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BUZ Insurance Doesn't Pay: Understanding Causes and Acting Successfully
Your occupational disability insurance is not paying out? This is a stressful situation, but not a reason to give up. This article highlights the most common reasons for benefit rejections and outlines concrete steps on how you can fight back and claim your rights.
The topic in brief and concise terms
If the disability insurance does not pay out, it is often due to formal errors, not reaching the fifty percent level of disability, or a breach of the pre-contractual duty of disclosure.
Accurate documentation, compliance with cooperation obligations and deadlines, as well as honest answers to health questions are crucial for success.
If your application is rejected, you should file an appeal. With professional support, such as from a specialised lawyer, you can significantly improve your chances.
Understanding Refusal to Perform: An Overview of the Most Common Reasons
When the occupational disability insurance refuses to pay, the causes often fall into three main areas. One of the most common reasons, accounting for up to forty per cent of cases, is the failure of the insured person to fulfil their duty to cooperate. This means that documents are missing or there is no response to requests from the insurer. Another key point is not reaching the required degree of occupational disability, usually fifty per cent, which is cited in over fifty per cent of rejections. Finally, the breach of the pre-contractual duty of disclosure plays a significant role, being cited as the cause in around twelve per cent of rejected claims. These figures highlight the importance of careful preparation and support during the claims application process.
The Path to Performance: Mastering Applications and Duties of Cooperation
The process from application submission to the insurance decision takes an average of ninety-nine days. If all documents are complete, a decision may be made in as little as nine days. To avoid delays or rejections, your active participation is crucial. Create a detailed weekly plan of your activities rather than solely using the insurer's forms. Communicate with the insurer exclusively in writing to avoid misunderstandings from phone inquiries. Only partially release your doctors from their duty of confidentiality to maintain control over your sensitive health data. Late reporting of occupational disability can also lead to problems, so pay attention to deadlines.
Your cooperation obligations include, among other things:
Complete and truthful answers to all questions in the claim application.
Submission of all requested medical documents and doctor's reports.
Accurate description of your most recent professional activity, including a typical weekly schedule.
If necessary, consent to required examinations by doctors appointed by the insurer.
Immediate notification of any changes in your health condition or professional situation.
Careful fulfilment of these obligations is an important building block for a successful claim application.
Receiving Rejection: Strategies and Next Steps for Those Affected
A rejection of the disability insurance application is a severe blow, but not the end of the road. First, you should carefully analyze the reason for rejection, which the insurance company must provide to you. File a written objection and substantiate it in detail, ideally with new or supplementary medical evidence. Be sure to observe the deadlines mentioned in the rejection notice for an objection to the insurance refusal. Continue paying your insurance premiums without fail to avoid jeopardizing your coverage. If the objection is unsuccessful, the next step is often a lawsuit, with sixty-four percent of such cases ending in a settlement.
Expert Knowledge: The Pre-contractual Disclosure Obligation and Its Pitfalls
The breach of the pre-contractual duty of disclosure is a common reason for rejection, affecting approximately twelve percent of cases. Insurers scrutinise claims applications very carefully to determine whether all health questions were answered correctly and completely at the time of contract conclusion, often for the past ten years. If they detect false statements or the concealment of relevant pre-existing conditions, they may withdraw from the contract (§ 19 Insurance Contract Act), terminate it, or challenge it on grounds of fraudulent misrepresentation (§ 22 Insurance Contract Act). The period for challenging on grounds of fraud is ten years from the conclusion of the contract. Our expert tip: Conduct an anonymised risk inquiry before submitting your application and answer health questions with absolute honesty to minimise this risk. A look into the Insurance Contract Act can provide additional clarity here.
The role of expert opinions and the importance of professional support
In approximately seven per cent of the performance assessments, medical reports are commissioned by the insurance company. It is important to understand that these assessors are not always neutral and their results should be critically examined, especially in cases of mental illnesses such as incapacity to work due to depression. A specialised lawyer for incapacity to work can ensure a 'level playing field' and represent your interests. Experience shows that many cases that go to court are settled by compromise – in sixty-four per cent of cases. A private legal expenses insurance policy can cover the costs of such a dispute and is therefore a sensible addition. The support of experts significantly increases your chances of receiving benefits.
nextsure provides discreet support in reviewing your claims. Our mission is to offer you comprehensive and understandable insurance solutions as a digital insurance portal.
Prevention and proper preparation: How to minimise risks
The best protection against refusal of benefits is thorough preparation when taking out occupational disability insurance. Honestly and fully answering health questions is crucial. Use the option of an anonymous preliminary risk inquiry to clarify your acceptance chances and possible conditions in advance without risking an entry in the insurance industry's information and advice system (HIS). Document all doctor visits and diagnoses from the last five to ten years meticulously. Carefully review the insurance terms, especially clauses on abstract and concrete referral as well as the definition of occupational disability. A clear understanding of when the disability insurance pays is vital.
Checklist for preparation:
Thoroughly compile your health history for the past ten years.
Answer all health questions in the application completely and truthfully.
Submit anonymous preliminary risk inquiries to several companies.
Carefully review insurance conditions (waiver of abstract referral, customer-friendly regulation of concrete referral).
Choose appropriate insurance coverage and duration.
Seek professional advice.
These steps help avoid problems later in the event of a claim.
More useful links
Wikipedia offers a comprehensive article on occupational disability insurance.
Laws on the Internet contains the official text of Paragraph 172 of the Insurance Contract Act (VVG).
FAQ
Meine BUZ Versicherung zahlt nicht, was sind meine ersten Schritte?
Analyse the rejection letter carefully to understand the reason. File a written objection in a timely manner and gather all relevant documents and medical evidence. It is advisable to consult a specialist insurance law attorney at an early stage.
Welcher Berufsunfähigkeitsgrad muss für eine Leistung vorliegen?
A disability level of at least fifty percent is generally required. This means you can no longer perform your most recent job to at least fifty percent, and this condition is expected to last for at least six months.
Was bedeutet abstrakte und konkrete Verweisung?
Abstract referral means the insurer can refer you to another occupation that you could theoretically still perform, even if you do not have a job. Concrete referral refers to a new job that you are already actually performing. Both referrals are subject to conditions such as comparability of life position and qualifications.
Wie lange hat die Versicherung Zeit, meinen Leistungsantrag zu prüfen?
The average processing time from application submission is about ninety-nine days. If all necessary documents are available, the decision can also be made within nine days. Your cooperation is crucial for prompt processing.
Soll ich meine Ärzte von der Schweigepflicht entbinden?
It is recommended to release doctors from confidentiality only in a limited way. This means the insurer may only obtain information with your explicit consent for each individual doctor. This way, you retain control over your health data.
Ist eine Rechtsschutzversicherung bei Problemen mit der BU sinnvoll?
Yes, legal protection insurance is very sensible. It can cover the costs for lawyers and court proceedings if there is a dispute with your disability insurance. This can help you enforce your rights without a high cost risk.
