Facts
On July 6, 2000, E. had a fatal traffic accident while driving with a high blood alcohol level. His wife [D.] and their son [B.] subsequently requested that the insurer Helsana re-examine the 50% reduction of survivors' benefits that had been imposed under the former Article 37(3) of the Accident Insurance Act (LAA). Helsana refused this request, leading [D.] and [B.] to file an appeal.
The Federal Court dismissed the appeal. It considered that despite the entry into force of the General Part of Social Insurance Law (LPGA), which had harmonized the regimes for reducing benefits, the derogations provided for in Article 37(3) of the LAA should be maintained. The legislator had indeed expressly wanted to retain this system of sanctions, particularly for cases of accidents caused by driving under the influence of alcohol.
Thus, the reductions in survivors' benefits imposed before the entry into force of the LPGA under the former Article 37(3) of the LAA must be maintained, even if the LPGA now provides a more favorable regime for the relatives of the at-fault insured person.
Considerations
According to the Federal Court, a literal interpretation of Articles 21 LPGA and 37(3) LAA reveals an inconsistency in the legislator's intent, which allows for a reduction in survivors' benefits in the event of the insured person's unintentional crime or offense, but not in the case of an intentional offense. However, the Court considers that the legislator clearly wanted to maintain the system of sanctions…