What to Do in Case of an Insurance Dispute

Private Insurance (ICA)

Contesting a Benefit Refusal

1. Request written, reasoned explanation 2. Contest in writing with arguments and supporting documents 3. Set reasonable payment deadline.

Insurance Ombudsman

Free, neutral mediator for private insurance disputes. Non-binding recommendations.

Court Proceedings

Forum: insured's domicile (art. 32 CPC). Mandatory conciliation (art. 197 CPC). Simplified procedure up to CHF 30,000 (art. 243 CPC). ICA prescription: five years (art. 46 ICA). Interrupt prescription if dispute persists.

Social Insurance (HIA, AIA, DI, OASI)

Objection Procedure

Social insurance decisions are administrative decisions. Object within 30 days (art. 52 ATSG). Free and must be reasoned. The insurer re-examines and issues an objection decision.

Cantonal Insurance Court

Appeal within 30 days of the objection decision (art. 56 ATSG). Procedure is free. Full review of facts and law.

Federal Supreme Court

Against cantonal judgment: public law appeal within 30 days (art. 100 FSCA). Social law division in Lucerne.

Health Insurance (HIA)

Basic insurance disputes: social insurance route (objection, then cantonal insurance court). Supplementary insurance disputes: civil route (ICA).

Practical Tips

Preserve all documents. Respect deadlines (30 days social insurance; 5 years ICA prescription). Send important correspondence by registered mail. Contact the ombudsman before litigation. Check if legal protection insurance covers the dispute.