Decision on opposition to the detriment of the opponent and insurer's duty to inform

Facts

The case concerns an insured person, S., who received a decision from the AI office Schaffhausen granting a disability pension of one quarter as of October 1, 2002, based on a degree of disability of 40%. S. filed an opposition to this decision on December 11, 2003, requesting additional medical investigation and a new decision. The AI office then issued a revision decision on January 27, 2004, canceling the initial decision and refusing the disability pension due to lack of disability giving rise to a benefit. The AI office subsequently classified the opposition as moot.

The cantonal court annulled the AI office's decisions and remanded the case so that the insured person could withdraw their opposition if the AI office decided to cancel the initially granted disability pension.

Considerations

The federal court's decision is based on Article 12 paragraph 2 of the Administrative Procedure Ordinance (GSSLO), which provides that the insurer must inform the opponent of the risk of being in a more unfavorable position (reformatio in peius) and of the possibility of withdrawing their opposition. The court considers that this provision would be deprived of its meaning if the insurer could cancel or modify the contested decision without warning the opponent and render a revision decision in the sense of a reformatio in peius.

The federal court believes that the AI office violated Article 12 paragraph 2 GSSLO and the insured person's right to be heard by rendering a revision decision without warning them of the possibility of…