Federal Supreme Court, Decision 9C_388/2020 of 3 March 2021

1 avril 2021 – In this decision, the Federal Supreme Court had to decide whether the health insurance (appellant) had to cover the costs of dental treatment with regard to a birth defect.

The lower court, in a concrete appraisal of the medical records, found that it was predominantly probable that the birth defect was "multiple non-congenital defects" (das Geburtsgebrechen "multiple Nichtanlagen"). It could not be completely ruled out that the lack of teeth could be due to an accident or an extraction. However, these possibilities seemed extremely unlikely. The health insurance company appealed against this and argued that it was possible that the undercount of teeth was due to reasons other than a birth defect. Thus, there was a lack of evidence.

However, the appellant did not succeed. The Federal Supreme Court did not find any violation of federal law and dismissed the appeal.

For the full decision, see here.