Legislator Rechtsdatenbank & Rechtsprechung
I 2022 40 • VG SZ I 2022 40 KI-strukturiert

I 2022 40 — Insured Recovers Sickness Benefits Despite Alleged Pre-Existing Condition Misrepresentation

Geschäftsnummer I 2022 40 (SZ_VG_003_I-2022-40_2022-11-10)
Gericht / Behörde
Entscheiddatum
Rechtsordnung Kanton Schwyz — Kantonale Gerichte (CH-SZ)

Zusammenfassung (Sachverhalt & Erwägungen)

KI-strukturiert

An insured individual brought an action seeking the recovery of daily sickness benefits under health insurance law, where the insurer refused payment based on the insured's alleged pre-existing condition, which the insurer claimed was not disclosed or inadequately disclosed during the application process, leading to the policy being deemed voidable or void *ab initio*. The court reasoned that the insurer failed to demonstrate that the undisclosed or misrepresented health facts were causally relevant to the subsequent claim for benefits or that the insurer would have acted differently in contracting had full disclosure been made, thus upholding the claim for benefits.

Leitsatz / Regeste

KI-strukturiert
An insured individual brought an action seeking the recovery of daily sickness benefits under health insurance law, where the insurer refused payment based on the insured's alleged pre-existing condition, which the insurer claimed was not disclosed or inadequately disclosed during the application process, leading to the policy being deemed voidable or void *ab initio*. The court reasoned that the insurer failed to demonstrate that the undisclosed or misrepresented health facts were causally relevant to the subsequent claim for benefits or that the insurer would have acted differently in contracting had full disclosure been made, thus upholding the claim for benefits.

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Volltext des Entscheids — I 2022 40

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\n\n| | | |\n I 2022 40 |\n |\n \n\n

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\n\n| | | |\n |\n Urteil vom 10. November 2022 |\n \n\n

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\n\n| | | |\n Besetzung |\n Dr.iur. Vital Zehnder, Vizepräsident |\n \n|\n |\n Dr.med. Bernhard Zumsteg, Richter Dr.med. Urs Gössi, Richter |\n \n|\n |\n MLaw Joëlle Sigrist, Gerichtsschreiberin |\n \n\n

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\n\n| | | |\n Parteien |\n A.________, \n Kläger, \n vertreten durch Rechtsanwalt lic.iur. B.________ |\n \n|\n |\n gegen |\n \n|\n |\n C.________ AG, \n Beklagte, |\n \n\n

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\n\n| | | |\n Gegenstand |\n Krankenversicherung (Krankentaggeld nach VVG) |\n \n\n

\n \n Sachverhalt: