sou · GQB31d2 · 2003-01-01 00:00:00 — This review was important as a means of identifying the measures that can be taken in various areas within the framework of our assignment, such as the possibility of enhancing damage prevention and reduction in certain areas. We also describe various issues and problems that we have noted in the course of the review. We have subsequently studied some of these issues in greater depth and have refrained from studying other issues, merely making a note of problems that may be worthwhile studying in other contexts. We commissioned Professor to describe the law and economics issues. A report written by him and the doctoral student is attached to the report as 3. We focused our analysis particularly on road traffic injuries. These probably represent the largest group of personal injuries for which liability for compensation exists. They are also covered by compulsory insurance, which means that it is practically and economically feasible to transfer costs from other systems. In a memorandum to the proposed extending traffic insurance liability to include all the income lost by injured parties during their working careers and rehabilitation aimed at helping injured parties to support themselves, at least in part, during this period. According to the Federation, one of the effects of this proposal would be to increase investment in rehabilitation for road traffic victims. The proposal corresponds closely to a system now applied in . We considered the advantages and disadvantages of this proposal. The majority of the Committee decided not to recommend extending traffic insurance liability, while a minority was in favour of such a reform. To sum up, a majority of the Committee feels that extending liability under traffic insurance to include some costs now covered by the national insurance system would be a major departure from the principle of the universality of the social insurance system. Such a change should only be considered if it entails significant advantages. The existing work-related rehabilitation system may not be entirely satisfactory, but reforms are being investigated, and it therefore appears inappropriate at this juncture to consider changing the rehabilitation organization in one specific area. In fact, the main advantage of transferring liability for costs would be the effect on government finances. This is not in itself a sufficiently good reason for dismantling the social security systems. We also considered the feasibility of levying a tax or charge in order to compensate for public expenditure on road traffic injuries, thus passing on more of the economic responsibility for road accidents to road users as a collective. It would not be consistent with the nature of social security benefits to recover the costs for such benefits offered to a certain category of injured persons from the party who is responsible for the damage. Consequently, we do not present any proposal for taxes or charges to be levied on traffic insurance. The states right of recovery It used to be possible at some times in the past for the state to require the injuring party to reimburse the amounts paid out in the form of sickness benefits and work injury benefits. This possibility was finally abolished with the entry into force on January 1 1963 of the Act, which explicitly prohibits the recovery of benefits paid out, and by the amendments to the industrial injury insurance scheme that entered into force on January 1 1969. We considered the option of reintroducing the states right of recovery. We assumed that in that case such a right would cover all types of liability for damages or compensation and not only liability for road traffic injuries. In this case too the Committee majority refrained from recommending changes in the existing systems, while a minority considered a reform justified. The view of the Committee majority is that the state should bear the cost of basic protection in the form of sickness benefit etc. even in cases where an individual is responsible. therefore the same as in the discussion of extending traffic insurance liability, i.e. the state should only be given a right of recovery if it entails significant advantages. Introducing a right of recovery might have some preventive effect, and the recovery process might reveal valuable information about the causes of injuries. However, once again the government finances would benefit most. A recovery system would, however, involve a rather large and costly administration. All in all, the majority of the Committee does not consider the advantages of introducing a right of recovery for the state sufficient to justify changing the system. In other words, the present prohibition of recovery should remain in force. A right of recovery or other entitlement to compensation for employers An employer who pays sick pay to an injured employee cannot at present demand reimbursement of the amount in question from the person responsible for the injury. This is because sick pay is a benefit which by law must be deducted in connection with the calculation of damages. According to the Committees terms of reference the payment by employers of sick pay to employees whose injuries are caused by another person is one of the situations in which the effects of the existing system have been considered less reasonable. This issue is therefore to be given special consideration. It has not been possible to obtain any data on the percentage of total costs for sick pay that are due to injuries caused by another person. These costs are probably quite small. Nonetheless, a single event, such as a robbery, that results in a person taking sick leave for 14 days can entail substantial costs for a small business. The view of the majority of the Committee is that employers should be entitled to recover their costs in such situations, while a minority is against this idea. One important reason for the majority view is the