Facts
The insurance company [A. AG] had rejected the cost coverage for medication withdrawal in the private ward of a hospital. The insured person [B.] then filed a lawsuit with the Social Insurance Court of the Canton of Zurich and demanded cost coverage. The Social Insurance Court upheld the claim.
The insurance company [A. AG] filed a civil law appeal with the Federal Supreme Court. It requested the dismissal of the claim or the remand of the case to the Social Insurance Court.
Considerations
The Federal Supreme Court dismissed the appeal, insofar as it was admissible. It concluded that the insurance company [A. AG] was generally obliged to provide benefits, as the insured person [B.] had taken the medication according to the physician's prescription and thus there was no medication abuse within the meaning of the insurance conditions.
The Federal Supreme Court stated that according to the ordinary understanding of language, only when a medication is not used as it should be used, can one speak of medication abuse. If the insured person adheres to the medication application specified…