Facts
H., born in 1958, was employed as a deputy department head at company Q. until September 30, 1995 and was insured against the consequences of accidents and occupational diseases with Elvia Swiss Insurance Company (now: Allianz Suisse Insurance Company AG) in this capacity. On December 27, 1994, she suffered a shock and various complaints in a train accident. Elvia then provided the statutory benefits.
In March and April 1996, an assessment was carried out on behalf of Elvia by the Medical Evaluation Center (MEDAS). The report of October 28, 1996 concluded that there was a 40% reduction in the ability to work.
By decision of May 19, 1998, Elvia informed the insured that, based on a settlement, a pension would be paid based on a disability degree of 80%. Also by way of settlement, an integrity compensation based on an integrity damage of 50% was determined and awarded.
On August 3, 2009, the IV ordered a multidisciplinary medical assessment at MEDAS. The report of May 27, 2010 concluded that the insured could be reasonably expected to perform an adapted activity for about five and a half hours per day and that there had never been an incapacity to work of more than 30%.
Allianz then concluded that there was a reason for revision and a reason for reconsideration, and that the UVG benefits should be discontinued as of September 1, 2010.
Considerations
The Federal Supreme Court concluded that the settlement was within the scope of Elvia's discretion in view of the legal and factual uncertainties existing in 1998. A reconsideration is therefore not permissible.
The Federal Supreme Court justified this as follows
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