1. check the risk of a breach of the duty of disclosure
If the occupational disability insurer is confronted with an application for a private occupational disability pension, this regularly represents a major loss for the insurer.
The insurer will therefore check very carefully whether it can avoid the high payments. A popular means is the assertion of a pre-contractual breach of the duty of disclosure.
The insurer compares the health information provided when the occupational disability insurance is taken out with the medical documents consulted as part of the benefit check.
If the medical documents contain treatments that were not stated in the application for occupational disability insurance, the insurer can declare the contract avoided due to fraudulent misrepresentation if this is relevant.
Experience shows that clients often underestimate this risk.
For example, you hold treatments are not relevant because the doctor did not make a diagnosis at the time or because they were only minor or cured illnesses. Unfortunately, however, the courts often agree with the insurers.
You should therefore consider whether there are any problems before applying for an occupational disability pension. For example, because the broker played down the importance of the health questions when taking out the insurance and therefore denied treatments or illnesses.
If problems become apparent, it may be, for example recommend not applying for a private disability pension until 10 years have passed since the contract was concluded. This is because the insurer may no longer contest the contract after 10 years (§ 21 Para. 3 VVG).
2. before you give details of your profession…
…you should bear in mind what the private occupational disability pension is all about in the vast majority of policies.
It is likely that you will no longer be able to carry out at least 50 percent of your last occupation as it was when you were healthy. Who, for example can only work 20 hours in a 40-hour week has reached 50 percent.
Anyone who inadvertently states that they have only worked 38 hours per week, for example. because he does not take regular overtime into account, would not yet be incapacitated for work if he works 20 hours, as 20 hours is still more than 50 percent.
It is also often ignored that it is about the “healthy days”. If you have already had to reduce your professional activity for health reasons and have therefore been working part-time for years, you should not state the number of hours you worked part-time, but the number of hours you worked full-time when you were healthy.
Otherwise, you may be assumed to be working part-time for 20 hours. If the expert determines that you can only work 11 hours per week, you would still not be incapacitated for work.
3. timing the transition from incapacity for work to occupational disability correctly
Private occupational disability is often preceded by a longer period of incapacity for work. If you have private health insurance, you will generally receive daily sickness benefits.
The daily sickness allowance or daily sickness allowance insurance ends with the inability to work. In addition, the vast majority of insurance policies do not allow you to receive daily sickness benefits and an occupational disability pension at the same time.
If you apply for a private disability pension for a past period, you may have to repay part of the higher daily sickness allowance you have already received.
It may therefore make sense not to apply for a private occupational disability pension for a past period.
If the private occupational disability pension is higher than the daily sickness allowance or if there is no daily sickness allowance insurance at all, it may make sense to date the start of the occupational disability as far back in time as possible.
If you have any questions about this or need support in enforcing your private occupational disability pension, Attorney Brandl will be happy to assist you.
