Facts
The appellant ([A.] ) was employed by the City of [U.] from 1 September 2000 to 31 March 2023 and was insured for collective daily sickness benefits with a previous insurer until 31 December 2022. He claimed entitlement to benefits from 9 March 2022. As of 1 January 2023, the appellant’s then employer transferred its daily sickness benefits insurance to the respondent ([B. AG] ). The latter declined liability for benefits from 1 January 2023 in a letter dated 17 February 2023.
The appellant filed a claim on 25 April 2023 with the Insurance Court of the Canton of Aargau, seeking an order against the respondent to pay CHF 17,824.65 plus interest at 5% from 1 March 2023. The Insurance Court dismissed the claim by judgment of 25 April 2024. The appellant then filed an appeal in civil matters with the Federal Supreme Court, reducing his claim in the reply to CHF 17,305.50. The respondent requested dismissal of the appeal.
Considerations
The Federal Supreme Court examined the appeal in civil matters pursuant to Art. 72 et seq. FSCA, as the dispute concerned an additional insurance to social health insurance subject to the IPA and of a private-law nature. The appeal was admissible irrespective of the value in dispute since the Insurance Court had been the sole cantonal instance to decide (Art. 74 para. 2 lit. b FSCA).
The Federal Supreme Court took the facts as established by the lower court (Art. 105 para. 1 FSCA). It reviewed only the grounds of appeal raised, unless the legal deficiencies were obvious. The appellant bore the burden of proof for the occurrence of incapacity to work due to illness during the relevant period (1 January 2023 to 31 March 2023). The lower court found that the appellant had not met his burden of substantiation, as he had not sufficiently concretely demonstrated his incapacity to work due to illness. A general reference to medical certificates was insufficient to meet the required standard of substantiation.
The Federal Supreme Court confirmed that the lower court had correctly applied the principles governing the burden of allegation and substantiation. Medical certificates and doctors’ reports are considered, for evidentiary purposes, as party allegations rather than actual means of evidence. A general denial of incapacity to work by the respondent was sufficient since the appellant had not sufficiently substantiated his claims. The lower court was not required to refute each of the appellant’s submissions individually, provided the decision was sufficiently reasoned.
The appellant alleged a violation of the right to be heard (Art. 29 para. 2…