Facts
Company A. AG had concluded a collective daily allowance insurance in case of illness with company C. GmbH. The insured was the manager of company C. GmbH, B. He was incapable of working on several occasions from February 2013 due to severe burnout syndrome and other health problems. The insurance company refused to pay benefits because there had been a suspension of insurance coverage from 20/21 September 2013 to 6 December 2013 due to non-payment of premiums. The dispute concerns whether the insured's incapacity for work occurred during this period of coverage suspension.Considerations
According to the case law of the Federal Tribunal, the insured event in a daily allowance insurance in case of illness is not the occurrence of the illness itself, but the resulting incapacity for work. When the insured is in arrears with the payment of premiums, the insurance coverage is suspended and the insurer is not obliged to pay benefits for insured events that occurred during this period of suspension.
In the present case, the Federal Tribunal considered that the insured event occurred on 4 October 2013, the date on which the insured…