plight of small businesses. Furthermore, it seems unfair that employers should pay for a loss caused by the injuring party, who is liable for compensation, and this is particularly unacceptable in the case of deliberate crimes. proposes that entitlement to compensation should correspond to the amount paid out in statutory and collective agreement-based sick pay during the sick pay period, i.e. days of sick leave at present. also proposes that employers should be entitled to compensation for the payroll taxes that are payable on the sick pay. The proposed legislation gives the employer a direct right to damages for these costs. This means that the person liable for damages on account of the personal injury sustained by the employee would also be liable to pay compensation to the injured persons employer. At present, the coordination of benefits in connection with loss of income and allowances is governed by chapter 5, section 3 of the of Damages. Coordination is based on the net approach. This means that damages are determined in an amount corresponding to the difference between the total cost of the damage and the benefits that are to be deducted. These consist of social security benefits such as sickness benefit, disability pensions and occupational injury annuities, and employee benefits such as sick pay and compensation from insurance schemes paid for by the employer. We were instructed under the terms of reference to consider a coordination system operated in accordance with the gross approach, which means that damages would be calculated on the basis of the total cost of the damage, after which the relevant benefits would be deducted before the damages are paid out. In view of the Committees previous conclusions – that the state should not have a right of recovery and that employers should have a direct right to claim damages for sick pay costs – the right of recovery does not constitute a reason for changing over to the gross approach. We therefore recommend retaining the net approach, which has obvious practical advantages. As regards other kinds of damages, i.e. compensation for expenses and for non-material damage, the coordination of benefits is not governed by law, but it may be inferred from other provisions and principles that certain benefits should be deducted, for example where they are linked to the right of recovery. As regards expense benefits, there is nothing to suggest that the injured party is over- or undercompensated in any way under the present system. Specifying all the situations in which compensation for expenses may be payable would be a complicated matter and a number of borderline problems might arise. We therefore propose that the coordination of expense benefits should not be governed by law. The coordination rules in the of Damages should not, in our opinion, be extended to apply to non-material damage too. The reason for this is that, unlike economic losses, it is not possible in the case of non-material damage to fix the value of the loss. It is doubtful whether there can ever be any question of overcompensation for consequences of a purely moral nature. We have found no reason to change the definition of the benefits that are to be deducted in accordance with chapter 5, section 3 of the of Damages as it now stands. Benefits paid out in other countries should, in accordance with case law, be deducted if they are payable on basically the same grounds as the Swedish benefits mentioned in the above section. This system is appropriate and there is no need for detailed provisions in this respect. Insurance companies right of recovery As mentioned above, we were instructed to deal with the insurers right of recovery both in connection with personal insurance and non- life insurance, e.g. property or liability insurance. We are to take into account the proposals concerning the insurance companies right of recovery that have been presented earlier in various contexts and the Agreement on the right of recovery that has been concluded between the insurance companies. In order to obtain the necessary data to make a decision, we also studied the practice of the insurance companies when it comes to the right of recovery. Under the present section 25 of the Act, the insureds right to damages from another person is transferred to insurance companies that pay compensation under non-life insurance policies if that person caused the injury deliberately or through gross negligence or is liable regardless of fault. However, they have no right of recovery from a person who is only liable for damage through negligence by another (i.e. in the case of an employers or the states liability for damages). In the case of personal insurance the general rule is that the insurance company cannot demand repayment of an insurance amount paid out by it from the person who has caused the damage or is otherwise liable for payment of compensation. This rule is applicable to fixed sum insured policies, i.e. payment of a predetermined amount If, in the case of accident or health insurance, the insurance company has undertaken to pay the actual amount of costs for health care or other costs and losses, the same rules apply as in the case of non-life insurance. Application of the provisions of the Act is optional, and the insurance companies can therefore reserve the right to full recovery in their insurance terms even where the injury is due to pure negligence or is covered by a fixed sum insured policy. Insurance companies often reserve the right to full recovery in the case of non-life insurance . However, they only exercise this right to a limited extent; they are particularly restrictive when it comes to private individuals. This is a consequence of the Agreement on the right of recovery to which most insurance companies are party. As regards personal insurance, insurance companies rarely reserve the right of recovery in the insurance terms except in the circumstances