Appeals regarding disability insurance and accident insurance decisions

The most important points in proceedings against IV and accident insurance

What does disability mean in social insurance law?

Disability is a total or partial inability to work that is likely to be permanent or last for a long period of time (Art. 8 ATSG). Disability can be the result of congenital defects, illness or an accident.

How is the degree of disability and the amount of disability determined?

Through an income comparison. The income without disability (e.g. 70,000) and the income with disability (e.g. 35,000) are compared. The loss results in the degree of disability (here 50%). If you were not gainfully employed, there are other methods to determine the degree of disability.

The degree of disability is determined by the IV office or accident insurance. The medical assessment of the extent to which someone can still work has a significant influence on the degree of disability. Someone who can only work 50% in an adapted activity will receive a pension sooner than someone who is still able to work 100% with optimal adaptations (e.g. sitting, without lifting weights, etc.). It is therefore important to check the assessment of the insurance doctors.

When am I entitled to a disability pension?

If the insured person is at least 10% disabled as a result of the accident, they are entitled to an accident insurance disability pension, provided the accident occurred before they reached the reference age.

Insured persons are entitled to a disability insurance pension from the disability insurance ( "Invalidenversicherung" or "IV") if:

1. cannot restore, maintain or improve their earning capacity or ability to work in their field of activity through reasonable rehabilitation measures;
2. have been unfit for work (Art. 6 ATSG) for an average of at least 40 % during one year without a significant interruption; and
3. are at least 40 % disabled after the end of this year (Art. 8 ATSG).

The IV pension entitlement arises at the earliest six months after submission of the application (BGE 142 V 547; judgement of the Federal Supreme Court 9C_655/2015 of 14 December 2015), provided that the insured event has occurred at this time.

Persons who are at least 40% disabled within the meaning of the IV and were insured at the time the incapacity for work occurred are entitled to disability benefits from the pension fund.

How is the amount of the IV disability pension determined?

The amount of the pension entitlement (disability insurance) is determined as a percentage of a full pension:

• The percentage share corresponds to the degree of disability from 50-69 per cent
• From 70 per cent you are entitled to a full pension.
• For a degree of disability below 50 per cent:
  49 per cent: 47.5 per cent
  48 per cent: 45 per cent
  47 per cent: 42.5 per cent
  46 per cent: 40 per cent
  45 per cent: 37.5 per cent
  44 per cent: 35 per cent
  43 per cent: 32.5 per cent
  42 per cent: 30 per cent
  41 per cent: 27.5 per cent
  40 per cent: 25 per cent

What does the principle of "integration before pension" mean?

According to the principle of "integration before pension", integration measures take precedence over pensions (Art. 28 para. 1 let. a IVG). An entitlement to a pension can therefore only arise after integration has failed. This principle also applies to integration measures, but not to clarification measures, which are used to clarify the ability to integrate (Art. 28 para. 1bis IVG). Before this time, a (temporary) pension entitlement may arise in exceptional cases if the insured person was not or not yet capable of integration (BGE 148 V 397; judgement of the Federal Supreme Court 9C_380/2021 of 31.01.2022; judgement of the Federal Supreme Court 9C_689/2019 of 20.12.2019; judgement of the Federal Supreme Court 9C_450/2019 of 14.11.2019).

Received a negative decision from the IV or accident insurance?

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