Facts
The appellant, [A.] , was employed by [C. GmbH] , which had taken out daily sickness benefit insurance with [B.] Insurance AG. On 7 January 2013, a complete incapacity for work that had existed since 24 November 2012 was reported. The insurance company provided daily allowance benefits from 7 January 2013 to 14 August 2013 on the basis of an incapacity for work of 100 % and from 15 August 2013 to 15 February 2014 on the basis of an incapacity for work of 60 %. The appellant brought an action and demanded from the insurance company CHF 15,155.75 plus interest at 5 % from the median due date, as he was of the opinion that he had been 100 % incapacitated for work until 31 January 2014.
The Social Insurance Court of the Canton of Zurich dismissed the action, as it concluded on the basis of the reports of the treating physicians and the insurance company's consulting physician, as well as an expert opinion commissioned by the insurance company and the fact that the insured person had undertaken several flights between 21 July and 24 October 2013, that from July 2013 to mid-August 2013, with overwhelming probability, an incapacity for work of 60 % still existed and that from 10 January 2014, no incapacity for work existed anymore.
Considerations
The Federal Court dismissed the appellant's appeal, as the lower court had correctly applied the burden of proof in the context of the insurance contract. The policyholder must assert and prove the facts justifying the insurance claim. The appellant did not provide evidence that the 100 % incapacity for work existed during the disputed period.
The Federal Court also found that the lower court had correctly evaluated the evidence and that the…