not include the replacement of a benefit in kind at the expense of an insurance.

To assess the degree of disability, the income that the insured could have earned if they were not disabled is compared with the income they could earn by engaging in an activity that can reasonably be required of them after treatments and rehabilitation measures, in a balanced labor market.

The invalidity pension is revised for the future, either ex officio or upon request, meaning it can be increased, reduced, or discontinued, when the insured person's degree of disability: a. undergoes a modification of at least 5 percentage points, or b. reaches 100%.

Similarly, any long-term benefit granted by a decision that has come into force is, either ex officio or upon request, increased or reduced accordingly, or discontinued if the circumstances on which its grant was based change significantly.

For social insurances that provide cash benefits determined as a percentage of earnings, the Federal Council sets the maximum amount of insured earnings.

As a general rule, periodic cash benefits are paid on a monthly basis.

Daily allowances and similar benefits are paid to the employer insofar as they continue to pay a salary to the insured despite the insured's entitlement to daily allowances.

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

If the right to benefits appears established and their payment is delayed, advances may be paid.

The insurer may pay all or part of the cash benefits to a qualified third party or an authority with a legal or moral obligation of support towards the beneficiary, or who provides continuous assistance to the beneficiary when: a. the beneficiary does not use these benefits for their maintenance or for the maintenance of the persons for whom they are responsible, or it is established that they are unable to use them for this purpose, and b. the beneficiary themselves or the persons they are responsible for consequently depend on public or private assistance.

Benefits paid to a third party or an authority cannot be offset by this third party or this authority with claims against the entitled party. An exception is the offsetting in the case of retroactive payment of benefits under Art. 22, para. 2.

If the insured has aggravated the insured risk or has intentionally caused its realization by committing a crime or offense intentionally, cash benefits may be temporarily or permanently reduced or, in particularly serious cases, refused.

Cash benefits owed to the relatives or survivors of the insured are only reduced or refused if they have intentionally caused the realization of the risk by committing a crime or offense intentionally.

To the extent that social insurances characterized as loss of earnings insurance do not provide any cash benefits for relatives, cash benefits may only be reduced by half according to para. 1. For the other half, the reduction foreseen in para. 2 remains reserved.

Benefits may be reduced or refused temporarily or permanently if the insured avoids or opposes, or does not spontaneously participate, within the bounds of what can be reasonably demanded of them, in a treatment or professional reintegration measure that is reasonably required and likely to significantly improve their work capacity or offer a new earning possibility. A written warning informing them of the legal consequences and providing a reasonable reflection period must have been sent to them. Treatments and rehabilitation measures that pose a danger to life or health are not required.

If the insured is serving a sentence or a measure, the payment of loss of earnings benefits can be partially or fully suspended for the duration of the sentence. If they avoid serving a sentence or measure, the payment of the benefits for loss of earnings is suspended from the time the sentence or measure should have been executed. Benefits intended for the maintenance of relatives referred to in para. 3 are excepted.

The right to benefits is non-transferable; it cannot be pledged. Any transfer or pledge is void.

However, benefits granted retroactively by the social insurer may be assigned: a. to the employer or a public or private social assistance institution to the extent that they have provided advances; b. to the insurer who has temporarily borne the costs of benefits.

The entitled person may waive benefits that are due to them. The waiver can be revoked at any time for the future. The waiver and the revocation must be made in writing.

The waiver and the revocation are null and void if they are detrimental to the interests of other persons, insurance or assistance institutions, or if they seek to circumvent legal provisions.

The insurer shall confirm in writing the waiver and the revocation to the entitled person. The confirmation must mention the object, scope, and consequences of the waiver and the revocation.

The right to benefits or arrears of contributions is extinguished 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.

If the contributor has evaded the obligation to contribute through a punishable act for which criminal law provides a longer statute of limitations, it is that statute which determines when the claim is extinguished.

Unduly received benefits must be restituted. Restitution cannot be required if the beneficiary acted in good faith and such restitution would place them in a difficult situation.

The right to claim restitution expires three years after the insurance institution became aware of the fact, but no later than five years after the benefit was paid. If the claim arises from a punishable act for which criminal law provides a longer statute of limitations, the latter shall be applicable.

