In its judgment of 2 September 2026, the Federal Supreme Court (the Court) dismissed the appeal of an insured minor against a decision of the Social Insurance Court of the Canton of Zurich (Sozialversicherungsgericht des Kantons Zürich). The question in dispute was whether a health insurer could issue a reconsideration decision to the detriment of the insured person while objection proceedings were pending.

By decision of 25 April 2025, Mutuel Krankenversicherung AG had limited the reimbursement of nursing care services provided to the insured person. The insured person had filed an objection. The insurer had subsequently reconsidered its decision and replaced it with a new decision of 3 December 2025, denying any reimbursement. The Social Insurance Court held that the new decision did not constitute an objection decision under art. 52 para. 2 of the Federal Act of 6 October 2000 on the General Part of Social Insurance Law (Bundesgesetz über den Allgemeinen Teil des Sozialversicherungsrechts, ATSG). It therefore declined to entertain the appeal and referred the matter to the insurer for a ruling on the objection.

The Court upheld this outcome on different grounds. It held that an insurer was not bound by the requests made in an objection and could amend its decision to the detriment of the insured person (reformatio in peius). Under art. 12 para. 2 of the Ordinance on the General Part of Social Insurance Law (Verordnung über den Allgemeinen Teil des Sozialversicherungsrechts, ATSV), however, the insurer first had to warn the insured person of the impending deterioration. It also had to inform the insured person of the possibility of withdrawing the objection. A reconsideration decision could not be used to circumvent this obligation. By failing to comply with it, the insurer had committed a manifest procedural defect. The decision of 3 December 2025 was therefore null and void and did not constitute a contestable object of appeal.

The Court further clarified that the insurer had to resume the objection proceedings. A substantive objection decision was to be issued only if the insured person maintained the objection after being heard. If the objection was withdrawn, the decision of 25 April 2025 would become final. In that case, the insurer could revisit its decision only under the stricter requirements for reconsideration under art. 53 ATSG, and in principle only with prospective effect.

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