When concluding insurance contracts, sometimes extensive health questions have to be answered. This concerns in particular the occupational disability insurance and the health insurance.
In this article we deal with the occupational disability insurance. In the second part we dedicate ourselves to the health insurance.
Many people are annoyed by the number of personal health questions and tend to simply answer "no" everywhere to have the health questions thus quickly settled.
But is this also the correct procedure?
Is it okay to simply leave out seemingly insignificant medical conditions?
The clear answer is: No, not at all.
We'll start with an example:
A civil engineer has taken out an occupational disability insurance policy.
Due to dynamic increases, the insured monthly pension at the onset of occupational disability was 2.640 Euro per month.
So a lot of money is at stake. For the insurance company – but also for the customer.
The 37-year-old civil engineer was found to have abnormalities during a routine examination, which led to further examinations. After these examinations the diagnosis of bone cancer was made. Due to chemotherapy and radiation, the civil engineer could no longer pursue his previous professional activity.
The occupational disability insurance must therefore 2.Pay 640 Euro per month.
These are per year already 31.680 euros.
The insurance period of the contract was until 67 years of age. planned for the second year of life, i.e. the normal start of the pension in Germany. This means that the insurance company still has to pay for 30 years; 30 years times 31.680 Euro are in the sum 950.400 Euro.
So the customer wants the insurance company to pay 950 until the statutory retirement date.400 euros paid to him. For the customer, this is often a matter of life and death.
The insurance company has contractually promised 950.400 euros to pay. There is no goodwill at this scale. Therefore, the insurance company will carefully check the conditions and analyze whether the contract has been established correctly. Legally, the rules are clear: the customer or. The insured person must answer all questions correctly and completely when applying for insurance.
If the check shows that the customer has forgotten or simply not stated any illnesses in the health information, the customer has a very big problem.
In this case, the insurance company will check whether the incomplete or incorrect information means that the contract can be contested.
This means: the insurance company does not have to pay an occupational disability pension, the client does not receive 950.400 euros and the premiums paid by the customer in the past also remain with the insurance company.
To emphasize: A lot of money is at stake for both the customer and the insurance company. At this point no good conditions help, here no goodwill helps. The only question is whether the customer has provided correct information when applying for insurance.
This topic is therefore extremely important and unfortunately often does not receive enough attention. When taking out an occupational disability insurance policy, it is of secondary importance whether you select the insurance company in first or second place in a price comparison and then believe that you have taken out the best policy.
It is much more crucial that the insurance company correctly checks and accepts the individual health information before an application is made. And at this point, the customer who wants to take out the insurance must answer the health information in detail. Otherwise, in the event of a benefit, he risks a challenge to the contract and the preordained scenario looms.
Health information must always be answered very precisely and in detail
Unfortunately, there are always customers who do not take this issue seriously and hope that it does not matter if the health information was not answered accurately.
Unfortunately, there are also insurance brokers or bank advisors who do not consider answering the health questions to be a central issue, but downplay its importance. The contract can be concluded more quickly if all the information is answered in the negative.
However, this endangers the insurance coverage and you should not rely on such "tips" under any circumstances listen, but quickly look for a new advisor.
Misrepresentation leads to 100% problems in benefits case. It is about a lot of money. You only get this money if the application was clean and there were no false statements in the application.
By the way, of course it is no problem if you have forgotten a preventive medical check-up or if a cold was forgotten in the application. However, each missing information leads to the fact that one makes oneself attackable opposite the insurance company. In case of emergency, the insurance company will check very carefully whether it is possible to contest the contract. This should not be risked by hastily answering health questions incorrectly.
After all, it is first and foremost a question of your own money.
What is occupational disability insurance??
With occupational disability insurance, you protect your most important asset – your ability to work. In the course of one's professional life, one often earns several hundred thousand euros. If one must leave the occupation because of illness or accident already before reaching the pension age, the financial chaos for the family is pre-programmed, if one did not lock a sufficient private occupational disability insurance.
Consumer protectionists therefore consider occupational disability insurance to be one of the most important insurance contracts in Germany.
Why may the insurance company cause problems in the case of false statements?
One of the customer's pre-contractual obligations is to answer the insurance company's questions correctly. If the insurance company asks about hospital visits, they must be answered completely. If the insurance company asks about back problems, these must be explained. If the insurance company asks about private dangerous hobbies (such as motorcycling or mountain climbing), then the questions must be answered correctly.
The customer is therefore obligated to disclose the circumstances of the risk known to him/her when submitting the application. This refers to all application questions, which must be answered completely and correctly.
Otherwise, the insurance company has the right to contest the contract on the grounds of a breach of the pre-contractual duty of disclosure.
In order for the contestation or withdrawal of the insurer to become effective, the insurance company must prove to the policyholder that he intentionally made false statements.
This accusation of pre-contractual breach of duty of disclosure is quickly raised by insurance companies. In such cases, the court ultimately decides whether the insurance company is in the right or the customer is.
However, if you have deliberately concealed illnesses or treatments, the insurance company is in the right and does not have to pay an occupational disability pension.
Even if it is doubtful: If one has become professionally incapacitated due to health complaints, then one would like to receive as a customer naturally as fast as possible the pension payment by its insurance – and not still several years in court to argue whether the health questions were answered now correctly or not.
Therefore it is of very high importance to answer all health questions correctly and completely. If you are not sure about the answers to the questions, you have to contact the attending physician and ask him to hand over relevant medical documents or make a copy of the patient's file. Based on these documents, the questions can usually be answered completely.
