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I 2022 52 • VG SZ I 2022 52 Generato dall'IA

Insurance Coverage Denial for Corrective Surgery

Numero d'incarto I 2022 52
Autorità giudiziaria
Giurisdizione Svizzera · Canton Svitto (CH-SZ)
Data della decisione
Esito del giudizio Respinto (Dismissed)
Apri la fonte ufficiale Archivio Entscheidsuche Versione Markdown leggibile dalle macchine (.md)

Sintesi Legislator

Generato dall'IA

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.

Regesto Legislator

Generato dall'IA

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.

Parole chiave

Generato dall'IA
copertura dell'assicurazione malattie trattamento medico stato anteriore riserva d'assicurazione falso certificato medico affezione nell'assicurazione militare

Disposizioni normative citate

Generato dall'IA
Art. 66 Abs. 1 lit. a BGG
This article governed the imposition of court costs on the losing party.
Generato dall'IA
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

Questioni giuridiche chiave estratte da Legislator

Generato dall'IA
Art. 66 Abs. 1 lit. a BGG

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

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Testo completo

\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

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