Federal Supreme Court, Decision 9C_336/2019 of 6 August 2019

30 August 2019 – In this decision of 6 August 2019, the Federal Supreme Court dismissed an appeal against a decision of the Social Insurance Court of the Canton of Zurich. The appellant’s gynecologist – referencing to a mastodynia increasing since 2014 – requested coverage for the replacement of her breast implant by compulsory health care insurance. The insurance company as well as the lower court rejected the coverage request. The Supreme Court upheld the argument that – on the basis of a report by an independent medical examiner – a change of the implant seemed to be inappropriate, as ultrasound examinations were not able to prove a connection between the appellant’s pain and the implant, which could originate from various sources. Thus, the gynecologist's reasoning that the pain was most likely caused by the implant was not comprehensible in the Court’s opinion. Therefore, the decision of the lower court was not arbitrary. In addition, the lower court was not obliged to conduct any further inquiries regarding the origin of the pain, since a connection to the implant was predominantly likely to be denied. For the full decision, see here.