Facts
The case concerns an insured, B., who was covered by a mandatory accident insurance policy with the Alpina insurance company. Due to professional difficulties, B. fell into a state of deep despair and attempted to commit suicide several times. On March 5, 1985, he jumped from the roof of a building and suffered multiple fractures. The insurer, Alpina, refused to pay the benefits, arguing that the insured was not completely irresponsible at the time of the accident. However, the cantonal court ruled that the insured was a victim of an accident and ordered the insurer to pay the benefits.
The key facts are as follows
- On February 26, 1985, B. was hospitalized on an emergency basis due to his state of deep despair.
- On March 5, 1985, B. jumped from the roof of a building and suffered multiple fractures.
- The insurer, Alpina, refused to pay the benefits, arguing that the insured was not completely irresponsible at the time of the accident.
- The cantonal court ruled that the insured was a victim of an accident and ordered the insurer to pay the benefits.
Considerations
The federal court examined the question of whether the insured, B., could be considered a victim of an accident within the meaning of the accident insurance law. The court ruled that the insured's capacity for discernment at the time of the accident was the determining criterion for deciding whether an accident was present.
The court examined the applicable legal provisions, including Article 37 paragraph 1 of the Accident Insurance Law (AIA) and Article 48 of the Accident Insurance Ordinance (AIO). The court also examined the relevant case law, including the judgment ATF 100 V 79.
The court concluded that the insured, B., was a victim of an…