Disability insurance (AI) — pension, rehabilitation, appeals

Swiss disability insurance — the LAI (RS 831.20) — covers loss of earning capacity caused by lasting health impairment. The procedure is technical, the timelines are long, and the most-contested element — the degree of disability — turns on medical expert reports that must often be challenged with rigour. The firm acts at every stage, from the initial application to a Federal Tribunal appeal.

Eligibility

Three conditions must be cumulatively met (LAI art. 4 + 28) :

• Lasting incapacity to work of at least 40%, after a one-year qualifying period (art. 28 al. 1 let. b LAI);
• Continuity — incapacity persists without significant interruption;
• Affiliation to AVS/AI — typically all Swiss residents and workers in Switzerland.

For frontaliers and EU/EFTA nationals, the bilateral agreement on social security coordinates Swiss AI with EU disability schemes.

The full procedure step by step

A detailed walk-through is in our procedure : Disability insurance claim.

Key milestones :

1. Early detection / pre-registration (LAI arts. 3a-3b) — voluntary signalling when capacity starts to decline durably.
2. Formal application (Form 318.001) within 6 months of lasting incapacity.
3. One-year qualifying period during which the insured is typically covered by employer’s loss-of-earnings insurance or unemployment insurance.
4. Medical instruction by the regional medical service (SMR) and, where needed, an independent expert centre (COMAI).
5. Calculation of the degree of disability (LPGA art. 16) — comparison between income-without-impairment and income-reasonably-expected-with-impairment.
6. Pre-decision (préavis) notified to the insured with a 30-day window to file objections.
7. Final decision by the OAI Geneva.
8. Appeal to the TAPI (Chambre des assurances sociales) within 30 days.
9. Appeal to the Federal Tribunal within 30 days.

Calculating the degree of disability — the most contested point

The disability degree determines the pension level :

Degree	Pension fraction
40 – 49 %	quarter pension
50 – 59 %	half pension
60 – 69 %	three-quarter pension
≥ 70 %	full pension

The calculation method varies :

• Ordinary method for working-age employees — comparison of the two incomes.
• Specific method for non-working persons (homemaker) — comparison of activities.
• Mixed method for partial workers — combination weighted by activity rate.

The mixed method has been reformed several times (the latest reform on 1 January 2018 corrected disadvantages for part-time workers). For files dating back further, the historical method may still apply.

Glossary : Degree of invalidity (LAI 28).

Medical expert reports — the operational battle

The single most common cause of file failure is the medical assessment that does not reflect the real impact of the impairment. To counter this :

• Right to ask additional questions to the appointed expert (LPGA art. 44).
• Right to produce a private expert report alongside the official one.
• Right to challenge the expert’s independence in proven conflict-of-interest situations.
• Right to a second-opinion report when the SMR or COMAI assessment is internally inconsistent.

A well-prepared file submits structured questions to the expert before the assessment, and produces independent medical evidence to anchor the disability degree.

Rehabilitation measures (priority over pension)

The LAI requires rehabilitation measures before any pension is granted (LAI arts. 14a-21). These include :

• Vocational reorientation to a job compatible with the impairment.
• Apprenticeship or training subsidies.
• Adaptation of the workplace or assistive devices.
• Placement assistance with employers.

A file rejected for “rehabilitation feasibility” requires intensive documentation of why the proposed measures will not work in the actual labour market — Geneva’s market for partially-incapacitated workers above 50 is, in practice, narrow.

Coordination with other benefits

• Supplementary benefits (PC) — if the AI pension does not cover basic needs, see Supplementary benefits.
• Second-pillar disability pension — usually doubled with the AI pension (LPP arts. 23-26).
• Accident insurance (LAA) — if the impairment results from a covered accident, alternative pension path.
• Daily-loss insurance (collective or private) — covers the gap during the qualifying year.

What you receive

• A pre-filing review of the medical and professional documentation.
• Drafting of the formal application with structured medical questions.
• Tracking of the OAI process with timely interventions at each milestone.
• Drafting of objections to the pre-decision.
• Full handling of the TAPI and Federal Tribunal appeals if needed.

Related pages

• Procedure : Disability insurance claim
• Glossary : Degree of invalidity (LAI 28)
• Supplementary benefits

First consultation CHF 50. Legal aid available based on cantonal scales.