Facts
S. is mandatorily insured for medical care with the Assura Health and Accident Insurance. In 2000, he reported complaints resulting from tick bites in 1999. The Zurich Insurance Company, with whom S. was insured against accidents in 1999, rejected the claim for benefits from the accident insurance, as the health impairments could not be attributed to an accident. S. filed an objection. For a riding accident in 2000, Visana as the responsible accident insurer initially provided benefits, but later denied any further obligation to pay. The Administrative Court of the Canton of Bern overturned the objection decision and referred the matter back for additional clarification. S. demanded that Assura as the health insurer cover the costs of medications and laboratory tests in connection with the alleged tick bite. Assura rejected this, whereupon S. filed a complaint.Considerations
According to the principles on the obligation of the health insurance to provide advance payments, the health insurance is obliged to make advance payments if it is established that a certain service must be provided, but it is unclear whether the health impairment is attributable to an accident or an illness. This also applies in cases where the accident causality is disputed and assessed controversially by the physicians.
Assura cannot argue that the treatments carried out were not medically indicated, as they appeared justified at the time of treatment based…