Dental injury resulting from a collision during a bumper car ride as an insured accident

Facts

H., born in 1996, is compulsorily insured for health and accident by Helsana Insurance AG. On July 2, 2005, he suffered a collision while riding a bumper car at a fair in X., during which he struck his head against the steering wheel and sustained damage to several teeth. Helsana rejected reimbursement of the resulting treatment costs of 564.20 Swiss francs, as the incident did not constitute an accident in the legal sense.

The Social Insurance Court of the Canton of Zurich dismissed H.'s appeal against the objection decision. H. then filed an administrative court appeal with the aim of having Helsana provide the statutory benefits for the consequences of the accident.

Considerations

The Federal Supreme Court upheld the appeal. It stated that, contrary to previous case law, the appellant had suffered an insured accident. The criterion of the unusualness of the external factor must be affirmed in the case of dental injuries caused by the use of bumper car facilities.

The Federal Supreme Court explained that the feature of the unusualness of the external factor must be related to the factor itself, not its effect. However, the nature of the health damage is indeed considerable, as there is an increased need for demarcation if the damage can also have causes other than a sudden external influence.

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