Social and private insurance

Disability, accident, old-age provision, insurance contracts…

Version française

In Switzerland, the term social insurance designates a system of protection designed to ensure financial support or coverage against certain risks or specific needs related to personal or professional life. This system is based on the principle of solidarity and covers various essential areas.

Social insurance comprises mandatory or voluntary schemes established by law to protect individuals against social risks such as old age, illness, disability, accidents, unemployment and maternity.

Main social insurance schemes in Switzerland

• OASI (Old-Age and Survivors’ Insurance): ensures an income after retirement or for survivors in the event of death.
• DI (Disability Insurance): provides support in the event of incapacity to work due to disability.
• OPA (Occupational Pension): complements OASI/DI to ensure a decent standard of living in retirement.
• UI (Unemployment Insurance): protects workers in the event of job loss.
• Mandatory Health Insurance: ensures access to medical care.
• AIA (Accident Insurance): covers the costs of occupational and non-occupational accidents.
• Income Compensation (IC): supports income in the event of military service, civilian service or maternity/paternity.
• SB (Supplementary Benefits): top up insufficient incomes for OASI/DI beneficiaries.

These insurance schemes are generally financed by contributions levied on the income of insured persons and employers, as well as by public contributions.

Private insurance (household, personal liability, supplementary health, travel, legal expenses, life insurance) is different: it rests on a contract governed by the Insurance Contract Act, with its own rules and remedies. It is covered in the sections Private insurance and Dispute with a private insurer.

In the event of a dispute concerning your rights or benefits, it is essential to consult a lawyer sufficiently in advance, so that the lawyer has a complete file on you in order to defend your interests as well as possible.

Challenging a decision issued by a social insurance body depends on the branch concerned. Schematically, the procedure unfolds as follows:

1. Initial decision: the insurer or cantonal social authority issues a written decision concerning benefits, claims or significant orders.

2. Objection: The insured person may file an objection to this decision within 30 days of its notification. The objection must be filed in writing and with reasons, with the authority that issued the initial decision. This procedure is free of charge. In disability insurance (DI) matters, there is no objection: the DI office first sends the insured person a draft decision (advance notice, in French préavis), on which they may comment within 30 days (art. 57a of the Disability Insurance Act, LAI); the DI office’s decision can then be appealed directly to the cantonal court.

3. Decision on objection: The insurer or cantonal social authority examines the objection and issues a new reasoned decision.

4. Appeal: If the insured person is not satisfied with the decision on objection, they may lodge an appeal within 30 days with the competent cantonal social insurance court. As a rule, this is the court of the canton where the insured person is domiciled (art. 58 ATSG) and, in DI matters, the court of the canton of the DI office that issued the decision (art. 69 LAI); special rules apply to persons domiciled abroad. The appeal must be reasoned and contain submissions. The procedure is in principle free of charge; in DI matters, however, it is subject to court fees of CHF 200.– to 1'000.– (art. 69 para. 1^bis LAI).

5. Cantonal court judgment: The cantonal court examines the appeal and issues a judgment. In Geneva, for instance, the competent judicial authority is the Social Insurance Chamber (in French Chambre des assurances sociales) of the Court of Justice (in French Cour de justice).

6. Appeal to the Federal Supreme Court: Judgments issued by the cantonal court may be challenged before the Federal Supreme Court, within a time limit of 30 days as well.

In the event of a dispute concerning your rights or benefits, it is essential to benefit from prompt legal advice to defend your interests.

Documentation and external links

• Guide social romand: ATSG (LPGA)PDF
• DI: The DI procedurePDF
• GE: Social Insurance ChamberWEB
• VD: Social Insurance CourtWEB
• NE: Cantonal Court (Court of Public Law)WEB
• VS: Cantonal Court (Social Insurance Court)WEB

Purpose of the insurance

Disability insurance (DI) aims to guarantee the means of subsistence for insured persons who have become disabled, whether through rehabilitation measures or pensions. It covers all persons domiciled in or engaged in gainful employment in Switzerland. Disability is defined as a reduction in earning capacity or in the ability to perform usual tasks, resulting from an impairment to physical, mental or psychological health. This incapacity must be permanent or long-lasting (at least one year) and may be due to a congenital infirmity, an illness or an accident.

DI operates on the principle that rehabilitation takes precedence over the right to a disability pension. Its main benefits include rehabilitation measures, disability pensions and helplessness allowances.

The calculation of the degree of disability depends on the insured person’s professional situation.