Repayment of overpaid contributions may be requested. The right expires one year after the contributor became aware of their excessive payments, but no later than five years after the end of the calendar year in which the contributions were paid.

Claims for due contributions are subject to the charging of default interest, and claims for the restitution of contributions unduly paid are subject to the payment of compensatory interest. The Federal Council may provide exceptions for modest claims or those that have become due recently.

Default interest is owed for any social insurance benefit claim at the expiration of a 24-month period from the origination of the right, but not earlier than twelve months from when the insured asserts this right, provided that they have fully complied with the obligation to cooperate that is incumbent upon them.

No default interest is owed when foreign insurers are responsible for the delays.

The following are not entitled to default interest: a. the person entitled to benefits or their heirs, when the benefits are retroactively paid to third parties; b. third parties who have provided advances or temporarily covered benefits in accordance with Art. 22, para. 2, and to whom the retroactively granted benefits have been assigned; c. other social insurances that have temporarily covered benefits in accordance with Art. 70.

Within the limits of their area of competence, insurers and the implementing bodies of the various social insurances are required to inform interested parties about their rights and obligations.

Everyone has the right to be advised, in principle free of charge, on their rights and obligations. The insurers required to provide such advice are those against whom the interested parties must assert their rights or fulfill their obligations. The Federal Council may provide for the levying of fees and set the tariff for consultations that require costly research.

If an insurer finds that an insured person or their dependents are entitled to benefits from other social insurances, they shall inform them without delay.

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

Anyone asserting their right to benefits must provide all necessary information free of charge to establish this right, determine the benefits due, and pursue recourse claims.

The applicant is required to authorize the relevant persons and institutions, particularly employers, doctors, insurers, and official bodies, to provide the necessary information to establish the right to benefits and pursue recourse claims. These persons and institutions are obliged to provide the required information.

Anyone asserting their right to benefits must submit their claim to the competent insurer in the prescribed form for the relevant social insurance.

Social insurers provide forms for asserting and establishing the right to benefits free of charge; these forms must be submitted to the competent insurer, completed fully and accurately by the applicant or their employer, and, if applicable, by the attending physician.

If an application does not meet the formal requirements or is submitted to an incompetent authority, the date on which it was posted or submitted to that authority is decisive for the compliance with deadlines and the legal effects of the application.

All implementing bodies of social insurance are obliged to accept applications, requests, or other documents that are received by them in error. They record the date of receipt and transmit them to the competent body.

The beneficiary, their relatives, or third parties to whom a benefit is paid are required to inform the insurer or, as the case may be, the competent body of any significant change in the circumstances that are decisive for the granting of a benefit.

Any person or institution participating in the implementation of social insurances is obliged to inform the insurer if they learn that the circumstances decisive for the granting of benefits have changed.

The administrative and judicial authorities of the Confederation, the cantons, the districts, the constituencies, and the municipalities shall provide the social insurance bodies with the necessary data free of charge, upon written and reasoned request, in particular cases in order to: a. determine or modify benefits, or demand their restitution; b. prevent undue payments; c. determine and collect contributions; d. assert a recourse claim against a responsible third party.

The social insurance bodies shall assist each other under the same conditions.

If the bodies of a social insurance, or the administrative and judicial authorities of the Confederation, the cantons, the districts, the constituencies, or the municipalities learn, in the course of their duties, that an insured person receives undue benefits, they may inform the concerned social insurance bodies as well as the affected provident institutions.

The bodies referred to in Art. 75 shall exchange the necessary data to perform the tasks assigned to them pursuant to Annex II of the Agreement of June 21, 1999, between the Swiss Confederation, on one hand, and the European Community and its Member States, on the other hand, on the free movement of persons (Agreement on the Free Movement of Persons) and other international social security conventions.

Persons involved in the implementation, monitoring, or supervision of social insurance laws are obligated to maintain confidentiality with respect to third parties.

The following are considered parties: individuals whose rights or obligations arise from social insurance, as well as persons, organizations, or authorities that have legal recourse against the decision of an insurer or an implementing body of the same level.

The insurer shall ex officio examine whether it has jurisdiction.

The insurer that considers itself competent shall determine so in a decision if a party contests its jurisdiction.

