Coordination of Social Insurances in Switzerland
The Swiss social insurance system is composed of several distinct insurances that may simultaneously cover the same insured person for the same risk. This overlap requires sophisticated coordination rules to prevent both under-indemnification (no insurance pays) and over-indemnification (the total exceeds the actual loss). PBM Avocats advises insured persons and employers in Geneva and Lausanne on navigating this complex system.
Swiss Social Insurance Pillars
| Insurance | Risk Covered | Main Benefits | Legal Basis |
|---|---|---|---|
| AVS/AHV | Old age, death, disability | Old age pension, survivor's pension | LAVS/AHVG |
| AI/IV | Disability, incapacity to work | Pension, rehabilitation, daily allowance | LAI/IVG |
| LAA/UVG | Workplace/non-workplace accidents | Medical costs, daily allowance, pension | LAA/UVG |
| LAMal/KVG | Illness | Medical costs | LAMal/KVG |
| LPP/BVG (2nd pillar) | Old age, disability, death | Pension or capital | LPP/BVG |
| ALV/LACI | Unemployment | Daily allowance (80% of insured salary) | LACI/AVIG |
Principle of Non Over-Indemnification
The fundamental principle of Swiss social insurance coordination is that the total benefits paid must not exceed the actual loss suffered. Art. 69 LPGA/ATSG establishes the general rule: when multiple insurances provide equivalent benefits for the same event, they must coordinate their payments.
In practice, this means:
- Priority rule: LAA/UVG takes priority over LAMal/KVG for accidents; AI/IV coordinates with LAA/UVG for disability pensions
- Deduction rule: AI/IV pension is deducted from LAA/UVG pension (and vice versa) to avoid cumulation exceeding 90% of the insured salary
- Subsidiary character: some benefits are only paid if other insurances are exhausted
Practical Issues in Coordination Disputes
Coordination disputes frequently arise when:
- An insured person suffers from both an illness and an accident, with each insurer trying to attribute the cause to the other
- An AI/IV pension is recalculated following a new LAA/UVG determination (or vice versa)
- An employer's loss-of-earnings insurance refuses to pay arguing another insurer is primarily responsible
- A 2nd pillar pension fund claims reimbursement after AI/IV or LAA/UVG benefits are paid
PBM Avocats has deep expertise in these complex coordination disputes and defends insured persons' rights to ensure they receive all benefits to which they are legally entitled.