Facts
The complainant [A.], born in 1970, worked as a commercial employee and carer in an emergency shelter run by the City of Zurich and was compulsorily insured against accident consequences with AXA Versicherungen AG (formerly Winterthur). On the night of 16 June 1994, she became the victim of a violent crime. From 1 June 1996, she initially received a full, later a half and from 1 March 1999 again a full disability pension (IV) from the disability insurance scheme. As of 1 April 2011, the IV pension was revised downwards to a half pension.
AXA granted [A.] a monthly supplementary pension of CHF 1,612.45 (degree of disability: 60 %) from 1 August 2010. Due to the reduction of the IV pension, AXA increased the supplementary pension to CHF 2,426.35 from April 2011. After [A.] was again granted a full IV pension from 1 June 2012, AXA adjusted the supplementary pension back to CHF 1,612.45. At the end of July 2015, the IV pension payments were finally discontinued. Based on this, AXA paid the normal pension of CHF 2,426.35 per month from 1 August 2015.
By decision of 29 November 2019, [A.] was again granted a full IV pension from 1 July 2017. AXA therefore corrected its supplementary pension retroactively to CHF 1,612.45 and demanded repayment of the pension payments overpaid between 1 July 2017 and 31 December 2019, amounting to a total of CHF 24,416.55. [A.] lodged an appeal against this repayment demand with the Social Insurance Court of the Canton of Zurich, which dismissed the appeal by judgment of 26 April 2022. [A.] then filed an appeal in public law matters with the Federal Supreme Court, seeking to have the repayment demand set aside and the statutory benefits granted.
Considerations
The Federal Supreme Court first examined whether legal costs incurred as a result of the insured event could be taken into account when calculating the AIA supplementary pension under Art. 20 para. 2 AIA. The starting point for interpretation is the clear wording of the provision, which provides for a deviation from the general coordination rules of Art. 69 GSSLA. With Art. 20 para. 2 AIA, the legislator created an independent calculation model based on the insured earnings and the actual IV or OASI pension. The supplementary pension corresponds to the lower of two amounts: either the maximum amount of the AIA pension or the difference between 90 % of the insured earnings and the IV or OASI pension. This system does not provide for the consideration of additional costs such as legal costs.
The complainant argued that Art. 69 para. 2 GSSLA contained general value concepts of the legislator and that Art. 20 para. 2 AIA represented a singular exception that had to be interpreted restrictively. The Federal Supreme Court rejected this view, as the wording of Art. 20 para. 2 AIA is clear and comprehensive. The provision contains no indication that only the criterion of insured earnings is to deviate from the general coordination rules. Rather, Art. 20 para. 2 AIA regulates the coordination of benefits conclusively and leaves no room for the offsetting of additional costs.
Systematic considerations confirm this interpretation. The coordination provisions of…