No entitlement to reimbursement of care and support costs by family members included in the SBA calculation

Facts

Parties: Social Insurance Institution of the Canton of St. Gallen, SBA Implementation Office (appellant) against heirs of A.A. (respondent)

Court: Federal Supreme Court, IVth Public Law Division

Date: March 6, 2024

Facts:

A.A. suffered from multiple sclerosis and received a disability allowance for severe disability from 2002, an assistance grant from 2012, and supplementary benefits (SBA) from 2011, including reimbursements for private care costs. In November 2019, the SBA Implementation Office rejected a claim for uncovered care costs, partially revoked the decision in January 2021, and granted A.A. CHF 4,980 for directly employed care personnel. After an objection and the death of A.A. in October 2021, the SBA Implementation Office rejected the objection in November 2021. The insurance court of the Canton of St. Gallen overturned the objection decision in July 2022 and referred the case back for further clarification. In December 2022, the SBA Implementation Office rejected the claim again, prompting the heirs of A.A. to file an appeal, which the insurance court granted in July 2023 and referred the case back for continuation of the administrative proceedings. The SBA Implementation Office then filed an appeal with the Federal Supreme Court in public law matters.

Considerations

The lower court had decided that the heirs were generally entitled to reimbursement of the costs for the care and support provided by the wife of the deceased SBA recipient. The Federal Supreme Court examined whether this decision violated federal law.

The Federal Supreme Court found that the cantonal regulation in Art. 12 para. 1 of the St. Gallen Ordinance on the Reimbursement of Illness and Disability Costs in Supplementary Benefits (VKB/SG) is compatible with federal law. This regulation provides that costs for care and support by family members are only reimbursed if they are not included in the SBA calculation and suffer a longer-lasting, substantial loss of income due to the care and support. This regulation corresponds to the former federal regulation and is therefore…