Decision on the coverage of spinal surgery performed abroad

Facts

Verena Geissbühler, born in 1937, suffers from severe thoracic scoliosis caused by childhood polio, resulting in back pain and cardiopulmonary disorders. Employed in the ironing workshop of an orthopedic clinic, she requested the IV (disability insurance) to cover medical measures, including spinal surgery in Lyon. After rejecting this request, the FSIO (Federal Social Insurance Office) appealed against the decision of the AHV (Old Age and Survivors' Insurance) Appeals Commission of the canton of Zurich, which had granted Ms. Geissbühler's request.

Considerations

The Federal Insurance Court considers that the question of whether the spinal surgery constitutes a vocational rehabilitation measure within the meaning of Art. 12 InvIA must be examined in more detail. Indeed, the Court is not convinced that Ms. Geissbühler's state of health is relatively stabilized, as accepted by the administration and the previous instance. According to case law, measures aimed at treating an unstable pathological condition fall within the scope of health insurance and not disability insurance.

Even if the pre-operative condition was sufficiently stable, the Court would still have to examine whether the surgery and preparatory treatments are…