The insurer that considers itself incompetent shall issue a decision of inadmissibility if a party claims it is competent.

Persons appointed to make or prepare decisions regarding rights or obligations must recuse themselves if they have a personal interest in the matter or if, for other reasons, they appear to be biased.

If the recusal is contested, the decision is made by the supervisory authority. In the case of the recusal of a member of a panel, the decision is made by the panel in the absence of that member.

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

The insurer may require the representative to justify their authority with a written power of attorney.

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

When circumstances require, free legal assistance is granted to the applicant.

If the time limit, counted in days or months, must be communicated to the parties, it begins to run the day after notification.

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

A communication that is only delivered against the signature of the recipient or an authorized third party is deemed received no later than seven days after the first unsuccessful delivery attempt.

When the time limit expires on a Saturday, Sunday, or a public holiday according to federal or cantonal law, its end is postponed to the first working day that follows. The applicable cantonal law is that of the canton where the party or its representative has their domicile or headquarters.

Time limits in days or months set by law or by the authority do not run: a. from the 7th day before Easter to the 7th day after Easter inclusively; b. from July 15 to August 15 inclusively; c. from December 18 to January 2 inclusively.

Documents must be submitted to the insurer, at its address, to Swiss Post, or to a Swiss diplomatic or consular representation no later than the last day of the deadline.

If a party addresses an incompetent insurer in a timely manner, the deadline is deemed to be observed.

The statutory deadline cannot be extended.

If the insurer sets a deadline for a specific action, they must simultaneously indicate the consequences of a delay. These consequences cannot differ from those mentioned in the warning.

The deadline set by the insurer can be extended for relevant reasons if the party requests it before its expiration.

If the applicant or his/her representative was prevented, through no fault of their own, from acting within the specified deadline, the deadline shall be restituted provided that, within 30 days from the date the impediment ceased, the applicant or his/her representative submits a justified request for restitution and completes the omitted act.

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

The insurer shall examine applications, take the necessary investigative measures on its own initiative, and gather the information it requires. Information provided orally must be recorded in writing.

The insurer determines the nature and extent of the necessary investigation.

The insured must undergo medical or technical examinations if they are necessary for the assessment of the case and can be reasonably demanded.

If the insured or other applicants unreasonably refuse to fulfill their obligation to provide information or to cooperate in the investigation, the insurer may make a decision based on the existing file or close the investigation and decide not to pursue the matter further. The insurer must have sent them a written warning outlining the legal consequences and granting them a suitable reflection period.

The insurer may secretly observe an insured person and, for this purpose, make visual and audio recordings or use technical instruments to locate them under the following conditions: a. there are concrete indications suggesting that an insured person is unjustly receiving or attempting to receive benefits; b. without surveillance measures, the investigative measures would have no chance of success or would be excessively difficult.

A person holding a managerial position in the relevant field of the case to be handled or in the field of the insurer's benefits has the authority to order surveillance.

The use of technical instruments aimed at locating an insured person requires authorization.

An insured person can only be observed in the following cases: a. they are located in an area accessible to the public, or b. they are located in an area that is freely visible from a place accessible to the public.

Surveillance may take place for a maximum of 30 days over a period of six months from the first day of observation. This period may be extended by a maximum of six months if sufficient reasons justify it.

The insurer may entrust surveillance to external specialists. These specialists are subject to the duty of confidentiality in accordance with Art. 33 and are prohibited from using the information gathered within the framework of their mandate for other purposes. The insurer may use the material collected during an observation conducted by another insurer under this law or an insurer under the Insurance Supervision Act of 17 December 2004, or by their mandate, provided that this observation complied with the conditions set out in para. 1 to 5.

The insurer informs the person concerned of the reason, nature, and duration of the observation, at the latest before issuing the decision regarding the benefit.

If the surveillance did not confirm the indications mentioned in para. 1(a), the insurer: a. issues a decision regarding the reason, nature, and duration of the surveillance conducted; b. destroys the material collected during the surveillance after the decision becomes legally binding if the insured has not expressly requested that it be retained in the file.

The Federal Council regulates: a. the procedure by which the insured can consult the complete material collected during the surveillance; b. the retention and destruction of the material collected; c. the requirements for specialists responsible for the surveillance.

