Facts
Hermann Wey joined the collective insurance contract concluded by his employer (Company M.) with the Swiss Health and Accident Insurance Fund Konkordia, effective from 1 September 1968. In the membership declaration, he provided incomplete information about previous illnesses and medical treatments. The health insurance fund subsequently decided to retroactively exclude Hermann Wey from the fund as of 1 September 1968. Wey filed a complaint with the Insurance Court of the Canton of Lucerne, which dismissed the complaint. Wey then filed a complaint with the Federal Insurance Court.Considerations
The Federal Insurance Court states that the statutory provision of a health insurance fund, according to which a member can be excluded from the fund for breach of the duty to notify, is not generally contrary to federal law. However, the principle of proportionality must be observed. The complainant Wey has indeed culpably violated the duty to notify by not providing complete information about previous illnesses and medical treatments. However, his fault is not particularly serious, as he could assume based on the medical information that it did not involve serious illnesses. Furthermore, a reference to the possible severe sanctions in the membership form would have been required. Therefore, the exclusion of the complainant from the health insurance fund is disproportionate.
The Federal Insurance Court sets aside the exclusion decision and the judgment of the lower instance and remands the case to the…