Facts
Josef Stössel, born in 1909, a wagon driver at SOB, reapplied to the disability insurance in 1972 and requested medical measures. The disability insurance had already taken over a Coxarthrosis operation on the right hip joint in 1964. The doctor diagnosed a right gonarthrosis and a painful left coxarthrosis. The compensation office rejected the application, as the statutory requirements were not met. Josef Stössel lodged a complaint and requested that the disability insurance take over the hip joint operation including aftercare.
The cantonal appeals board dismissed the complaint, as the question of whether there was an entitlement to medical measures was to be assessed according to the medical prognosis before the surgical intervention and it was not certain that a lasting improvement in earning capacity could be expected.
Considerations
The Federal Insurance Court considers that the disability insurance takes over medical measures that are not aimed at treating the illness itself, but directly at vocational rehabilitation and are suitable for permanently and significantly improving or preserving earning capacity.
The court emphasizes that the distinction between the treatment of the illness itself and the rehabilitation measure is based on the principle that the treatment of a disease or injury, regardless of the duration of the illness, primarily belongs to the tasks of health and accident insurance. The disability insurance usually only takes over measures directly aimed at eliminating or correcting stable defect states or functional failures, provided they foresee the essentiality and permanence of the desired success in the sense of Art. 12 para. 1 InvIA.
The court finds that the coxarthrosis operation is a medical rehabilitation measure that is to be taken over by the disability insurance if it can permanently cure the pathologically-anatomical condition of the skeleton as the cause of the unphysiological…