Full-time worker

For persons engaged in full-time gainful employment, two incomes are compared: the income without disability, corresponding to what the person could earn if they were not disabled, and the income with disability, which represents what the person can still earn despite their health impairment. For instance, if a person could earn CHF 60'000.– without disability and can now earn only CHF 27'000.– with their disability, their degree of disability would be 55 %. When the person no longer earns an income, the income with disability is set on the basis of statistical wages, reduced by a flat rate of 10 % (20 % if the person can only work at 50 % or less); this deduction has applied since 1 January 2024 (art. 26^bis para. 3 of the Disability Insurance Regulation, RAI).

Person without gainful employment

For persons without gainful employment (for example, homemakers), the usual activities performed before and after the occurrence of the disability are compared. Limitations are expressed as a percentage for each activity, then weighted and summed to obtain the degree of disability.

Part-time worker

For persons engaged in part-time gainful employment, a combination of the two preceding methods is used: the hypothetical percentage of gainful activity without disability is first determined and the degree of disability is calculated separately for the gainful activity and for usual tasks. The degrees of disability thus obtained are then weighted according to the hypothetical rate of activity.

Amount of the pension

Since 1 January 2022, a new system of linear pensions has been in force for disability insurance (DI):

1. For a degree of disability of 70 % or more: 100 % of the pension (full pension).
2. For a degree of disability between 50 % and 69 %: the percentage of the pension corresponds exactly to the degree of disability.
3. For a degree of disability between 40 % and 49 %: the pension ranges from 25 % to 47.5 %.
4. A degree lower than 40 % does not give entitlement to a pension.

The amount of the pension in francs depends on several factors, in particular the number of years of contributions up to the disability and the average annual income.

In 2026, a full DI pension amounts, for a complete contribution period (scale 44), to at least CHF 1'260.– and at most CHF 2'520.– per month. Unlike old-age pensions, DI pensions do not give entitlement to a 13th pension payment.

Documentation and external links

• CH.ch: Disability insurance (DI)WEB
• DI: FAQ on disability insuranceWEB
• DI: The DI procedurePDF
• BE: DI application and procedureWEB

Principle of the insurance

Accident insurance (abbreviated AIA, or LAA in French) is distinct from ordinary health insurance and generally provides better protection in the event of an accident, in particular in terms of coverage of costs and additional benefits. It only applies in the event of an accident. An accident is defined as “any harmful, sudden and involuntary impact on the human body caused by an extraordinary external cause which impairs physical, mental or psychological health, or causes death”.

Thus, AIA coverage in Switzerland mainly includes occupational and non-occupational accidents. This encompasses injuries in the workplace (such as falls or machine-related accidents), as well as accidents in the context of leisure, traffic or at home. Accidents occurring on the journey between home and work are non-occupational accidents; they are treated as occupational only for persons working less than 8 hours per week for the same employer.

Concerning occupational diseases, the AIA covers conditions linked to exposure to harmful substances (such as asbestos or solvents) or to specific working conditions (such as excessive noise). Since 2017, the law also provides that accident insurance covers certain bodily injuries even without an extraordinary external cause: fractures, dislocated joints, meniscus tears, muscle tears and strains, tendon tears, ligament injuries and eardrum injuries, unless the insurer proves that they are preponderantly due to wear or to an illness (art. 6 para. 2 AIA). Finally, the AIA also covers certain specific cases, such as injuries during work-related assaults, accidents caused by natural disasters in a professional context, and accidents occurring during sporting activities in a specific context. The exclusions mainly concern psychological disorders without an identifiable accidental event, or degenerative diseases, unless they are connected with a covered accident.

The best-known accident insurer is the SUVA (Swiss National Accident Insurance Fund), but other insurance providers are possible depending on the employer and the sector of activity concerned.

Benefits granted by accident insurance

The benefits include, in particular, the coverage of medical costs linked to the accident without the insured person’s contribution, the payment of daily allowances, of disability and survivors’ pensions if necessary, as well as coverage of care abroad up to twice the amount of the costs that would have been incurred in Switzerland.

Dispute with accident insurance

In terms of disputes, the main disagreements concern the recognition of the accidental nature of the insured person’s conditions, as well as the date of recovery (status quo ante or sine). Indeed, if the condition results predominantly from illness or aging (wear of limbs, shoulder, knee, etc.), it is generally not covered by accident insurance, but by health insurance or disability insurance. Exceptions may exist.

Documentation and external links

• CH.ch: Accident insurance (AIA)WEB
• FOPH: accident insuranceWEB
• DI: Accident insurance (AA)WEB
• The distinction between illness and accidentWEB

The old-age provision system in Switzerland rests on three pillars, each playing a specific role in ensuring the financial security of retirees.