When the insurer plans to order an observation measure using technical instruments aimed at locating the insured, they shall submit a request to the competent court containing the following elements: a. the indication of the specific purpose of the observation measure; b. the data related to the persons concerned by the observation measure; c. the planned modalities of the observation measure; d. the justification for the necessity of using technical instruments aimed at locating the insured as well as the reasons why, without the use of these instruments, investigative measures have proven futile, would have no chance of success, or would be excessively difficult; e. the indication of the start and end of the observation measure and the time frame within which it must be implemented; f. the essential documents for the processing of the request.

The president of the competent court of the competent tribunal shall decide as a single judge within five working days from receipt of the insurer's request, indicating the reasons briefly; this task may be entrusted to another judge.

They may authorize the observation on a provisional basis, attach conditions to the authorization, or request that the file be supplemented or that further clarifications be provided.

The competent court is: a. the cantonal insurance court of the canton of domicile of the insured; b. the Federal Administrative Court for insured persons domiciled abroad.

If the insurer deems an expert opinion necessary within the framework of medical investigation measures, it determines the type according to the required needs; three types are possible: a. monodisciplinary expert opinion; b. bidisciplinary expert opinion; c. multidisciplinary expert opinion.

If the insurer must resort to the services of one or more independent experts to elucidate the facts within the framework of an expert opinion, it communicates their name to the parties. The parties may challenge the experts for the reasons indicated in Art. 36, para. 1, and submit counter-proposals within a ten-day deadline.

When communicating the names of the experts, the insurer also submits to the parties the questions it intends to pose to the experts and informs them that they have the opportunity to submit additional questions in writing within the same timeframe. The insurer makes the final decision on the questions posed to the experts.

If, despite the request for challenge, the insurer maintains its choice of the prospective experts, it notifies the parties via an incidental decision.

The medical disciplines are definitively determined by the insurer for the expert opinions referred to in para. 1, let. a and b, and by the expertise center for those referred to in para. 1, let. c.

Unless advised otherwise by the insured, the interviews between the insured and the expert are subject to audio recordings, which are kept in the insurer's file.

The Federal Council: a. may regulate the nature of assigning the mandate to an expertise center for the expert opinions referred to in para. 1; b. issues criteria for the admission of medical experts and experts in neuropsychology for the expert opinions referred to in para. 1; c. establishes a commission bringing together representatives from various social insurances, expertise centers, medical professionals, neuropsychologists, scientific communities, as well as patient and disability support organizations to monitor the accreditation, the process, and the result of medical expert opinions. It issues public recommendations.

The costs of the instruction are covered by the insurer who ordered the measures. If not, the insurer reimburses the costs incurred by measures essential for the assessment of the case or included in the benefits granted subsequently.

The insurer compensates the parties as well as the persons required to provide information if they suffer a loss of earnings or incur expenses.

The costs may be charged to the party that prevents or hinders the instruction in an inexcusable manner after a warning and indication of the consequences.

If the insured person has obtained or attempted to obtain a benefit by knowingly providing false information or in another illegal manner, the insurer may charge the insured with the additional costs incurred by the use of specialists engaged to conduct observations to combat the undue receipt of benefits.

During each procedure related to social insurance, the insurer systematically records all documents that may be decisive.

The right to consult the file is granted, provided that overriding private interests are safeguarded: a. the insured, for data concerning them; b. the parties, for data necessary for the exercise of a right or the fulfillment of an obligation arising from social insurance law, or to assert a legal remedy against a decision based on this same law; c. the authorities empowered to rule on appeals against decisions based on social insurance law, for data necessary to fulfill this task; d. the responsible third party and their insurer, for data necessary to assess a recourse claim from the relevant social insurance.

In the case of health data, where communication could lead to a health impairment of the person authorized to consult the file, they may be required to designate a doctor who will communicate it to them.

A document that has been withheld from a party may only be used to their disadvantage if the insurer has communicated to them, orally or in writing, the essential content relating to the matter and has given them the opportunity to express themselves and provide counter-evidence.

The insurer must issue in writing decisions that concern significant benefits, claims, or directives, or with which the interested party disagrees.

