Facts
S. was employed as an upholsterer in a furniture factory from 1988 to the end of December 1996. He was covered by a group daily allowance insurance policy under the Federal Insurance Contract Act (LCA) concluded by the employer with Visana. S. was declared 100% incapable of work as of 27 February 1996 due to low back pain. Visana granted its benefits for certain periods. On 24 September 1996, S.'s employer terminated his employment contract as of 31 December 1996, informing him that the payment of daily allowances would cease on that date and that he had the possibility to take out individual insurance. On 4 February 1998, S. sued Visana, claiming payment of the daily allowances due under the group contract for the period from 6 May to 5 December 1996, and then from 6 February 1997 until the exhaustion of the entitlement to benefits.Considerations
The Federal Tribunal considered that, in a group daily allowance insurance policy under the LCA, the entitlement to benefits does not depend on membership, unlike group daily allowance insurance under the HIA. Thus, in the absence of contractual clauses limiting or eliminating the entitlement to benefits beyond the coverage period, the insured person who, after an event giving rise to the entitlement to benefits, leaves a group insurance policy because he or she ceases to belong to the circle of insured persons defined by the contract, can assert his or her entitlement to benefits also for the consequences of the event that occur after the termination of the insurance relationship.
In the present case, the group insurance contract does not contain any special clauses…