1^st pillar (state provision): the mandatory Old-Age and Survivors’ Insurance (OASI) aims to cover basic vital needs. It is financed by contributions from active workers and employers, according to a principle of solidarity between generations.

2^nd pillar (occupational pension): this is the mandatory occupational pension, often called the “pension fund”. Its aim is to maintain the retiree’s usual standard of living, as a supplement to OASI. Contributions are shared between employer and employee.

3^rd pillar (private provision): this is voluntary individual saving with tax advantages. It complements the first two pillars to maintain, as far as possible, the standard of living enjoyed before retirement.

Supplementary benefits (SB) to the Old-Age and Survivors’ Insurance (OASI) and to disability insurance (DI) are financial aids granted to eligible persons when pensions and other income from these insurance schemes do not cover basic vital needs. They form an integral part of the Swiss social-security system and supplement OASI pensions in order to ensure a minimum income.

The calculation of supplementary benefits (SB) is based on the following formula: Supplementary benefits = Recognised expenses − Determining income. The annual supplementary benefit corresponds to the amount of expenses recognised by law that exceeds the person’s determining income.

Recognised expenses: the main expenses taken into consideration include a flat-rate amount for basic vital needs, rent (for persons living at home), health insurance premiums, as well as, where applicable, costs for stays in a nursing home.

Determining income: the income taken into account comprises in particular OASI/DI pensions (but not the 13th old-age pension payment), income from wealth, a share of net wealth, as well as a hypothetical income from gainful activity in certain situations. For federal benefits, this share is ¹⁄₁₅ (¹⁄₁₀ for old-age pensioners) of the portion of net wealth above CHF 30'000.– for a single person or CHF 50'000.– for a couple (art. 11 of the Supplementary Benefits Act, LPC). In Geneva, this fraction is ¹⁄₈ (¹⁄₅ for old-age pensioners) for cantonal supplementary benefits, and for persons living in a care home (EMS).

Wealth: since 2021, federal supplementary benefits are no longer granted when net wealth reaches CHF 100'000.– for a single person or CHF 200'000.– for a couple, not counting a home that the beneficiary owns and lives in (art. 9a LPC). In addition, benefits paid since 2021 must be repaid out of the beneficiary’s estate, on the portion of the estate exceeding CHF 40'000.– (art. 16a LPC).

Private insurance is not social insurance

A private insurance company does not issue a “decision” in the sense used in social insurance. You challenge a refusal by a written complaint and then, if necessary, before the courts. The competent court in Geneva and the procedure depend on the branch of insurance (see dispute with a private insurer).

The date of the contract determines which rules apply

For a contract concluded before 1 January 2022, only the new rules on form (“in writing or in any other form that allows proof by text”, e.g. an email) and the right of termination under art. 35a (new tab) and 35b LCA (new tab) apply; for the rest, the former law continues to apply (art. 103a LCA (new tab)). The Federal Supreme Court has held that this list is exhaustive (ATF 151 III 35 (new tab)). In particular, an older contract therefore gives no right to payments on account and no direct action by the injured party against the liability insurer, and claims under it become time-barred after two years. The former law does, however, contain several rules very close to the new ones.

Before signing: information, general terms and conditions, copy of your file

Before the contract is concluded, the insurer must inform you in a comprehensible way, in a form that leaves a written record, in particular about the insured risks, the scope of cover, the premiums, the term and the end of the contract, the right of revocation, the time limit for notifying a claim and the period during which the cover is valid; you must also have received the general terms and conditions (GTC) (art. 3 LCA (new tab)). If it fails in this duty, you can terminate the contract within four weeks of learning of the breach, but no later than two years after it (art. 3a LCA (new tab)): this right therefore now only concerns contracts concluded less than two years ago.

The GTC are interpreted in the sense you could give them in good faith. The insurer is liable for all events that have the characteristics of the insured risk, unless an exclusion is worded in a precise and unambiguous manner (art. 33 LCA (new tab)): a vague exclusion works against the insurer. If you accepted the GTC as a whole, an unusual clause to which your attention was not specifically drawn does not bind you, e.g. a clause that halves daily allowances in the event of mental illness (see general terms and conditions).

You can obtain a copy of the statements you made in the insurance application (art. 11 para. 2 LCA (new tab)). Since 1 January 2024, under the Insurance Supervision Act (LSA), you are also entitled at any time to a copy of your file and of any document concerning you drawn up by the insurer or by the intermediary: the request is made in writing or by email, the copy is free of charge and must be provided within 30 days (art. 80 (new tab) and 81 LSA (new tab)). A refusal may be taken into account by the court when allocating the costs of any later lawsuit. Before challenging a refusal of benefits, this is often the first useful step.

