Admissibility of Settlements in Appeal Proceedings before the Cantonal Social Insurance Court

Facts

B. was obligatorily insured for healthcare and voluntarily insured for daily allowance with SWICA Krankenversicherung AG. In connection with an illness from October 2001, there were disagreements about the amount and duration of the daily allowance payments, which is why B. filed a lawsuit with the Social Insurance Court of the Canton of Zurich. At the same time, B. had not paid the premiums, which is why SWICA took debt collection action against him. Within the framework of a referee hearing with settlement negotiations on January 20, 2005, the parties concluded a settlement that resolved all outstanding issues. Based on this settlement, the Social Insurance Court struck the case off the roll as settled by agreement.

Considerations

The Federal Office of Public Health (FOPH) filed an administrative court appeal against the striking off the roll, as the settlement not only covered social insurance benefits, but also the insured person's outstanding premiums.

The Federal Insurance Court held that Art. 50 para. 1 ATSG restricts the admissibility of settlements to "social insurance benefits". However, according to para. 3 of this provision, this restriction also applies mutatis…