mentioned in section 25 of the Act. Liability insurance is of particular interest in connection with the right of recovery. Under the general terms of a liability insurance policy the insurance company, with certain exceptions, undertakes to pay any damages for which the insured becomes liable in connection with personal injuries or damage to property. Private individuals have access to this protection through their householders comprehensive insurance policies. of the population had such policies in 1999. As regards companies, practically all companies in 2000 had company insurance policies with liability coverage or were self-insured. This means that insurance cost recovery claims are generally paid out under liability insurance policies. The insurance companies have had a free right of recovery for a long time. Our study of recovery practice shows that they exercise some caution in exercising this right. has not found any evidence of criticism of the companies exercise of their right of recovery. We have concluded that the insurance companies act rationally and judiciously when it comes to exercising their right of recovery. It is difficult in the context of legislation to define the situations in which recovery is appropriate, and detailed rules on the right of recovery would tend to complicate the system. Unlike the committees that have studied this issue previously, our view is that the most suitable course would be for the right of recovery to apply to the injured partys right to damages without restrictions. It would thus be left to the insurance companies to decide on a case-by-case basis when it is appropriate to recover insurance costs, as is the case today. Anyway, liability insurance policies are so common nowadays that liability is distributed among a large collective and there is risk of ruinous recovery claims. Where the injuring party does not have an insurance policy, he will probably be adequately covered under the general adjustment rule laid down in chapter 6, section 2 of the of Damages. The above remarks apply to non-life insurance and accidents and health insurance policies other than fixed sum insured policies. Accident and health insurance in the form of fixed sum insured policies are a different matter. The amount paid out from a sum insured policy is not compensation for damage, and the person who receives the compensation is therefore entitled to claim damages. This precludes the possibility of a right of recovery for insurance companies. The same applies to compensation from a life insurance policy. In our view, it should not be possible to exercise the right of recovery in the case of such sum insured policies or life insurance policies, and we propose that this should be laid down in mandatory rules. The right of recovery in connection with joint and several liability Where several parties are liable for compensation for the same damage, they are usually jointly and severally liable in relation to the person entitled to compensation. The of Damages does not regulate the distribution of liability between those liable for compensation, and this has often been considered a defect in the legislation. At present, the only course is to fall back on general principles established by doctrine and case law. The question of determining the liability of parties who are jointly and severally liable is directly related to the rules concerning the insurance companies right of recovery. In connection with the new rules on the right of recovery that we propose, a rule should be introduced into the of Damages determining the distribution of liability, and this rule should be applicable, inter alia, to reimbursement claims under a liability insurance policy against a party who is jointly responsible. According to the rule proposed by the Committee, liability should be distributed on the basis of a reasonableness assessment, for which the circumstances in individual cases would play a significant part. The draft provision mentions special circumstances to which special consideration should be given in connection with such assessments. One such circumstance is the grounds for liability, i.e. the question whether liability for damages is incurred as a result of the persons own fault or that of another person, or on grounds of strict liability. Another factor that is given special mention is the degree in which each party was at fault. However, we see no reason to refer in the provision to the specific insurance situation. One reason for this is that, since the majority of the population have liability insurance policies, there is nowadays no reason to make special provision for persons who have not taken out such a policy. However, the section concludes with a reference to other circumstances, which makes it possible to take such matters into account if the need arises. In our view, the proposed rule would make it necessary to repeal certain special provisions in other legislation. The Environmental Code contains a rule on the allocation of risk that is basically similar to the rule we propose in the of Damages. We do not however propose any amendments to the Environmental Code at the moment. Samordningen mellan skadestånd, försäk- ringar och andra ersättningsformer vid person- Beslut vid regeringssammanträde . En parlamentarisk kommitté får i uppdrag att se över reglerna om samordningen vid personskada mellan skadestånd, ersättning från offentlig försäkring och ersättning från försäkringar av annat slag. I denna del blir kommitténs huvuduppgift att lämna förslag om hur reglerna skall vara utformade när det gäller vilka förmåner som skall räknas av när skadestånd bestäms och vilken metod som skall tillämpas vid avräkningen, vilken rätt som offentliga och privata försäkringsgivare skall ha att kräva utbetalade försäkringsbelopp åter av den som är ansvarig för skadan. För vissa verksamhetsområden har det satts i fråga om det är rimligt att det allmänna svarar för en så