Revoking or terminating the contract

You can revoke your application or your acceptance within 14 days, in writing or by any other means that leaves a written record. The period runs from the time you applied for or accepted the contract, and it is met if the notice is posted on the last day. Revocation is excluded for provisional cover, group personal insurance and contracts with a term of less than one month (art. 2a LCA (new tab)). This right also applies to a contract concluded by telephone.

To end the contract, the law provides in particular for:

• ordinary termination: any contract may be terminated in writing or by email for the end of the third year or of any following year, with three months’ notice, even if it was concluded for five or ten years; the contract may allow earlier termination, with identical notice periods for both parties (art. 35a LCA (new tab)). This rule also applies to contracts concluded before 2022; for these, however, how the three years are to be counted has not yet been clarified by the case law, to our knowledge;
• termination for just cause, at any time and by either party, where, in good faith, continuation of the contract can no longer be required (art. 35b LCA (new tab)), whatever the date of the contract;
• termination after a loss: after a partial loss for which compensation is claimed, both the insurer and the policyholder may withdraw from the contract, at the latest when the compensation is paid; the cover ends 14 days after notification (art. 42 LCA (new tab));
• termination in the event of a substantial reduction in the risk: for a contract concluded since 2022, the policyholder may terminate with four weeks’ notice or demand a lower premium (art. 28a LCA (new tab)); for an older contract, the former law only allows a premium reduction in line with the tariff to be demanded.

A tacit renewal clause can only extend the contract by one year at most each time (art. 47 LCA (new tab)). Two branches have their own rules: in supplementary health insurance, only the policyholder may terminate on an ordinary basis or after a loss, except in group daily allowance insurance, where both parties may do so (art. 35a para. 4 LCA (new tab)); life insurance has no ordinary termination (see below).

Household contents and building insurance in Geneva

Geneva has no cantonal insurance institution: according to a presentation by the State of Geneva of November 2025, there is neither a public monopoly nor an obligation to insure buildings against fire and natural hazards. In practice, very few buildings are uninsured, in particular because mortgage lenders require such insurance. Household contents insurance is not compulsory under federal law, but a lease or a loan agreement may require it.

Any fire insurance for a building or movable property located in Switzerland must include natural hazards, with uniform scope and premium rates: high water, flooding, storms (wind of at least 75 km/h), hail, avalanches, snow pressure, rockfalls, falling stones and landslides. Excluded in particular are groundwater, sewer backflow, damage due to faulty construction or maintenance, and earthquakes (art. 33 LSA (new tab); art. 171 (new tab), 173 (new tab) and 174 of the Insurance Supervision Ordinance, OS (new tab)). Sewer backflow is often covered by a separate “water damage” insurance: check your GTC. Earthquakes require specific cover: the federal bill that would have provided for a conditional commitment by owners to cover earthquake damage (parliamentary item 24.095) failed, Parliament having refused to consider it; the item has been closed since 30 September 2026.

Check that the sum insured corresponds to the replacement value of your belongings: otherwise, the compensation may be reduced proportionally (underinsurance, see dispute with a private insurer). In condominium ownership (propriété par étages), it is the assembly of condominium owners that insures the building against fire and other risks and takes out the customary liability insurance; a condominium owner who has fitted out their unit at extraordinary expense may have to pay an additional share of the premium, unless they have insured these fittings themselves (art. 712m para. 1 no. 6 of the Civil Code, CC (new tab)).

Personal liability insurance

Liability insurance covers the claims of persons to whom the insured has caused damage (art. 59 para. 2 LCA (new tab)); whether the insured is actually liable is dealt with on the civil liability page. The injured party has a lien on the compensation owed to the insured, and the insurer may pay the injured party directly (art. 60 para. 1 LCA (new tab)).

The injured party may also bring a claim directly against the liability insurer of the person who caused the damage, within the limits of the cover and subject to the defences the insurer can raise under the law or the contract (art. 60 para. 1^bis LCA (new tab)), but only if that person’s contract was concluded since 1 January 2022 (ATF 151 III 35 (new tab)): ask for the date of the policy. The same limit applies to two protections specific to compulsory liability insurance: intent, gross negligence, breach of obligations, unpaid premiums or the insured’s deductible cannot be raised against the injured party (art. 59 para. 3 LCA (new tab)), and the injured party may require the insured or the supervisory authority to name the insurer, which must inform them about the cover (art. 60 para. 3 LCA (new tab)). Some special regimes have long provided for a direct action, such as motor vehicle liability insurance.

In Geneva, anyone who keeps a dog must have valid liability insurance, and the policy must be produced to obtain the dog tag (art. 16 (new tab) para. 3 and 5 let. a of the Geneva Dogs Act, LChiens (new tab)).

