Facts
The plaintiff was insured with the defendant under a collective daily benefits insurance contract. He reported himself unable to work on June 28, 2002, and received daily benefits until June 12, 2004. A criminal proceeding was initiated against the plaintiff on suspicion of fraud. The defendant requested the plaintiff to reimburse the paid daily benefits. The Insurance Court of the Canton of Aargau upheld the complaint and ordered the plaintiff to pay the defendant CHF 69,908.60 plus interest of 5% from December 8, 2011.
Considerations
The Federal Court had to examine whether the defendant was entitled to assert the claim for recovery. The lower court had established that the defendant was the carrier of the insurance and had provided the insurance benefits in its capacity as a party to the insurance contract. The Federal Court confirmed this decision and stated that the defendant was also entitled to assert the claim even if it was not directly named in the insurance contract, since it had paid the daily benefits and [C. AG] , which was named in the contract, had to accept its behavior.
The Federal Court also examined whether the defendant's claim for recovery had expired. The lower court had established that the claim for recovery had not expired, since the defendant had only had sufficient documents to assess whether daily benefits had been paid unjustly after the police investigation and with the delivery of the police dossier on March 4, 2011. The Federal Court confirmed this decision and stated that the defendant had only had knowledge of the approximate extent of the financial loss and sufficient documents to assess whether daily benefits had been paid unjustly with the delivery of the police…