Facts
This decision concerns a dispute between J. and the Schweizerische Mobiliar Versicherungsgesellschaft (accident insurance company) as well as the Social Insurance Court of the Canton of Zurich. The main issue concerns the calculation of overcompensation and the reduction of accident insurance benefits.
The Schweizerische Mobiliar Versicherungsgesellschaft has carried out an overall calculation of the overcompensation for the period from June 16, 2000 to November 30, 2002, taking into account the benefits of the DI (full pension as well as supplementary pension for the spouse and two children's pensions from June 1, 2001). In its decision of May 5, 2003, the accident insurer stated that, from December 1, 2002 onwards, any daily allowances would be paid on the basis of the coordinated daily allowance of the accident insurance of CHF 33.55, corresponding to the difference converted into calendar days between the presumed lost salary and the DI pensions, reduced by 50%.
Considerations
The Federal Insurance Court considers that the procedure confirmed by the previous instance is in principle in line with the case law, provided that daily allowances from the accident insurance continued to be paid after November 30, 2002. According to the case law, any calculation of overcompensation must be carried out globally over the entire period of payment of the daily allowances.
However, the Federal Court considers that it must be possible to establish an overcompensation that has already occurred before the end of the entitlement to daily allowances and to recover the daily allowances that have been…