Casco insurance and motor vehicle liability insurance: see the road traffic page.

Supplementary health insurance and sickness loss-of-earnings insurance

Unlike basic health insurance, supplementary insurance (e.g. hospitalisation in a private ward) is governed by the LCA. Before the contract is concluded, the insurer may ask questions about your health, impose reservations (exclusions from cover) or refuse to insure you; an inaccurate answer may allow it to terminate the contract (see non-disclosure or misrepresentation). Once the contract has been concluded, the insurer cannot terminate it on an ordinary basis, nor after a loss (art. 35a para. 4 LCA (new tab)), nor because you change basic insurer (art. 7 para. 7 and 8 LAMal (new tab)). You can terminate in accordance with the GTC; a clause providing for a minimum term of several years or a long notice period does not prevent you from terminating for the end of the third year, with three months’ notice (art. 35a para. 1 LCA (new tab)).

Sickness loss-of-earnings insurance (daily allowances) is often taken out collectively by the employer; if a written agreement, a standard employment contract or a collective employment contract so provides and it grants at least equivalent benefits, it replaces the employer’s obligation to pay salary in the event of illness (art. 324a para. 4 of the Code of Obligations, CO (new tab)). Where it is governed by the LCA, the employee has an independent right against the insurer from the onset of the illness (art. 95a LCA (new tab)). For a contract concluded since 2022, a clause allowing ongoing daily allowances to be discontinued because the contract ends is void (art. 35c LCA (new tab)). Caution: claims under this group insurance become time-barred after two years, not five (art. 46 para. 3 LCA (new tab)).

In a dispute with a health insurance fund, mediation is a matter for the Health Insurance Ombudsman (Office de médiation de l’assurance-maladie), not for the Ombudsman of Private Insurance; if your loss-of-earnings insurance was taken out with an insurance company that is not a health insurance fund, enquire with the Ombudsman of Private Insurance and of Suva. In Geneva, supplementary health insurance and LCA loss-of-earnings insurance come directly under the Social Insurance Division of the Court of Justice (Chambre des assurances sociales), without conciliation and at no cost to the insured, whereas supplementary insurance to compulsory accident insurance (LAA) goes through conciliation at the Court of First Instance (Tribunal de première instance), then to the Administrative Court of First Instance (Tribunal administratif de première instance). Remedies, time limits and costs: see dispute with a private insurer.

Brokers and cold calling. Since 1 September 2024, all supplementary health insurers have been bound by industry rules declared mandatory: a ban on cold calling people who have never been customers or have not been customers for some time, a cap on intermediaries’ remuneration and a signed record of the advisory meeting (art. 31a LSA (new tab); art. 190e and annex 7 OS). Every intermediary must tell you before the contract is concluded whether or not they are tied to an insurer and who is liable for their errors (art. 45 LSA (new tab)); an untied intermediary may accept remuneration from an insurer only if they have expressly informed you of it (art. 45b LSA (new tab)). For unsolicited selling of other contracts, see subscriptions and doorstep selling.

Cancellation and travel insurance

If you are unable to travel (illness, accident…), cancellation insurance may cover the cancellation costs, depending on its terms. The insurer is liable for all events that have the characteristics of the insured risk: an exclusion, e.g. of a “pre-existing” illness, must be worded in a precise and unambiguous manner, otherwise it is interpreted against the insurer (art. 33 LCA (new tab)).

If it is the organiser of a package holiday who cancels, even for force majeure, the organiser must refund you (see travel and holidays): contact the organiser first. The insurer may indeed refuse to pay by relying on a subsidiarity clause; the Geneva Court of Justice applied such a clause, whose validity was not disputed, to trips cancelled during the COVID-19 pandemic (judgment ACJC/1457/2024 of 19 November 2024 (new tab), in French).

Report the claim as soon as you become aware of it and provide the required documents, e.g. medical certificates: on notification of the claim, supporting documents and the limitation period, of five or two years depending on the date of the contract, see dispute with a private insurer.

Revocation within 14 days is excluded if the insurance contract lasts less than one month (art. 2a para. 4 LCA (new tab)): what counts is the term of the contract, not the length of the trip. An annual policy taken out individually can be revoked within this period. Insurance linked to a credit card is often a group insurance taken out by the card issuer: if it covers the same costs as your travel policy, declare both covers and read the subsidiarity clauses (see the questions below).

