Trouble with the insurance? We can help you!
Disagreements with the insurance company are more common than you might think: The life or pension insurance pays out much less after the contract has been terminated than the insurer or insurance agent had promised when the contract was concluded. The occupational disability insurance does not pay because the requirements for occupational disability – allegedly – are not supposed to be met or the policyholder – allegedly – is supposed to have violated contractually agreed notification obligations. The motor vehicle insurance of the person who caused the accident “plays for time” by refusing to settle the claim with the remark that the – actually clarified – accident has not yet been “finally examined”. The building or household contents insurance does not want to settle a claim because it denies its occurrence or the concrete amount of the damage. Private health insurance refuses to pay for a medical treatment, although this could contribute to the recovery. The liability or accident insurance refuses to make a payment with reference to the insurance conditions. There is a variety of reasons why insurance companies refuse their payments.
Whether such negative or deviating decisions by the insurance companies are correct an insured person can only rarely judge for himself. This is because an insurance is an extremely complex legal product, the content of which is not only defined by contractual agreements – which are often very hard to understand – but also by a large number of legal regulations (in particular the regulations of the VVG), which can hardly be apprehended without legal expertise. In addition, the extensive case law on legal issues must also be taken into account.
We help you with the legal assessment of your request and the legal enforcement of your insurance claims. We are aware of the fact that policyholders or insured persons are often in a crisis situation when they have to resort to their insurance cover, so that it is even more frustrating when an insurance company fails to provide the promised service, especially in this situation. We therefore try to solve your problem as quickly as possible by discussing your matter with the insurance company as soon as possible and working towards an amicable (= extrajudicial) settlement. However, should an insurance company fail to see the point, we will – of course – also pursue your claim vigorously in court.
You are welcome to contact us with your insurance law issues by using our contact form, writing us an e-mail or calling us. You will receive feedback in short time and a free initial assessment of the prospects of success of your case.
Below you will find some selected insurance classes in which we – inter alia – legally advise and represent policyholders.
Life and pension insurance
Statistically speaking, every consumer in Germany has a (endowment) life and/or pension insurance policy as a form of retirement provision or to provide for the family. Unfortunately, the high acquisition and administration costs as well as the currently very low investment returns lead to insurers granting their customers ever lower interest rates, so that it is not worthwhile for many policyholders to continue paying into the insurance. However, terminating the insurance is often not a good solution, as the policyholder only receives the cash value of the insurance, which typically falls far short of the sum of the paid-in insurance premiums. Therefore, in many cases, a revocation of the insurance contract is a much more lucrative solution to part with an unprofitable life or pension insurance, because in this case a policyholder receives in addition to his paid-in insurance premiums a compensation from the insurer for his usage of the capital. Under certain circumstances, a revocation may still be permissible many years after the conclusion of a (endowment) life and/or annuity insurance policy (even after the termination or closure of the contract), as long as the revocation terms and conditions in the contract are incorrect, which is surprisingly often the case in practice – especially with insurance contracts concluded between 1994 and 2007.
We would be pleased to advise you in this regard and show you possibilities of how to part with an unprofitable endowment life or pension insurance policy in a “worthy” way.
Occupational disability insurance
Occupational disability insurance is intended to step in when an insured is no longer able to earn his own living for health reasons – for example, after an accident or due to illness. Unfortunately, it happens all too often in practice that insurers delay or even fail to meet their payment obligations – a circumstance that is certainly related to the sometimes very high sums insured (often significant amounts of annuities over many years). Thus, insurers often dispute their obligation to pay with the argument that a policyholder – allegedly – had answered the health questions incorrectly due to gross negligence, intent or even fraudulent intent when concluding the contract. In some cases, insurers also deny the existence of occupational disability as such. In some cases, they also claim that a policyholder made mistakes when filling out the – often very extensive and complicated – claim form.
We will be happy to assist you with all questions relating to occupational disability insurance. We recommend that you seek legal advice as early as possible, for example when filling out the – quite complicated – claim form, in order to avoid unnecessary problems with the insurance.
