Medically necessary treatment
In private health insurance, the insured event begins with medically necessary treatment for illness or accident consequences. Medical necessity and treatment purpose are central.
Official RIS decision →Case law
Austrian Supreme Court decisions explained clearly.
Verified decisions on private health insurance, medical disclosures and benefits.
Private health insurance
Private health insurance
Selected verified decisions with practical context.
Cosmetic treatment and exclusions
The Court reviewed an exclusion for cosmetic treatment, operations and their consequences. Medical indication and contractual exclusion must be distinguished carefully.
Official RIS decision →Answer health questions carefully
Pre-contract health information requires great care. The policyholder generally bears the burden of showing an absence of fault for an incorrect or incomplete answer.
Official RIS decision →Frequency as well as severity may be material
For health-risk assessment, not only the severity of one illness but also the frequency of treatment or recurring complaints may be material.
Official RIS decision →Pre-contract disclosure and fault
Health questions must be answered completely to the best of the applicant’s knowledge. The insurer must prove the legal basis for its response, while the applicant must show any absence of fault.
Official RIS decision →Specific health questions must be taken seriously
Questions about drug use, ongoing treatment, hospital stays or mental illness are risk-relevant. Incomplete answers may endanger cover.
Official RIS decision →Purpose of a hospital daily allowance
A hospital daily allowance typically cushions additional burdens during inpatient treatment and differs from reimbursement of specific treatment costs.
Official RIS decision →Illness as the central trigger
A contractual illness is a central trigger for private health-insurance benefits. Diagnosis and medical necessity must still be assessed separately.
Official RIS decision →Important note
The summaries do not replace individual review.
The full judgment, the individual policy and the facts remain decisive.