Legal expenses insurance

The contract must guarantee the free choice of lawyer when a lawyer has to be instructed for judicial or administrative proceedings, and in the event of a conflict of interest (art. 167 para. 1 OS (new tab)); whenever a conflict of interest arises, the insurer must inform you of this right (art. 167 para. 3 OS (new tab)). A contrario, before any proceedings, the insurer may in principle handle the case itself. The contract may provide that, if the insurer refuses the lawyer you have chosen, you propose three others, one of whom must be accepted (art. 167 para. 2 OS (new tab)): this is a contractual option, not a general rule.

A clause obliging you to release your lawyer from professional secrecy towards the insurer does not apply in the event of a conflict of interest, where the information could harm you (art. 168 OS (new tab)). On refusal of cover for lack of prospects of success, see the questions below.

Life insurance and pillar 3

Except in the tied pillar 3, where the order of beneficiaries is laid down by the ordinance (see below), you freely designate the beneficiary of your life insurance and can change that choice until your death, including by will, unless you have waived this right by a signed written statement in the policy itself, handed to the beneficiary. The beneficiary acquires an independent right, outside the estate (art. 76 (new tab) to 78 LCA (new tab)). Where your spouse, your registered partner or your issue are beneficiaries, your creditors can seize neither their right nor yours, subject to existing pledges (art. 80 LCA (new tab)).

What happens to this capital on death is explained on the inheritance page: order of beneficiaries of the tied pillar 3 (pillar 3a), whose rules change on 1 June 2027 (who inherits?), how the surrender value is taken into account for the heirs’ statutory entitlement (statutory entitlement, hotchpot and abatement) and how the insurance is preserved for relatives who disclaim the inheritance (accepting or disclaiming). In Geneva, a dispute over a tied pillar 3 taken out in the form of insurance comes under the Social Insurance Division (see dispute with a private insurer).

The policyholder may terminate a life insurance policy after one year, whatever the agreed term, and receive the surrender value if there is one (art. 35a (new tab) para. 3, 89 (new tab) and 90 LCA (new tab); for a contract predating 2022, the former art. 89 gives a similar result). On request, the insurer must calculate the surrender value within four weeks; the Swiss Financial Market Supervisory Authority (FINMA) reviews this calculation free of charge, and the surrender amount is payable three months after the request (art. 92 LCA (new tab)). In a tied pillar 3, however, retirement benefits can only be paid to you under the conditions of the ordinance: in principle no earlier than five years before the reference age, or in the cases of early payment it provides for (art. 3 OPP 3 (new tab)).

Documentation and useful links

• Priminfo (FOPH): frequently asked questions, including on supplementary insurance, in FrenchWEB
• GE: Dogs Act (LChiens), in FrenchWEB

Non-disclosure or misrepresentation: an inaccurate answer when the contract was concluded

Before concluding the contract, the applicant must disclose the material facts that they know or ought to know, by answering the questionnaire or the other questions put in writing, on paper or electronically (art. 4 LCA (new tab)). Facts are deemed material if the insurer has asked precise and unambiguous questions about them. An ambiguous question is read in the sense the applicant could give it in good faith: an answer that is truthful on that reading does not amount to non-disclosure or misrepresentation.

If an answer was false or incomplete, the insurer may terminate the contract in writing or by email, but only within four weeks of becoming aware of the non-disclosure or misrepresentation. For losses that have already occurred, it may refuse or claim back its benefits only to the extent that the undisclosed fact influenced the occurrence or extent of those losses; a life insurance policy with a surrender value keeps that surrender value (art. 6 LCA (new tab)). Termination is excluded, in principle, if the fact had ceased to exist before the loss, if the insurer caused the non-disclosure or misrepresentation, if it knew or ought to have known the fact, if it waived its right to terminate or if it concluded the contract although a question had been left unanswered (art. 8 LCA (new tab)). For the most part, these rules also apply to contracts concluded before 2022.

In a tied 3^rd pillar case decided under the former law, the Social Insurance Court of the Vaud Cantonal Court had set aside the termination of the policies; the Federal Supreme Court dismissed the insurer’s appeal. Bound by the facts established by the cantonal judges, it accepted that brief reactive depressive episodes, without lasting treatment, did not have to be declared under “health problems”, and that unfitness for military service does not in itself imply a health impairment that must be declared (Federal Supreme Court judgment 9C_589/2024 of 12 November 2025 (new tab)). Each case, however, depends on the question asked and on the medical file.

Three different grounds must be distinguished:

• non-disclosure or misrepresentation when the contract is concluded: termination within four weeks (art. 6 LCA (new tab));
• fraud, i.e. intentional deception: under the Code of Obligations (CO), the insurer may invalidate the contract by a declaration made within one year of discovering it (art. 28 (new tab) and 31 CO (new tab));
• a fraudulent claim in connection with a loss (art. 40 LCA (new tab), see below).

