Facts
A.A., born in 2011, suffers from a congenital developmental disorder of the urethra (hypospadias) and was hospitalized and operated on December 9, 2012. The invoice for this treatment was received by SWICA Krankenversicherung AG (SWICA), the insured's mandatory health insurance provider, on February 3, 2014, which covered the costs in advance. On August 12, 2014, A.A. was registered with the Disability Insurance (IV) for benefit entitlement due to the congenital defect. The IV-Stelle Basel-Landschaft informed the parents on April 29, 2015 that SWICA's advance payments could only be reimbursed for the twelve months preceding the registration, as the requirements for further reimbursement were not met.
SWICA's appeal against this decision was dismissed by the Cantonal Court of Basel-Landschaft. SWICA then filed a public law appeal, requesting the IV-Stelle to reimburse the advance payments of CHF 8,506.05.
Considerations
The Federal Supreme Court upholds the appeal. It states that the wording of Art. 48 Para. 2 IVG must be deviated from insofar as the Disability Insurance's obligation to make subsequent payments not only exists in favor of the insured person, but also analogously towards the advance-paying health insurance provider. The time limit is determined by the time the advance-paying health insurance fund itself became aware of the facts.
The Federal Supreme Court justifies this by stating that the purpose of Art. 48 Para. 2 IVG is to prevent an undeserved loss of rights. Such a loss would occur if the advance-paying health insurance fund could be confronted not with its own state of knowledge, but with that of the insured person or their parents…