Beware of wrong health information
the essentials in brief
- Those who want to take out certain insurance policies often have to answer extensive health questions in their application. This applies, for example, to occupational and disability contracts, life insurance and private health insurance.
- However, you only need to specify the diseases or treatments that you are specifically asked for.
So go ahead
- Be sure to answer the questions truthfully and leave out any supposed trifles. In the worst case, you will not get any benefit later.
- Do not fill in the health questions directly with your broker or fee advisor, but take the bow home and answer the questions in peace.
- Be sure to consult with your doctors because their files often contain things you do not think about or know about. The insurances check that you have provided information from your medical records before granting benefits.
When it comes to taking out all life, illness and labor insurance, questions about health play a big role. On the basis of health information, an insurance company estimates the risk of insuring a customer. Accordingly, the company calculates the premiums, raises risk premiums for certain diseases or even rejects the application. Anyone who is ill can find it difficult to get a contract at all. But even those who have made the contract, the topic will not go.
Why are health issues important?
How detailed an insurer cares about your health depends on the contract you wish to complete. If there is a lot of money for the provider in the event of an insurance claim, for example in the case of occupational disability or term life insurance, you generally have to fill in multi-page questionnaires. If you want to insure only a relatively limited range of benefits, as with supplementary dental insurance, the health check is less extensive.
Health status is important not only when concluding a new contract, but also when an insured wishes to improve the benefits of an existing contract. This is the case, for example, if the customer wants to increase the sum insured or reduce the deductible of his private health insurance. Then the insurer can demand a new health check.
This can be avoided by a contract with Nachversicherungsgarantie. This clause makes it possible to adjust the insurance retroactively for special events such as marriage, childbirth or a salary increase – without renewed health issues.
Even if it is later that a benefit should be paid out, the insurance companies again check exactly whether all information on the health issues were truthful and complete. If the insurance company detects a mistake, it can sometimes refuse to pay.
Why should you answer the health questions truthfully?
Do not cheat on health issues. Otherwise, in the worst case, you risk your insurance coverage and the loss of all paid contributions. However, you only have to specify things that are specifically asked in text form. For example, if you are asked in the insurance application for “medically treated illnesses and conditions”, you do not need to mention any complaints that did not give you medical treatment.
Consumer-friendly health issues relate to a limited period of time: the past five years are usually for outpatient treatment and a maximum of ten years for inpatient treatment. In addition, should be specifically asked for medical treatment, not for “complaints and ailments”.
When should you consult your doctors?
It makes the conclusion of an insurance though laborious, but health questions should only be answered after consultation with your doctors. Do not fill the sheet directly with the insurance broker, but take your time. If the answers do not all fit on the insurance form, take an extra sheet of paper.
It is best to request all your medical records from all the relevant doctors. In case of doubt, this is not only the family doctor, but also the gynecologist, dermatologist or orthopedist. Because over and over it happens that doctors settle diagnoses, of which you know nothing. In order to remember all the doctor’s visits of the past years, the view in old calendars often helps. In addition, you can request a so-called insured information from your health insurance company free of charge. It contains a list of all medical services billed through health insurance over the past 18 months.
If you find any information that might be wrong in your records, you should consult your doctor and ask for correction. If you have difficulty completing the questionnaire, it is also best to ask your doctor for advice and to discuss the questions together. This will allow you to ensure that answers to the health questionnaire are in line with the records. Because one day it actually comes to the approval of an insurance benefit, such as a disability pension, the insurance company will request the patient records.
By signing the questionnaire, you must release your doctors from the obligation of secrecy to the insurance company. You should not do this on a flat-rate basis for all doctors, but only on a case-by-case basis at the request of the insurance company. This is useful so that you can talk to the doctor again and ask him to limit his information strictly to the period requested in the application. Alternatively, you can also obtain the required information from the respective doctor and pass it on to the insurance company. This will prevent the doctor from accidentally giving you information that could harm you.
What is meant by a pre-contractual obligation to notify?
Keep all the documents you have used to fill out the health questions. In this way, you can better prove in a possible dispute that you have fulfilled your pre-contractual duty to notify.
The Insurance Contract Act (VVG) regulates this duty of disclosure of the policyholder in clause 19. It states that the customer has “until the submission of his contract declaration the known risk circumstances that are significant for the decision of the insurer to conclude the contract with the agreed content and after which the insurer in writing asked to inform the insurer “.
When calculating your contribution, the insurance company assumes that the health information is correct. Lack of information, there is a risk that you lose the insurance coverage.
The insurance company may challenge the contract if the customer has “fraudulently” seized the insurance cover by, for example, deliberately concealing previous illnesses. In such a case, the customer must refund already received benefits to the insurance and also loses his paid contributions. However, this only applies within the first ten years after conclusion of the contract. After that, the malicious deception lapses. In addition, the insurance must prove that the customer has deliberately lied to them and has not made false or false shame false information.
The insurance can challenge the contract in case of fraudulent deception even if the secretive illness is insignificant for the occurrence of the insured event. This happened to a woman in a dispute with her occupational disability insurance: The plaintiff could no longer work because she had fallen down the stairs during operation and had seriously injured herself. However, at the time of signing the contract she had concealed that she had been treated by several physicians for a heart valve failure, elevated cholesterol and anxiety after a car accident. The insurance did not have to pay.
If the customer has made incomplete information out of fault, this can also have adverse consequences. The insurer may, for example, terminate the contract within one month or increase the contributions retroactively or exclude benefits in certain cases. Which sanctions the insurance can take depends on how negligently the customer has acted and whether the provider would have concluded the contract even if he knew the secretive circumstances.
If it comes to the dispute with the insurance, you should not immediately add. For the resignation of the insurer from the contract or a contract challenge there are high legal hurdles. Often the attempt to dissolve the contract fails, already at form errors. For this reason, be sure to seek advice from a specialist lawyer for insurance law if the company does not want to pay.
The risk of breaching the pre-contractual duty to disclose is also significantly lower if a provider refrains from adapting or terminating the policy under Paragraph 19 VVG. The terms of the insurance should contain approximately the following wording: “We waive the rights under Section 19 VVG to adjust the contract and terminate the contract if the breach of duty to report has occurred through no fault of one’s own.”
When are you entitled to a lower insurance contribution?
Insurers require risk premiums for some pre-existing conditions, which are in addition to the insurance premium. However, this does not mean that the customer has to pay the increased premium until the end of the term of the insurance contract. Insurance law stipulates that the policyholder may demand to reduce the contribution if the former illness no longer poses an increased risk).
If in doubt, you can enforce the claim for reduction of the insurance premium also in court. The district court of Coburg ruled that the policyholder can claim cancellation of the risk premium as soon as the risk is removed.
In this case, a privately-insured person had healed a spinal disease after years so that there was no longer an increased risk of illness. Therefore, the insurance company had to cancel the risk premium. The insured should, however, be able to prove the cure, for example by a medical report.