Private health insurance
For a long time, private health insurers reimbursed almost every bill from doctors, clinics and pharmacies. This enabled them to establish their good image on the market. But these times have changed. Because in times of low interest rates on the capital markets, health insurers are trying to reduce their costs by increasingly delaying, reducing or – in the worst case – even completely rejecting cost reimbursements to their customers – the policyholders. In this context, health insurers have a multitude of (fake) reasons for not having to meet their reimbursement obligations. For example, it is often claimed that the medical treatment is not necessary; that the treatment is not covered by one’s own insurance policy; that the doctor’s fees or the extent of the treatment are excessive; or that the policyholder had given false health information when concluding the contract, which is why the insurer withdraws from the insurance contract. In such a case, there is a risk that the policyholder will “get stuck” with the – often very high – doctor or treatment costs.
Also in the area of daily sickness benefit insurance insurers have been increasingly refusing to provide benefits to policyholders. They often argue that an insurer is not 100% unfit for work, so that the conditions for payments under the insurance contract are not met; that an insured person has earned less in the past than stated in the insurance contract, so that there is “overinsurance” and therefore the contractually agreed daily sickness benefit rate must be reduced accordingly; that the policyholder is unable to work, so that the conditions for benefits under the insurance contract are not met; or that the policyholder made false statements about his state of health when concluding the contract, so that the insurer withdraws from the insurance contract. Such a refusal by the insurer can very quickly put a policyholder in financial distress – at a time when he is already “ailing” due to illness.
If you also have problems with your private health insurance, you are welcome to contact us. We will be happy to advise you.
Liability insurance
Liability insurance typically covers the risk that a policyholder will cause damage to a third party and that the third party therefore has a legal claim for compensation against the policyholder. In such a case, liability insurers should – actually – quickly indemnify the policyholder from such third-party liability claims, if necessary with the assistance of lawyers. In practice, however, it happens time and again that liability insurers refuse their obligation to assume liability with the argument that the realised risk – allegedly – should not be covered by the insurance cover at all; that the policyholder should have – allegedly – caused the damage intentionally or that the policyholder has violated a contractual obligation to provide information and cooperate.
If you also have difficulties with a liability insurer, you are welcome to contact us. We will be glad to help you.
Car Insurance
The generic term “motor vehicle insurance” covers various types of insurance:
(1.) Motor vehicle liability insurance – This is a statutory compulsory insurance that every motor vehicle owner must conclude. It covers claims for damages from third parties arising from the operation of a motor vehicle (e.g. as a result of a traffic accident). This insuranve usually covers personal injury, property damage and financial losses as well as immaterial damage (e.g. compensation for pain and suffering).
(2.) The auto physical damage insurance (partial and full coverage) – This is an optional (= voluntary) insurance, which basically pays for the destruction, damage or loss of your vehicle. The partial coverage insurance usually covers the following risks: Fire and explosion, theft and robbery, damage caused by natural forces, wind damage, glass breakage, damage to wiring, damage caused by short circuits and damage caused by marten bites. In addition, the full coverage insurance also covers damage to your own vehicle caused by accident, vandalism or willful damage by third parties.
(3.) Passenger Accident Insurance – This is an accident insurance that compensates the occupants of a motor vehicle for accidents that occur during the use of an insured vehicle.
For all motor vehicle insurers is true: they do not always want to pay. In the area of motor vehicle liability insurance, for example, it is the order of the day that the motor vehicle insurers tend to present the damage caused by their insured persons as smaller than it actually is, or to blame the accident victim for the accident. In addition, many insurers try to direct victims of traffic accidents to specific workshops or rental car companies that are “associated” with the insurers and to engage their own experts in order to reduce costs as much as possible – often at the expense of the legitimate interests of the injured parties. In the area of an auto physical damage insurance, insurers often refuse to pay compensation on the grounds that the policyholder himself – allegedly – caused the accident through gross negligence, for example, because he was under the influence of alcohol or drugs, exceeded the permitted speed limit or disregarded other traffic regulations. In addition, the insurers often accuse their policyholders of having reported the damage late or of having given incorrect information about the mileage or previous damage of the vehicle, which should result in the insurer’s exemption from liability.
In the case of passenger accident insurance, insurers often deny that a health problem was caused by an accident – which is covered by insurance – or claim that the injured party was at least partly responsible for the accident, so that the insurance benefit must be reduced accordingly.
