Facts
X., a urologist, was insured against accidents with company B. His benefits included a death benefit of CHF 50,000 payable to his wife. The General Insurance Conditions (GIC) stipulated, among other obligations, a "duty of medical treatment" (Art. 16 GIC). In case of non-compliance with this provision, the insurance was in principle entitled to reduce or refuse its benefits (Art. 18 GIC). On August 11, 1993, X. was involved in a head-on car accident (collision at approximately 100 km/h) and was transported by helicopter to a hospital with chest injuries, a concussion, and facial wounds. Against the medical advice of hospital supervision, X. left the hospital the same day and returned to his vacation apartment. In the night of August 12 to 13, 1993, X. died after complaining of severe chest pains. The claim of K., the beneficiary, to order the insurance to pay the death benefit with interest, was rejected by the Commercial Court. The Federal Tribunal partially upheld K.'s appeal and ordered the insurance to pay CHF 25,000 with interest.Considerations
According to case law, the benefits paid by a lump-sum insurance, as well as those of a liability insurance, can be reduced or refused due to a breach of a contractual obligation. Although the accidental death benefit is a flat-rate benefit, independent of the existence of damage, this does not exclude the existence of ancillary obligations, such as the duty to minimize the consequences of a bodily injury. Violation of such obligations may justify a reduction of the benefit, as well as intentional fault or gross negligence in the occurrence of the insured event.
In the present case, the Commercial Court considered that the…