If the applicant demonstrates a protectable interest, the insurer shall issue a declaratory decision.

The decisions indicate the legal remedies available. They must be reasoned if they do not fully grant the parties' requests. An irregular notification of a decision should not harm the interested party.

An insurer making a decision affecting another insurer's obligation to provide benefits is required to communicate a copy thereof to the latter. This other insurer has the same legal remedies as the insured.

In its decision, the insurer may deprive any objection or appeal of its suspensive effect, even if this decision pertains to a cash benefit. Decisions ordering the repayment of benefits unduly paid are excepted.

Disputes concerning social insurance benefits may be resolved by settlement.

The insurer is required to notify the settlement in the form of a decision that is subject to appeal.

Paragraphs 1 and 2 apply by analogy to the objection procedure as well as to the appeal procedure.

Benefits, claims, and orders not covered by Art. 49, para. 1, may be handled according to a simplified procedure.

The party concerned may request that a decision be issued.

Decisions may be contested within thirty days by filing an objection with the insurer that issued them, with the exception of decisions relating to the ordering of procedural measures.

Decisions on objections must be issued within a reasonable time. They must include a statement of reasons and indicate the available legal remedies.

The objection procedure is free of charge. As a general rule, legal costs cannot be awarded.

In its decision on objection, the insurer may deprive any appeal of its suspensive effect, even if this decision concerns a cash benefit. Exceptions are decisions on objections ordering the restitution of unduly paid benefits.

The insurer may provisionally suspend the payment of benefits if the insured has failed to fulfill their obligation to notify in the cases referred to in Art. 31, para. 1, if they have not submitted the requested certificate of life or civil status within the time limits, or if the insurer has serious reasons to believe that the insured is receiving benefits to which they are not entitled.

Decisions and decisions on formal oppositions that have become final may be subject to revision if the insured or the insurer subsequently discovers important new facts or finds new evidence that could not have been presented previously.

The insurer may reconsider decisions or decisions on formal oppositions that have become final when they are manifestly erroneous and their correction is of significant importance.

Until the insurer sends its notice to the appellate authority, it may reconsider a decision or a decision on opposition against which an appeal has been filed.

Decisions and decisions on opposition are enforceable when: a. they can no longer be contested by opposition or an appeal; b. the opposition or appeal does not have a suspensive effect; c. the suspensive effect granted to an opposition or an appeal has been lifted.

Enforceable decisions and decisions on opposition requiring payment of a sum of money or the provision of security are equivalent to enforceable judgments within the meaning of Art. 80 of the Federal Debt Collection and Bankruptcy Act of April 11, 1889.

Procedural matters that are not exhaustively regulated in Articles 27 to 54 of this Act or by the provisions of special laws are governed by the Federal Act of December 20, 1968, on Administrative Procedure.

The Federal Council may declare applicable to procedures governed by this Act the provisions of the Federal Act of December 20, 1968, on Administrative Procedure relating to electronic communication with authorities.

The procedure before a federal authority is governed by the Federal Act of December 20, 1968, on Administrative Procedure, except in cases of benefits, claims, and orders under social insurance law.

Decisions on objections and those against which the objection procedure is not available are subject to appeal.

An appeal may also be lodged if the insurer, despite a request from the interested party, does not issue a decision or a decision on the objection.

Each canton establishes an insurance tribunal, which decides in a single instance on appeals in the field of social insurance.

The competent social insurance court is that of the canton of residence of the insured or another party at the time the appeal is filed.

If the insured or another party are domiciled abroad, the competent social insurance court is that of the canton of their last residence in Switzerland or that of the canton of residence of their last Swiss employer; if none of these residences can be determined, the competent social insurance court is that of the canton where the executing authority has its headquarters.

The court that declines jurisdiction shall promptly forward the appeal to the competent court.

Anyone affected by the decision or the decision on opposition and having a legitimate interest worthy of protection in its annulment or modification has the standing to appeal.

The appeal must be filed within thirty days following the notification of the decision subject to appeal.

Articles 38 to 41 apply by analogy.

