Facts
[H.] concluded two disability insurance contracts with insurance company X. in 1986 and 1992 for the event of disability due to an accident. [H.] suffered three traffic accidents between 1989 and 1993 that resulted in disability. The insurance company paid [H.] a total of 420,000 Swiss francs under these two contracts. However, as no agreement was reached on the actual amount owed, [H.] filed a lawsuit against the insurance company on November 13, 1996 before the Commercial Court of the Canton of Zurich, claiming payment of additional amounts.
Considerations
According to the case law of the Federal Supreme Court, disability within the meaning of Art. 88 Para. 1 ICA encompasses any lasting impairment of physical integrity with effects on the ability to work, i.e. the theoretical or abstract incapacity to work, and not the actual economic loss suffered by the insured person. However, the parties may agree that the actual economic damage incurred will be taken into account.
In the present case, the insurance contracts provide for a schedule of lump-sum indemnities for certain cases of partial disability. However, H.'s health issues do not correspond to these specific cases. The general clauses of the contracts therefore apply, stipulating that disability must be determined based on the permanent limitations of physical or mental functions and their impact on exclusively non-professional…