If the occupational disability insurer is confronted with an application for an 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.
Contents
- Check the risk of a breach of the duty of disclosure
- Before you give details of your profession…
- Timing the transition from incapacity for work to occupational disability correctly
1. check the risk of a breach of the duty of disclosure
A popular method used by the insurer when reviewing the application is to claim a pre-contractual breach of the duty of disclosure. The insurer compares the health information provided when the occupational disability insurance was 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 on the grounds of fraudulent misrepresentation if this is relevant.
Experience shows that clients often underestimate this risk. For example, they consider treatments to be irrelevant 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 prove the insurers right. You should therefore consider whether there could be 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 advisable, for example, not to apply for an occupational 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 have elapsed(§ 21 Para. 3 VVG).
2. before you give details of your profession…
…you should bear in mind what the private occupational disability pension in the vast majority of policies is all about. It is likely that you will no longer be able to work at least 50 percent of the time in your last occupation, as it was when you were healthy.
For example, if you can only work 20 hours in a 40-hour week, you have reached 50 percent. Anyone who inadvertently states that they have only worked 38 hours per week, for example because they do not take regular overtime into account, would not yet be incapacitated for work if they were able to work 20 hours, as 20 hours is still more than 50 percent.
It is often not taken into account 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 worked part-time, but the number of hours worked full-time on healthy days. Otherwise, based on 20 hours of part-time work, you may still not be incapacitated for work if the expert determines that you can only work 11 hours per week.
3. timing the transition from incapacity for work to occupational disability correctly
Incapacity to work is often preceded by a longer period of incapacity. If you have private health insurance, you will usually receive daily sickness benefits. The daily sickness allowance or daily sickness allowance insurance ends with the inability to work. Furthermore, with the vast majority of insurance policies, daily sickness benefits and an occupational disability pension cannot be drawn at the same time.
If you apply for an occupational 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 an occupational disability pension for a past period. If the 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.
Image source: © fizkes / PantherMedia