Subject to Art. 1, para. 3, of the Federal Act of December 20, 1968, on Administrative Procedure, the procedure before the cantonal insurance court is governed by cantonal law. It must satisfy the following requirements: a. it must be simple, swift, and, as a general rule, public; b. the appeal must contain a succinct statement of the facts and reasons invoked, as well as the conclusions; if the appeal does not comply with these rules, the court shall grant the appellant a reasonable period to remedy the deficiencies, warning them that failure to do so will result in the dismissal of the appeal; c. the court shall establish the facts necessary for resolving the dispute with the cooperation of the parties; it shall administer the necessary evidence and assess it freely; d. the court is not bound by the parties’ conclusions; it may reform the contested decision to the detriment of the appellant or grant more than was requested; however, it must give the parties the opportunity to comment or withdraw the appeal; e. if circumstances justify, the parties may be summoned for oral arguments; f. the right to be assisted by legal counsel must be guaranteed; when circumstances justify, free legal aid is granted to the appellant; fbis. for disputes concerning benefits, the procedure is subject to court fees if provided for by the special law; if the special law does not provide for court fees for such disputes, the court may charge them to the party acting recklessly or without due consideration; g. the appellant who prevails is entitled to reimbursement of costs and expenses as determined by the court; their amount is determined without regard to the value in dispute based on the importance and complexity of the dispute; h. judgments contain the reasons, indication of means of appeal, and the names of the court members, and are notified in writing; i. judgments are subject to revision if new facts or evidence are discovered or if a crime or offense influenced the judgment.

Judgments rendered by cantonal insurance courts may be subject to an appeal before the Federal Supreme Court, in accordance with the Federal Supreme Court Act of 17 June 2005.

The Federal Council regulates the standing to appeal before the Federal Supreme Court of the social insurance execution bodies.

Art. 54 applies mutatis mutandis to the enforcement of judgments rendered by the appeal authorities preceding the Federal Supreme Court.

The coordination rules provided in this section apply to benefits granted by multiple social insurances.

The OASI and DI are considered as a single social insurance.

The coordination of benefits within the same social insurance is governed by the respective special law.

The treatment is exclusively the responsibility of a single social insurance in so far as it consists of benefits prescribed by law.

If the conditions of the specific law concerned are met, the treatment, within legal limits, shall be borne in the following order by: a. military insurance; b. accident insurance; c. disability insurance (DI); d. health insurance.

The social insurer required to pay benefits shall bear alone and without limitation the costs of hospital treatment, even if the health impairment is not entirely due to the event it is required to cover.

Furthermore, the social insurer required to pay benefits shall cover the treatment of health impairments for which it is not responsible, when these impairments occur during a hospital treatment and cannot be treated separately.

Other benefits in kind, such as assistive devices or rehabilitation measures, are covered, within the limits of the relevant special law and in the following order, by: a. military insurance or accident insurance; b. old-age and survivors' insurance (OASI) or disability insurance (DI); c. health insurance.

Subject to overcompensation, the pensions and lump-sum benefits from various social insurances are aggregated.

The pensions and lump-sum benefits are disbursed according to the provisions of the relevant special law and in the following order: a. the Old-Age and Survivors' Insurance (OASI) or the Invalidity Insurance (II); b. the military insurance or accident insurance; c. the occupational pension scheme for old age, survivors, and disability in accordance with the Federal Act of June 25, 1982 on Occupational Old Age, Survivors and Disability Pensions (OPA).

Allowances for the impaired are, according to the provisions of the relevant special law and in the following order, exclusively disbursed by: a. the military insurance or accident insurance; b. the OASI or the II.

When a beneficiary of daily allowances or a pension stays at the expense of social insurance in a hospital establishment, the social insurer responsible for covering the treatment may, taking into account the family obligations of the insured, deduct a fixed amount for boarding costs in the hospital establishment. This deduction may be made from the daily allowance or the pension.

If the beneficiary of an allowance for the helpless stays in a hospital establishment at the expense of social insurance, the right to the allowance is suspended for each entire civil month spent in the establishment.

Subject to overcompensation, daily allowances and pensions from various social insurances are combined.

The combination of benefits from different social insurances shall not lead to an overcompensation of the entitled person. Only benefits of the same nature and purpose granted to the insured due to the damaging event are considered in the calculation of overcompensation.