- Case 1: Back problems
When applying for insurance, one has inadvertently not given any information about back problems. The back complaints are medically documented, because the doctor prescribed massages two years before the contract for the occupational disability insurance was concluded.
When a slipped disc later leads to the fact that the occupation must be given up, the occupational disability insurance refuses the achievement. The reason is that the back complaints were not stated when the application was made.
- Case 2: Mental health problems
Due to severe problems at university, several sessions were held with a psychotherapist. This was not stated when the occupational disability insurance was taken out. When the pressure in professional life became too great and led to depression, the profession had to be given up for health reasons. The occupational disability insurance refused to pay the agreed pension because no information about the sessions with the psychotherapist was provided when the application was submitted.
- Case 3: Group contract in large groups with simplified health assessment
It often happens that employers have group contracts with an insurance company that include simplified health questions. At this point, you also have to be very careful, because contracts with simplified health questions have to be answered precisely. Otherwise, the insurance company may again challenge the contract. Usually, the health questions of such group contracts are shortened in number, but contain an "open" question Question, which leads to the fact that health complaints or medical treatments of the last years must be indicated nevertheless again.
As a rule, the consultants in the company are not insurance experts in the field of occupational disability insurance and do not know the legal consequences.
But if you then hastily sign a contract, all health questions with "no" and trusting that the employer has agreed on a good contract for its employees, the problems show up in an emergency. It happens again and again that the "insurance advisors" within the company, put the importance of the health information into perspective, or. downplay. At this point you should be very, very careful and not sign hastily. It is often even true that a group contract through the employer can offer slightly improved conditions compared to the normal insurance contract. A wrong answer to a few questions, however, leads to a challenge just as with all other contracts. In addition, it is rather rare that the employer cooperates with the insurance company that is best for the individual customer. After all, there are more than 50 insurance companies offering occupational disability insurance policies. We check such group contracts for our customers again and again and often have to find out that there can be problems here in the case of an emergency or that there is a lack of information. there are significantly safer solutions.
What is the significance of the preliminary risk inquiry??
These examples make it clear that it is extremely important to proceed very carefully when making an application. It is also wrong to submit an application to an insurance company and wait to see how the insurance company evaluates the health information. Rejections are often stored in a central file, which in turn can be accessed by other insurance companies.
All insurance companies can evaluate the health information differently.
Only by a so-called risk preliminary inquiry one can let determine, which insurance company individually fits best and offers the greatest possible security. The risk pre-inquiry is for us a central component of the consultation of our customers.
It may be, for example, that an insurance company requires a 50% risk surcharge due to high blood pressure. Another insurance company accepts the identical data to the high blood pressure however without risk surcharge.
Allergies are a frequent topic: Insurance companies often demand a risk surcharge of, for example, 30% for existing allergies. In the context of a risk preliminary inquiry one can examine however also whether there are insurance companies, which require no addition for allergies at all.
Even one-time back pain and a few massages have an influence on the selection of occupational disability insurance.
While some insurance companies demand a permanent exclusion of benefits for the spine after back pain, other insurance companies have no problem at all with this and would accept an application without restrictions. However, an exclusion of benefits for the spine means that if you become incapacitated due to an illness related to the spine, the insurance company does not have to provide benefits. So, of course, it would be better to find an insurance company that waives the benefit exclusion.
Insurance companies evaluate illnesses, doctor visits, allergies, etc. very different. It is very important that everything is stated correctly. But before you choose an insurance company, you should know how the different insurances evaluate your information. In this case, one has to contact an expert who can carry out preliminary risk inquiries.
We have been conducting risk pre-inquiries since 2006!
Conducting anonymous risk inquiries has long been part of our daily business.
All health data of the last years are summarized in writing beforehand. If necessary, medical documents or patient records are enclosed.
All information is anonymized by the insurance broker and then a check is made as to how the insurance companies would evaluate the health information.
A 31-year-old customer wants to take out an occupational disability insurance policy with 1.500 Euro occupational disability pension until the age of 65. Year of life.
The client is an employee in a telecommunications company.
The client has the following health conditions:
– Presence of defective vision with -7 dioptres
– Cyst, benign, surgically removed without consequences
– Skin disease: mild form of neurodermatitis
– spinal complaints, back pain about two years earlier. For this purpose, several appointments were made with a physiotherapist for massage.
We carry out an anonymous risk pre-inquiry for the customer.
Insurance company A:
Rejects an application based on health information.
Justification: The insurance company would require a benefit exclusion for vision loss in both eyes, skin conditions and spinal conditions.
If there are three or more benefit exclusions, this insurance company will reject a claim.
Insurance company B:
Requires a benefit exclusion for vision loss in both eyes.
Also requires an exclusion of benefits for skin diseases.
Also requires a benefit exclusion the spine.
Insurance Company C:
Insurance company C accepted the application without any restrictions.
Eye diseases, skin diseases and spinal diseases are covered by this contract.
We experience such and similar results again and again. Therefore, a comparison of different tariffs is only meaningful if one has first completed the evaluation of the health information and knows at which conditions one is really insurable.
A simple price comparison via an online comparison calculator tends not to help when taking out occupational disability insurance. This procedure is of course somewhat more complex, than over a comparison portal or an Internet side with the health data 10 times "no" tick the box and then have taken out a policy.
But by this procedure our customers have a maximum of security that the agreed upon insurance protection in the case of emergency also actually seizes and it then not to a "bad awakening" comes. As part of our consultation, we therefore always carry out a risk pre-inquiry. Only then can you really tell which insurance company is the best fit for the customer.