Particularly in the case of chronic illnesses, many private health insurers eventually reach the point at which they gradually or abruptly stop or reduce the reimbursement of treatment costs. The medical necessity of the treatment is usually called into question. For those affected, this often marks the beginning of years of dispute with the insurance company.
Longer periods of incapacity for work are usually also a thorn in the side of private health insurance. The insurance company will always try to have one of its experts “write you back to health” and stop paying the daily sickness allowance.
We help you to successfully end these and other battles against the insurance company.
Decisions for policyholders:
A private health insurance company can only withdraw from the insurance contract if it has informed the policyholder of the consequences of a pre-contractual breach of the duty of disclosure by means of a separate notification in text form at the time of application. This information must be clearly emphasized in relation to other information. The content of the notice is incorrect if it informs about the insurer’s alleged right of withdrawal in the basic tariff and misleading if the consequences of a contract adjustment are not clearly explained.
Incapacity to work must only exist in relation to the specific workplace. If the policyholder falls ill due to a bullying situation at his workplace, this is sufficient to receive daily sickness benefits. It does not matter that the policyholder could carry out their job with another employer.