How often do insurance companies refuse to pay

Disability insurance does not pay: this is how you get your money

Questions about dangerous circumstances when taking out disability insurance

When a claim occurs, it happens again and again that the insurance company gives its policyholder a "Violation of his pre-contractual obligation to notify" accuses. This means that when the insurance contract was initiated, the policyholder did not answer, or did not answer correctly, certain questions from the insurer about relevant circumstances - mostly health issues.

In principle, the policyholder is obliged to notify the insurer of all so-called risk-relevant circumstances. These are circumstances that could cause the insurer not to conclude the insurance contract or to demand a higher insurance premium.

The case law counts the following illnesses and complaints in particular among the dangerous circumstances:

  • Heart and circulatory problems
  • Spinal problems as well as protracted back problems
  • disc prolapse
  • Knee discomfort
  • Inflammation of the kidneys
  • Cervical spine discomfort
  • gout
  • Circulatory disorders
  • depressions

The insurer can withdraw from the contract due to the non-disclosure of the circumstances. If the policyholder is of the opinion that the health disorders are not significant and therefore the questions did not need to be answered, then he must also prove this.

It is different if an insurance agent has completed the insurance application form for the applicant. Then the completed application alone does not prove the wrong answer to the questions in the application form if the policyholder credibly claims to have verbally correctly informed the agent or not to have been confronted by him with the individual questions. In such a case, the insurer must prove that all questions answered in writing in the form were actually put to the applicant and answered by him as written down.

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Incapable of working now what? - The pitfall in applying for a disability pension

If an occupational disability actually occurs, the process leading to the granting of an occupational disability pension can be very long and arduous. The first requirement is that the insured person fills out their application for occupational disability in detail and submits it in good time. An accident or illness can be the trigger for an employed person to no longer be able to do his or her regular job. If the doctor proves that an accident or illness means that the insured person can only do 50% of his regular work, he can apply for a disability pension.

But if you make mistakes or neglect when applying for the disability pension, you can at best significantly delay your pension payment and at worst risk it.

Before you make mistakes when applying for insurance or a pension, which in the end will cost you dearly due to the rejection of the application for pension payment, hiring a lawyer is a worthwhile "investment". This is especially true if - for whatever reason - you are already expecting problems.

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Disability insurance no longer pays: Problems with the review process

The so-called abstract or specific referral - usually regulated in the insurance conditions - enables the insurer to refuse benefits if the insured person could pursue another reasonable profession. In the review procedure, the insurer usually ceases to provide benefits on the grounds that the insured person can pursue another activity. However, this must correspond to his previous professional position and experience and ensure him an approximately comparable income. However, these requirements are often not met.

In the review process, the insurance company checks whether the occupational disability still exists and which benefits are covered. According to the current insurance conditions, the right to obtain information from the policyholder “at any time” exists. The insurance company can request detailed examinations once a year - including by doctors commissioned by it. During the review process, the current state of the policyholder is recorded in order to classify the degree of occupational disability. If the review procedure shows that the insured person can pursue an activity that meets the referral criteria through regained or newly acquired skills, the obligation to provide benefits may expire. The disability insurance no longer pays.

Since a lot can be at stake in the review procedure and the insurance companies often try to cut or suspend benefits, we recommend professional support from a specialist disability insurance lawyer.

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Disability insurance does not pay: the objections of the insurance company

The two most common objections made by insurance companies in relation to occupational disability are:

  • there is no occupational disability (med. BU degree not achieved)
  • Wrong information was given in the insurance application (so-called breach of obligation)

For most consumers, the loss of their manpower is already a major turning point, and if the occupational disability insurance taken out especially for this case does not pay, the situation will get even worse.

We will help you if the insurance company tries to reject your pension or if the process is dragging out. We also represent you in all other disputes with yours Occupational disability insurance.

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