Overcompensation occurs to the extent that the legally due social benefits exceed, due to the occurrence of the risk, both the income the insured is presumed to have been deprived of, the additional expenses, and any potential loss of income experienced by the relatives.

Cash benefits are reduced by the amount of overcompensation. Exempted from any reduction are AVS and AI pensions, as well as allowances for aid and compensation for impairment. For capital benefits, the value of the corresponding pension is taken into account.

The entitled person may request the provisional coverage of their case when an insured event entitles them to benefits from a social insurance but there is doubt as to the debtor of these benefits.

The following are obliged to provisionally cover the case: a. the health insurance, for benefits in kind and daily allowances whose coverage by health insurance, accident insurance, military insurance, or AI (Invalidity Insurance) is contested; b. the unemployment insurance, for benefits whose coverage by unemployment insurance, health insurance, accident insurance, military insurance, or AI is contested; c. the accident insurance, for benefits whose coverage by accident insurance or military insurance is contested; d. the occupational pensions for old-age, survivors and disability according to the LPP (Occupational Pensions Act), for pensions whose coverage by accident insurance, military insurance, or occupational pensions for old-age, survivors and disability according to the LPP is contested.

The entitled person addresses their request to the relevant social insurance institutions.

The insurer provisionally responsible for handling the case allocates the benefits according to the provisions governing its operations. When another insurer takes over the case, the latter reimburses the former for its advances to the extent that they correspond to the benefits it would have been obliged to provide itself.

Upon the occurrence of the damaging event, the insurer is subrogated, to the extent of the legal benefits, to the rights of the insured and their survivors against any liable third parties.

When there are multiple liable parties, they are jointly and severally liable to the insurer.

The limitation periods applicable to the rights of the injured person are also applicable to the rights transferred to the insurer. However, for the insurer’s recourse claims, the relevant time limits do not begin to run until the insurer is aware of the benefits it must allocate as well as the liable party.

When the injured person has a direct right against the liability insurer, this right also passes to the subrogated insurer. Exceptions based on the insurance contract that cannot be invoked against the injured person cannot be invoked against the insurer's recourse claims either.

The Federal Council enacts provisions concerning the exercise of the right of recourse. It may, in particular, order that in the case of recourse against a responsible party who is not insured for liability, several insurers participating in the recourse assert their recourse claims through a single insurer. The Federal Council arranges the representation with respect to third parties if the interested insurers cannot reach an agreement.

The insurer is subrogated to the rights of the insured and their survivors only to the extent that the benefits it provides, combined with the compensation owed for the same period by the third party responsible, exceed the damage caused by the latter.

However, if the insurer has reduced its benefits in accordance with Art. 21, para. 1, 2, or 4, the rights of the insured or their survivors are transferred to the insurer to the extent that the non-reduced benefits, combined with the compensation owed for the same period by the third party, exceed the amount of the damage.

The rights that do not pass to the insurer remain with the insured or their survivors. If only part of the compensation due by the responsible third party can be recovered, the insured or their survivors have a preferential right to this part.

Claims transfer to the insurer for benefits of the same nature. Benefits of the same nature include: a. reimbursement of treatment and rehabilitation expenses by the insurer and by the liable third party; b. daily allowances and compensation for incapacity to work; c. disability pensions or old-age pensions granted in their place, compensation for loss of earnings and compensation for pension damage; d. benefits for impairment, assistance contributions, and reimbursement of care-related expenses and other expenses due to impairment; e. compensation for personal injury and compensation for moral damages; f. survivor's pensions and compensation for loss of support; g. funeral expenses and other costs related to death; h. expenses incurred for the assessment and evaluation of the damage.

The insurer has a right of recourse against the insured's spouse, ascendants, descendants, or persons living in a common household with him only if they caused the insured event intentionally or through gross negligence.

If the recourse claims arise from an occupational accident, the same limitation applies to the employer of the insured, the employer's family members, and the workers in the employer's enterprise.

There is no limitation on the insurer's right of recourse insofar as the person against whom the recourse is directed is covered by mandatory liability insurance.

