Coverage of the Costs for a Cochlear Implant by the Disability Insurance

Facts

Rita B., born in 1966, suffers from bilateral deafness, where the deafness on the right side is congenital and on the left side occurred after a recurrent hearing loss. On November 16, 1985, a cochlear implant (CI) was implanted in her left ear, after conventional hearing aids had not been successful. Rita B. then applied to the Disability Insurance for coverage of the costs of the CI surgery. The Disability Insurance initially rejected this, as the procedure was still in the development phase. However, the Administrative Court of the Canton of Lucerne overturned this decision and obliged the Disability Insurance to cover the costs of the CI surgery.

Considerations

1. The Federal Supreme Court states that the CI does not fall under the term "aid" according to Art. 21 of the Federal Act on Disability Insurance (IVG), but is to be assessed as a medical measure for the treatment of a congenital defect pursuant to Art. 13 IVG. 2. Rita B.'s congenital deafness on the right side constitutes a congenital defect within the meaning of Art. 13 IVG. The CI is to be qualified as a medical measure, as it is indicated according to the established knowledge of medical science and aims to achieve the therapeutic success in a simple and appropriate manner. 3. The very high costs of the CI are in a reasonable proportion…