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30 October 2019
On 6 August 2019 the Federal Supreme Court dismissed an appeal against a Zurich Social Insurance Court decision.(1)
Since 2014, the appellant had suffered from worsening mastodynia. A gynaecologist requested coverage for the replacement of the appellant's breast implant under compulsory health insurance. However, the insurer (and subsequently, the Zurich Social Insurance Court) rejected this request.
On the basis of an independent medical examiner's report, the Supreme Court held that replacing the implant seemed inappropriate, as ultrasound examinations were unable to prove a connection between the appellant's pain and the implant (ie, the pain could have multiple origins).
According to the Supreme Court, the gynaecologist's reasoning that the pain was most likely caused by the implant was incomprehensible and therefore the Zurich Social Insurance Court's decision was not arbitrary. In addition, the Zurich Social Insurance Court was not obliged to conduct further inquiries regarding the origin of the appellant's pain, as a connection to the implant was unlikely to be found.
For further information on this topic please contact Andreas Wildi at Walder Wyss by telephone (+41 58 658 20 00) or email (firstname.lastname@example.org). The Walder Wyss website can be accessed at www.walderwyss.com.
(1) Federal Supreme Court, Decision 9C_336/2019 of 6 August 2019. Further details are available here.
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