Proof of the occurrence of the insured event, burden of proof of the entitled person; distribution of the burden of proof

Facts

[A.] worked as a carpenter at [C. GmbH], which had taken out a collective supplementary health insurance policy with B. AG. On July 10, 2018, [C. GmbH] reported to [B. AG] that [A.] was incapable of work from June 14, 2018, initially at 100% and later at 70%, due to neurological problems in his arms. [B. AG] granted daily allowance benefits to [C. GmbH] for A.

On May 29, 2020, [A.] filed a lawsuit with the Social Insurance Court of the Canton of Zurich and requested that [B. AG] be obliged to pay him further daily sickness allowance benefits from November 1, 2018 to March 31, 2020. The Social Insurance Court dismissed the claim.

[A.] filed a civil law appeal with the Federal Supreme Court against the decision of the Social Insurance Court.

Considerations

The Federal Supreme Court states that according to the basic rule of Art. 8 of the Swiss Civil Code, the entitled person must prove the facts to justify the insurance claim, in particular the existence of an insurance contract, the occurrence of the insured event and the scope of the claim. The insurer bears the burden of proof for facts that entitle it to reduce or refuse the contractual benefits or make the insurance contract…