The Federal Council designates the organizations responsible for carrying out the tasks assigned to the various social insurances, particularly as the competent authority, liaison body, or competent institution, pursuant to the relevant acts in the version binding on Switzerland from Annex II of the Agreement on the Free Movement of Persons and pursuant to other international social security agreements.

The Federal Council designates the federal services responsible for establishing and operating the infrastructure intended for the electronic exchange of data with foreign countries, including the necessary electronic access points and interfaces between the national system and the international data exchange system.

The federal services referred to in para. 1 may grant the organizations referred to in Art. 75a online access to data within their area of competence.

The services of the Confederation referred to in Art. 75b charge fees to the competent institutions referred to in Art. 75a for the connection to the infrastructure intended for the electronic exchange of data with foreign countries and its use.

The Federal Council sets the fees in accordance with Art. 46a of the Government and Administration Organization Act of March 21, 1997. It consults the relevant bodies beforehand. It takes into account the extent of the use of the infrastructure when calculating the fees.

The Federal Council supervises the implementation of social insurance and regularly reports on it.

The report drafted for this purpose contains a presentation of the systemic risks of the various social insurances and outlines the strategic management of social insurances by the Federal Council.

In the event of serious and repeated violations of legal provisions by an insurer, the Federal Council or the supervisory authority it has designated orders the necessary measures to restore insurance management in compliance with the law.

The Federal Council regulates the electronic exchange of social security data between Swiss insurers and between them and federal authorities. Provisions relating to data communication in the various social security laws are reserved.

The Federal Council may delegate the authority to regulate electronic data exchange to supervisory authorities.

Social insurers are required to provide the supervisory authorities with all the information they need to monitor their activities and to compile meaningful statistics. They are obligated to submit an annual report and financial statements.

Public law corporations, private founding organizations, and insurers are liable, as guarantors of the activities of the social insurance execution bodies, for damages unlawfully caused to an insured person or third parties by their execution bodies or their personnel.

The competent authority issues a decision on compensation claims.

The subsidiary liability of the Confederation for institutions independent of the Confederation's ordinary administration is governed by Art. 19 of the Act of March 14, 1958, on liability.

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

Persons acting as organs or agents of an insurer, an audit or supervisory body, or entrusted with tasks under special laws, are subject to the same criminal liability as members of authorities and officials, according to the provisions of the Penal Code.

The general part of the Criminal Code and Art. 6 of the Federal Law of March 22, 1974, on Administrative Criminal Law are applicable.

Criminal prosecution falls under the jurisdiction of the cantons.

In the event of criminal proceedings for violation of Art. 148a of the Criminal Code or Art. 87 of the Federal Law of December 20, 1946, on Old-Age and Survivors Insurance, the insurer may exercise the rights of a complaining party.

Insurers and executive bodies are exempt from federal, cantonal, and communal direct taxes as well as cantonal and communal taxes on inheritances and donations insofar as their income and assets are used exclusively to implement social insurance or to allocate or guarantee social insurance benefits.

Documents used in the implementation of social insurance for correspondence with insured persons or third parties, and other organizations are exempt from taxes and public fees. The collection of legally due contributions is not subject to federal stamp duty on premium receipts.

The Federal Council is responsible for the implementation of this law. It enacts the necessary provisions.

The substantive provisions of this Act do not apply to benefits that are ongoing or to claims established before its entry into force. However, upon request, disability or survivors' pensions that were reduced or denied due to the fault of the insured person will be re-examined and, if necessary, re-determined in accordance with Art. 21, paras. 1 and 2, at the earliest from the date of entry into force of this Act.

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Appeals pending before the court of first instance at the time of the entry into force of the amendment of 21 June 2019 are governed by the former law.

The articles listed in the annex are repealed or amended.

Before the entry into force of this law, the Federal Assembly may, by ordinance, modify the annex to adapt it to any amendments made to the relevant laws that have come into force since the adoption of this law.

This law is subject to an optional referendum.

The Federal Council shall set the date of entry into force.

Art. 83, para. 2, shall enter into force, in the absence of a referendum, on the first day of the second month following the expiration of the referendum deadline or, in the case of a referendum, on the day of the acceptance of this Act by the people. Date of entry into force: January 1, 2003 Art. 83, para. 2: March 1, 2001