Facts
This case is about the obligation to provide benefits under a supplementary insurance to the social health insurance. Such supplementary insurances are subject to the Insurance Contract Act (VVG). Since the Social Insurance Court of the Canton of Zurich is the only cantonal instance that decides on disputes from such insurances, an appeal in civil matters against its decisions is admissible, even if the amount in dispute is less than 30,000 Swiss francs.
The Federal Supreme Court had to assess whether the insurance company had validly terminated the contract after the policyholder had fallen into arrears with the premium payment. The decisive factor is whether the reminder from the insurance company met the legal requirements.
Considerations
According to the provisions of the VVG, the reminder in the event of default on premium payments must explicitly, clearly and comprehensively threaten the consequences of the default. This includes not only the suspension of the insurer's obligation to perform, but also the insurer's right to withdraw from the contract, or the legal presumption of withdrawal.
The reminder letter from the insurance company did contain the reference to the suspension of the obligation to perform, but not to the…