stor del av kostnaderna för personskador som är fallet . Kommittén skall överväga om an- svaret i större utsträckning kan överföras till dem som är upphov till kostnaderna. Också frågan om försäkringsgivares regressrätt vid skadeförsäkring skall utredas. En utgångspunkt i kommitténs arbete skall vara att skyddet för enskilda skadelidande mot ekonomiska följder av personskador inte får försämras. Olika former av ersättning för personskada Den som drabbas av en personskada kan ha rätt till ersättning från olika håll. Ekonomiska följder av skadan kompenseras ofta helt eller delvis av någon offentlig försäkring, t.ex. den allmänna sjuk- försäkringen eller den allmänna arbetsskadeförsäkringen. Med offentliga försäkringar avses här sådana försäkringsformer som administreras av det allmänna. Finansieringen av dessa varierar. Obligatoriska försäkringar är inte offentliga i den angivna meningen men har ett tydligt offentligrättsligt inslag. Exempel är trafikförsäkringen (se trafikskadelagen, 1975:1410) och patientför- säkringen (se patientskadelagen, 1996:799). Dessa försäkringar är författningsreglerade men handhas helt eller delvis av privaträttsliga subjekt. De skyddar den skadelidande, oavsett om denne har rätt till skadestånd enligt allmänna regler, men fungerar i realiteten som ett slags ansvarsförsäkring. Även beträffande dessa försäkringar varierar finansieringen. Liknande frivilliga försäkringar tecknas av vissa grupper eller kollektiv till skydd för den som tillfogas personskada genom gruppens eller kollektivets verksamhet. Exempel på sådan försäkring är trygghetsförsäkringen vid arbetsskada (TFA) och läke- medelsförsäkringen. är den skadelidande själv försäkrad mot personskada genom en individuell eller kollektiv personförsäkring i form av en sjuk- eller olycksfallsförsäkring. Om en personskada leder till döden kan de efterlevande tänkas ha rätt till ersättning ur en livförsäkring, t.ex. den kollektiva tjänstegrupplivförsäkringen TGL. Vid sidan av olika former av försäkringsersättning kan den skadelidande (eller dennes efterlevande) vara berättigad till skadestånd av den som har orsakat skadan (se t.ex. skadeståndslagen, 1972:207, och produktansvarslagen, 1992:18). Skadeståndsansvaret kan vara beroende av vållande – vilket är huvudregeln enligt skadeståndslagen – eller oberoende av vållande, s.k. objektivt ansvar. Av såväl vållandeansvaret som det objektiva ansvaret finns flera olika varianter. På särskilda områden förekommer dessutom andra former av er- sättning från staten. Dessa har drag av skadestånd men är särreglerade på ett eller annat sätt. Som exempel kan nämnas ersättning enligt brottsskadelagen (1978:413), ersättning enligt lagen (1998:714) om ersättning vid frihetsberövanden och andra tvångsåtgärder och ersättning enligt lagen (1977:265) om statligt personskadeskydd. En grundläggande regel är att den skadelidande inte har rätt till mer än full ersättning för en skada. Däremot kan det finnas en rätt till ersättning från flera håll, varvid dock fullgjord betalning från någon av de ersättningsskyldiga i regel medför att ersättning inte kan krävas från de övriga. I vissa fall – främst vid s.k. summaförsäkring – kan den skadelidande emellertid bli överkompenserad. Summaförsäkring innebär att ett på förhand avtalat belopp utgår vid försäkringsfall, oavsett den verkliga förlustens storlek. Systemen för personskadeersättning medför att det finns ett behov av dels regler om avräkning, eller med andra ord regler om hur de olika ersättningsformerna skall samordnas med varandra när den skadelidande får sin ersättning, dels regler om regressrätt (rätt till återkrav mot den som har orsakat skadan) i vissa fall för den som har betalat ersättningen till den skadelidande. Reglerna om bestämmande av skadestånd för personskada finns i 5 kap. skadeståndslagen. De kom till 1975 (se prop. 1975:12, bet. 1975:LU16, rskr. 1975:133, bet. 1975:LU23, rskr. 1975:209, SFS 1975:404). Utöver att ge besked om bestämmande av skadestånd som ges ut enligt skadeståndslagen har reglerna i 5 kap. stor betydelse utanför lagens tillämpningsområde. Det beror på att t.ex. trafikskadelagen, brottsskadelagen och patientskadelagen hänvisar till 5 kap. skade- ståndslagen i frågan hur ersättningen för personskada skall be- stämmas. Men det finns också lagar som föreskriver skadestånds- skyldighet för personskada utan att hänvisa till 5 kap. skadestånds- lagen. Om inte avvikande regler ges kommer då skadeståndslagens regler att tillämpas (jfr 1 kap. 1 § den lagen). Det gäller t.ex. pro- duktansvarslagen och 32 kap. . Det sagda medför att förändringar av bestämmelserna i 5 kap. skadeståndslagen påverkar stora delar av det ersättningsrättsliga systemet. I 5 kap. 1 § anges vad ersättningen till den som har tillfogats per- sonskada skall omfatta. Ersättning skall ges ut för dels sjukvårds- kostnader och andra utgifter, dels inkomstförlust, dels viss ideell skada (sveda och värk, lyte eller annat stadigvarande men samt olägenheter i övrigt till följd av skadan). intrång i näringsverksamhet. I 5 kap. 2 § finns regler för de fall då en personskada har lett till döden. De efterlevande kan då få ersättning för begravningskostnader och andra kostnader till följd av dödsfallet samt för förlust av underhåll. Bestämmelserna i 5 kap. 1 och 2 §§ innebär inte att kostnader och förluster av sådant slag som avses där alltid ersätts i form av skadestånd. Sjukvårdskostnader betalas i stor utsträckning av det allmänna genom att den som skadats får vård (se bl.a. hälso- och sjukvårdslagen, 1982:763). Kostnader av andra slag, t.ex. för medicin, ersätts också i betydande grad av det allmänna. Även när det gäller ersättning för inkomstförlust betalas större delen från det allmänna i form av sjukpenning enligt lagen (1962:381) om allmän försäkring. av en sjukperiod betalas dock sjuklön enligt lagen (1991:1047) om sjuklön. Sjuklönen ges ut av arbetsgivaren. Ersättning för ideell skada betalas inte ur de offentliga ersätt- ningssystemen.