Each is subject to its own conditions: an insurer that lets the time limit for non-disclosure or misrepresentation, or for fraud, expire can no longer rely on it.

After a loss: notice, documents and proof

• Notice: report the loss as soon as you become aware of it, in writing if the contract requires it. Late notice through your own fault only allows the compensation to be reduced to the amount it would have reached with timely notice; the insurer is released entirely only if notice was omitted to prevent it from establishing the circumstances of the loss (art. 38 LCA (new tab));
• Limiting the damage: do what you can to limit the damage and, if the matter is not urgent, ask the insurer for instructions and follow them; only an inexcusable breach of this duty allows the compensation to be reduced. Before the assessment, do not alter the damaged items without the insurer’s consent, except to limit the damage or in the public interest. Costs incurred to limit the damage are reimbursed even if unsuccessful, provided they were not manifestly inappropriate (art. 38a (new tab) to 38c LCA (new tab); very similar rules apply in indemnity insurance for contracts concluded before 2022);
• Information and documents: on request, provide the relevant information and the documents specified in the contract that you can obtain without great expense, e.g. medical certificates. Loss of the right for failure to provide information or documents in time requires a clause in the contract and a written formal notice setting a sufficient time limit and pointing out the consequences of delay (art. 39 LCA (new tab)).

A sanction provided for in the contract does not apply if the breach is not attributable to you, nor, for a contract concluded since 2022, if you prove that it had no effect on the loss or on the extent of the benefits. If you missed a time limit through no fault of your own, you may carry out the act as soon as the impediment ceases (art. 45 LCA (new tab)).

Proof: under the Swiss Civil Code (CC), the insured proves the contract, the loss and the extent of the claim; the insurer proves the facts that allow it to reduce or refuse its benefit, such as gross negligence or fraud (art. 8 CC (new tab)). For a theft, case law as a rule recognises a difficulty of proof and is satisfied with preponderant probability.

Gross negligence, intent and fraud

If the loss was caused intentionally, the insurer owes nothing. In the event of gross negligence, it may reduce its benefit in proportion to the degree of fault; in the event of slight negligence, or if the insured acted out of a humanitarian duty, the benefit remains payable in full (art. 14 (new tab) and 15 LCA (new tab)). According to the Federal Supreme Court, gross negligence is committed by someone who breaches an elementary duty of care that any reasonable person would have observed in the same situation; fault is assessed objectively, and more strictly when the insured had time to think. The insurer must prove it, and the rate of reduction, which is a matter of discretion, can be discussed with supporting documents.

If the loss was caused, intentionally or through gross negligence, by a person who lives in the same household as you, e.g. a child, the insurer may reduce its benefit only if you yourself were grossly negligent, in particular in supervising that person, and only according to the degree of your own fault (art. 14 para. 3 LCA (new tab)).

Finally, the insurer is not bound towards a person entitled who, in order to mislead it, conceals or misstates facts that would have excluded or limited its obligation, or who, for that purpose, fails to provide or delays the information they must provide (art. 40 LCA (new tab)). Exaggerating the damage can thus result in the loss of all benefits. For casco insurance, see also dispute with a motor insurer.

Assessment of the damage, underinsurance and payment

Either party may require the damage to be assessed without delay. If one party refuses or if they cannot agree, the assessment is carried out, unless otherwise agreed, by experts appointed by the court. You may always be assisted, and the costs of the assessment are shared equally (art. 58 LCA (new tab)).

The insurer is liable only up to the sum insured. If this is lower than the replacement value (underinsurance), the damage is compensated only proportionately, unless the contract waives this rule (art. 51a LCA (new tab); same rule for contracts concluded before 2022). Example: household contents worth CHF 100'000.– are insured for CHF 50'000.–; after water damage of CHF 10'000.–, the insurer in principle pays only half, i.e. CHF 5'000.–.

The benefit becomes due four weeks after the insurer has received the information enabling it to satisfy itself that the claim is well founded. A clause making payment conditional on its acknowledgement by the insurer or on a judgment is void (art. 41 LCA (new tab)). For a contract concluded since 2022, once that period has expired, you may demand payments on account up to the undisputed amount (art. 41a LCA (new tab)).

Time limits to remember and limitation period

Claims against the insurer become time-barred after 5 years for contracts concluded since 1 January 2022 and after 2 years for older contracts, because the list of new rules applicable to old contracts is exhaustive (art. 46 (new tab) and 103a LCA (new tab)). Claims under collective daily sickness allowance insurance governed by the LCA always become time-barred after 2 years. The period runs objectively, as soon as all the elements on which the insurer’s obligation is based are present, e.g. as soon as a disability is established in principle, even if the insured is unaware of it or the benefit is not yet due. The law does not deal with an old contract amended or renewed after 2022: if in doubt, take action within two years.

