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I 2022 52 • VG SZ I 2022 52 KI-generiert

Insurance Coverage Denial for Corrective Surgery

Geschäftsnummer I 2022 52
Gericht / Behörde
Rechtsordnung Schweiz · Kanton Schwyz (CH-SZ)
Entscheiddatum
Ausgang Abgewiesen (Dismissed)
Originalquelle öffnen Entscheidsuche-Spiegel Maschinenlesbares Markdown (.md)

Legislator-Zusammenfassung

KI-generiert

The appellant challenged a decision by the lower court regarding the non-coverage of a corrective surgery (osteotomy) under their health insurance policy, which was deemed medically necessary for correcting a malunion fracture. The court reasoned that the initial decision not to cover the procedure was correct because, while the insured had a pre-existing condition, the required surgery constituted a significant orthopedic intervention whose necessity and medical justification, as per the policy terms for covering treatment of malunions, were not sufficiently established by the medical documentation provided to warrant overturning the insurer's assessment.

Legislator-Regeste

KI-generiert

Art. 66 Abs. 1 lit. a BGG; Insurance Coverage Denial for Corrective Surgery: The court reasoned that the initial decision not to cover the procedure was correct because, while the insured had a pre-existing condition, the required surgery constituted a significant orthopedic intervention whose necessity and medical justification, as per the policy terms for covering treatment of malunions, were not sufficiently established by the medical documentation provided to warrant overturning the insurer's assessment.

Schlagwörter

KI-generiert
Deckung der Krankenversicherung medizinische Behandlung Vorzustand Versicherungsvorbehalt falsches ärztliches Zeugnis Gesundheitsschädigung in der Militärversicherung

Zitierte Gesetzesbestimmungen

KI-generiert
Art. 66 Abs. 1 lit. a BGG
This article governed the imposition of court costs on the losing party.
KI-generiert
I 2019 90
Health Insurer Coverage Denial for Bimaxillary Setback Osteotomy Upheld
II 2017 76
Denial of Coverage for Foreign-Performed Phalloplasty Under Mandatory Health Insurance
I 2017 41
Policyholder v. Health Insurer: Reduction Mammoplasty Coverage Dispute
I 2018 23
Insurance Coverage Dispute Over Orthopedic Shoe Inserts
I 2022 48
Insurer Denial of Accident-Related Hip Coverage Overturned for Lack of Causal Analysis

Zentrale Rechtsfragen, extrahiert von Legislator

KI-generiert
Art. 66 Abs. 1 lit. a BGG

This article governed the imposition of court costs on the losing party.

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Volltext

\n \n \n \n \n

\n\n| | | |\n I 2022 52 |\n |\n \n\n

\n \n \n \n \n

\n\n| | | |\n |\n Entscheid vom 19. Januar 2023 |\n \n\n

\n \n \n \n \n \n

\n\n| | | |\n Besetzung |\n Dr.iur. Vital Zehnder, Vizepräsident |\n \n|\n |\n Dr.med. Urs Gössi, Richter Dr.med. Pierre Lichtenhahn, Richter |\n \n|\n |\n MLaw Manuel Gamma, Gerichtsschreiber |\n \n\n

\n \n \n \n \n \n

\n\n| | | |\n Parteien |\n A.________, \n Beschwerdeführer, \n vertreten durch Rechtsanwältin MLaw B.________, |\n \n|\n |\n gegen |\n \n|\n |\n C.________ AG, Vorinstanz, |\n \n\n

\n \n \n \n \n \n

\n\n| | | |\n Gegenstand |\n Krankenversicherung (Leistungspflicht; Umstellungsosteotomie) |\n \n\n

\n \n

Sachverhalt: