Facts
The case concerns an insured, B., who was affiliated with the insurer ASSURA since July 1, 1994. The insured did not regularly pay their premiums, which led to several lawsuits and the issuance of acts of default for a total amount of 3'205 fr. 45. The canton of Vaud, where the insured is domiciled, did not grant a premium reduction to the insured and refused to take over the premium arrears owed by the insured. The insurer then decided to suspend the insured's right to benefits until the arrears were reimbursed, and then terminated the insured's insurance policy with effect as of August 31, 1997.
The insured appealed against this decision before the Cantonal Insurance Court of Vaud, which admitted the appeal and reformed the insurer's decision. The insurer filed an administrative appeal with the Federal Insurance Court, requesting the annulment of the cantonal judgment and the confirmation of the termination of the insured's insurance policy.
Considerations
The Federal Insurance Court examined whether the insurer was entitled to exclude the insured for non-payment of premiums. It considered that the insurance obligation implies that the exclusion of an insured, in particular for non-payment of premiums, is no longer admissible under the HIA regime.
The Court also examined Article 9 para. 4 HIO, which allows the insurer to terminate the insurance relationship if the insured is not subject to Swiss social assistance legislation. However, the Court considered that this provision does not apply to the insured's case, who is domiciled in Switzerland and subject to cantonal social assistance legislation.
The Court concluded that the insurer was not entitled to exclude the insured for non-payment of premiums and that the…