The limitation period is interrupted, in particular, by an acknowledgement of debt by the insurer (e.g. a payment on account), debt enforcement, a request for conciliation or a court action (art. 135 CO (new tab)). Negotiations or mediation suspend it only if the parties have agreed to this in writing (art. 134 para. 1 no. 8 CO (new tab)). The insurer may also waive in writing its right to plead limitation, for ten years at most from the start of the period (art. 141 CO (new tab)).

A Geneva example, for supplementary accident insurance taken out before 2022: the period of 2 years ran from the moment the disability was established in principle, here from the start of entitlement to the disability insurance (DI) pension, in November 2015, although the DI only recognised it in 2019, and not from when its degree was set nor from the due date provided for in the general terms and conditions. The first payment order, sent in 2019, i.e. four years after the period began, could no longer interrupt the limitation period, and the insurer’s later waivers had no effect: the claim for CHF 87'282.– was dismissed (Geneva Administrative Court of First Instance, judgment JTAPI/748/2025 of 9 July 2025 (new tab), in French).

Time limits set by law
Conclusion, revocation and termination of the contract: see Private insurance: the contract.

Time limits and sanctions provided for in the contract
Read the general terms and conditions of the policy: the law limits their scope.

For time limits in contract law in general, see Time limits to remember in contract law.

Complaint, mediation and court in Geneva

First challenge the refusal in writing with the insurer, asking for its precise reasons and, if necessary, a copy of your file. Two free mediation services can then step in:

• the Ombudsman of Private Insurance and of Suva (new tab), for affiliated insurers, once you have written to the insurer and received its written reply. Its mediation is not binding. It has no jurisdiction over health insurance funds, even for supplementary insurance, and no longer intervenes if a lawyer, an insurance adviser or a legal expenses insurer has been instructed;
• the Health Insurance Ombudsman (new tab) (in French), for supplementary insurance and daily allowances offered by health insurance funds, except after a formal decision, during court proceedings or if a lawyer has been instructed.

No mediation interrupts the limitation period, nor does it suspend it without a written agreement with the insurer. Failing agreement, the competent court depends on the insurance concerned. The social insurance procedure (decision, objection, appeal) does not apply, except for daily sickness allowances under the Federal Health Insurance Act (LAMal), which the employer can also take out collectively: check on the policy whether the cover falls under the LCA or the LAMal.

Proceedings are free of charge only before the Geneva courts: before the Federal Supreme Court, the losing party in principle bears the court costs and party costs.

Under the Civil Procedure Code (CPC), at the conciliation stage before the Court of First Instance, the conciliation authority may submit a decision proposal to the parties if the amount in dispute does not exceed CHF 10'000.– and, at the plaintiff’s request, decide a dispute itself up to CHF 2'000.– (art. 210 (new tab) para. 1 let. c and 212 para. 1 CPC (new tab)).

Before taking action, read the jurisdiction clause in the general terms and conditions: it often designates the insured’s Swiss domicile or the insurer’s registered office, and the action can then in principle only be brought before the court so designated (art. 17 CPC (new tab)). However, insurance taken out for your private needs may be classified as a consumer contract: the Geneva Court of Justice accepted this for legal expenses insurance (ACJC/853/2021). You can then sue before the court of your domicile or of the insurer’s registered office, and a clause signed in advance cannot deprive you of this right (art. 32 (new tab) and 35 CPC (new tab)). Without a clause, you can also sue at the place of the branch to which the contract relates or at the place where the characteristic performance is to be rendered (art. 10 (new tab), 12 (new tab) and 31 CPC (new tab)).

If your resources are insufficient and your case does not appear to be devoid of any chance of success, legal aid can exempt you from court costs and have a court-appointed lawyer assigned to you, but it does not cover the party costs owed to the other party if you lose (art. 117 (new tab) and 118 CPC (new tab)).

Documentation and useful links

• Ombudsman of Private Insurance and of Suva: frequently asked questionsWEB
• Health Insurance Ombudsman (Office de médiation de l’assurance-maladie), in FrenchWEB
• GE: Social Insurance Division of the Court of JusticeWEB
• GE: Court of First InstanceWEB
• GE: Administrative Court of First Instance (supplementary accident insurance)WEB

M^e Jean-Philippe Anthonioz is available by appointment only.

If you would like further advice, please do not hesitate to contact the firm’s secretariat by telephone to arrange a meeting at a flat-fee rate. You can also reach the firm using the contact details and means below. You can also book an online appointment (new tab).

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