B., whose mother is employed by the A. LLC to provide him with care, applied for reimbursement of care costs from his health insurer, Avenir. When Avenir refused coverage for the care provided from January 2021, both B. (before the Glarus Administrative Court) and A. LLC (before the cantonal arbitration tribunal) initiated separate proceedings seeking full reimbursement, with A. LLC asserting claims based on an assignment of rights from B. The arbitration tribunal declined jurisdiction over A. LLC’s claim, finding that only the administrative court was competent, since the claim stemmed from B.’s entitlement as an insured person.

The Federal Supreme Court clarified that the arbitration tribunal under art. 89 Swiss Federal Law on Health Insurance (Bundesgesetz über die Krankenversicherung, KVG) is competent only for disputes arising directly between insurers and service providers over their own (original) claims, not for claims merely assigned by an insured person to a service provider. The Court noted that the existence of parallel proceedings with identical claims raised the problem of possibly conflicting decisions, which the assignment mechanism is designed to prevent. The Court also found that the arguments for granting the service provider direct standing in such cases were unconvincing and unsupported by existing precedent. It distinguished previous case law cited by A. LLC, emphasising that the jurisdictional allocation depends on who is asserting which entitlement and the nature of the underlying legal relationship. Thus, the arbitration tribunal correctly declined to hear the claim. The appeal was dismissed.

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