831.201 IVVRAIOAI

CH

Art. 2 Ordinanza del 17 gennaio 1961 sull'assicurazione per l'invalidità (OAI) - Provvedimenti sanitari d’integrazione

OAI; Capo secondo: Integrazione ; Abis. Provvedimenti sanitari

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Art. 2 OAI · Provvedimenti sanitari d’integrazione

Per provvedimenti sanitari d’integrazione ai sensi dell’articolo 12 LAI s’intendono in particolare le cure chirurgiche, fisioterapeutiche e psicoterapeutiche. Una volta curata l’affezione in quanto tale e raggiunto uno stato di salute stabile, tali provvedimenti sono destinati direttamente all’integrazione secondo l’articolo 12 capoverso 3 LAI.

L’assicurazione per l’invalidità può assumere i costi per provvedimenti sanitari d’integrazione che non rispettano i principi di cui all’articolo 14 capoverso 2 LAI, se: a. il potenziale d’integrazione è particolarmente elevato; e b. i possibili risparmi che potrebbero derivare da un’integrazione risultano maggiori rispetto ai costi dei provvedimenti sanitari d’integrazione.

Un provvedimento sanitario d’integrazione deve essere richiesto al competente ufficio AI prima dell’inizio della cura secondo l’articolo 12 LAI. È fatto salvo l’articolo 48 LAI. Alla richiesta va allegata una prognosi d’integrazione favorevole emessa dal medico specialista curante prima dell’inizio della cura.

La natura, la durata e l’entità di un provvedimento sanitario d’integrazione nonché il fornitore della prestazione sono stabiliti nella decisione o comunicazione di assegnazione. La durata non può essere superiore a due anni. Il provvedimento sanitario d’integrazione può essere prolungato.

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Decisioni giudiziarie che applicano questa disposizione (71)

A/4286/2024 · ge (art. 2 al. 1 RAI)

Appeal Regarding Cessation of Medical Coverage for Infantile Epilepsy Sequelae

Cited in relation to the definition of medical rehabilitation measures under Art. 12 LAI, used to deny coverage for the neuropsychological assessment.

IV.2021.00065 · zh (Art. 2 Abs. 2 IVV)

Disability Insurance Not Liable for Child's Rehabilitation Costs

This provision is applied to determine the point at which medical measures for paralysis and other motor function impairments should be granted by the invalidity insurance, specifically when the treatment of the underlying health damage is considered complete or of secondary importance.

IV.2022.2 · sg (Art. 2 IVV)

Disability Insurance Benefits Denial for Football Injury Initial Treatment

This provision, specifically paragraph 4, was used to exclude the liability of the IV insurance for the treatment because the injury was deemed to fall under the scope of 'Verletzungen' (injuries) requiring initial treatment.

IV.2022.2 · sg (Art. 2 Abs. 4 IVV)

Disability Insurance Coverage for Initial Treatment of Traumatic Hip Injury

Used to exclude the claim for medical measures because the underlying event was considered a 'Verletzung' (injury) in common parlance, thereby excluding the primary treatment costs from IV liability.

S 2020 18 · gr (art. 2 cpv. 1 OAI)

Occupational Therapy Coverage Appeal: Integrative Purpose vs. Symptom Management

Mentioned as part of the criteria for assessing the validity and appropriateness of the measure under Art. 12 LAI, which was deemed fulfilled in the final orders' context.

2020.OG.V.19.53 · ur (Art. 2 Abs. 1 IVV)

Insurance Coverage Denial for Mollii®-Anzug Treatment for Birth Defect Disorder

The court used this provision as the standard for determining whether the treatment aligns with established medical knowledge, which was the core issue.

VSBES.2019.214 · so (Art. 2 Abs. 1 IVV)

Insurer Appeal Regarding Coverage for Post-Encephalitis Inpatient Rehabilitation as Integration Measure

This provision defines medical measures under Art. 12 IVG, which formed the basis for granting the appeal regarding the rehabilitation measures.

200 2019 481 · be (Art. 2 Abs. 1 IVV)

Insured vs. IV: Physiotherapy Benefits for Hip Condition

Cited in the reasoning to define medical measures under Art. 12 IVG.

OG O3V 18 26 · ar (Art. 2 Abs. 1 IVV)

Disability Coverage Appeal Rejected Due to Insufficient Early Autism Documentation

Cited in the reasoning to define what counts as medical measures (e.g., physiotherapy, psychotherapy).

IV.2017.01223 · zh (Art. 2 Abs.1 IVV)

Insurance Denial Appeal for Epilepsy Evaluation Costs

Cited in the reasoning when discussing whether diagnostic measures qualify as medical measures under social insurance law, in connection with Art. 12 IVG.

608 2018 176 · fr (Art. 2 al. 1 RAI)

Appeal Regarding Denial of Scoliosis Surgery Coverage Due to Discrepancy with Sibling's Case

Cited to define medical measures under Art. 12 LAI, though not the direct basis for the final order.

608 2017 301 · fr (art. 2 al. 1 du règlement du 17 janvier 1961 sur l'assurance-invalidité (RAI; RS 831.201))

Claimant v. Disability Insurance Office: Psychotherapy Coverage Denial Upheld

This article was cited in the reasoning section to specify what is considered a medical measure under Art. 12 LAI.

C-5612/2016 (Art. 19, 2ème phrase, RAI)

Roofing and Tiling Disability Claim with Focus on Retraining Adequacy

Cited in relation to daily allowances during job search after professional training or retraining.

S 2016 139 · gr (Art. 2 IVV)

Morbus Perthes Osteotomy Coverage as Preventive Medical Integration Measure for Minor

This provision, linked to Art. 12 IVG, defines the scope of medical measures covered by the IV.

605 2014 194 · fr (art. 2 al. 1 RAI)

Disability Insurance Appeal Denied: Failure to Meet Congenital Disability Criteria and General Medical Measure Requirements

Cited in the reasoning section regarding medical measures under Art. 12 LAI, but not explicitly in the final orders (I-IV).