If you also have problems with a car insurance, you are welcome to contact us. We will be glad to help you.
Accident Insurance
An accident insurance usually covers disability damages after an accident. If a policyholder suffers an accident and is left with permanent disability, he has a claim for payment against the insurer.
In practice, however, accident insurers often reject claims for payment. They often claim that a disability was not caused by an accident at all, but rather by a previous illness. Or they dispute the amount of the disability, often with reference to a medical report commissioned by them.
If you have difficulties with your accident insurance, we will be happy to help you. Please contact us for this.
Building and household insurance
A building insurance policy serves to provide economic security for buildings, whereas a household contents insurance policy covers the (movable) objects located in a building. Both building and contents insurance usually cover various risks, such as fire, storm, burst pipes, robbery or burglary, etc. However, the contractual agreements are always the decisive factor, since in a building or household insurance policy often only (some) individual risks are covered, which regularly reduces the policyholder’s premium obligation.
For homeowners, a building or contents insurance is usually of great importance, as for many policyholders their house and the items it contains make up the majority of their assets. This makes it even more frustrating, of course, if the insurance company does not pay immediately after a loss event, e.g. after a house fire or burglary. Yet such negative attitudes of insurers are – unfortunately – on the agenda. For example, insurers often deny the existence of an insured loss or claim that a policyholder has caused the loss himself intentionally or (at least) through gross negligence, which is why the insurer – allegedly – should not have to pay. Often insurers also dispute the precise amount of the damage. With this regard, they know – of course – that after a house fire or a burglary, for example, it will be difficult for an insured to provide complete proof of the loss or theft of all insured objects. In addition, it is not uncommon for an insurer to accuse the policyholder of deliberately deceiving the insurer about the actual amount of damage, so that the insurer withdraws from the insurance contract on the grounds of fraudulent deception. In doing so, an insurer often relies on the statements of (employed) detectives who were supposed to clarify the facts of the case for the insurer. Furthermore, in practice insurers often raise the objection that the building or the objects in it were not sufficiently insured (so-called “underinsurance”), which is why an insurer would only have to compensate the damage proportionately. The reasons/excuses with which insurers wish to withdraw from their obligation to pay are very numerous.
If you also have problems with your building or household contents insurer, we will be happy to advise you. You are welcome to contact us for this.
Credit and surety insurance
Credit insurance protects companies from the risk of defaulting on their supplier credit claims against third parties.
Credit insurance protects companies from the risk of default on their supplier credit claims against third parties. The credit insurance contracts usually exclude various risks, such as the realisation of so-called “political” risks or so-called “economic risks”. And on this basis, credit insurers sometimes refuse to make payments, sometimes also with the argument that an insured party – allegedly – has not fulfilled his contractual obligations to provide information. In such a case, the policyholder usually has to bear the loss completely on his own, since the reservations of title usually agreed in the context of supplier credits are often not (fully) realisable in practice.
In the area of surety insurance, insurers issue sureties or guarantees to their creditors on behalf and at the expense of their policyholders. Contrary to what it is called surety insurance is not a typical insurance business, but rather a bank loan business, since a bonding and guarantees insurer grants its customers a liability credit by issuing sureties or guarantees – just like banks do with their guarantee credits. Bond insurance is particularly problematic if a bond insurer must make a payment on one of his guarantees or sureties. Because in such a case, a bond insurer regularly takes recourse against its customer. In this connection often the question arises whether the bond insurer was allowed to make payment on his surety or guarantee and thus take recourse against his customer.
We will be happy to advise you on all questions relating to credit and surety insurance.
Residual debt insurance
Residual debt insurance is intended to ensure that a current loan (e.g. a bank loan or an instalment payment agreement with a furniture store or car dealer) continues to be paid if the loan debtor falls ill, becomes unemployed or dies. Residual debt insurance policies are often virtually “imposed” by lending banks or other lending companies on their borrowers. At least in principle, there is nothing wrong with residual debt insurance. However, practice shows that insurers repeatedly put forward (fake) arguments to avoid having to pay in the event of an insured event. For example, insurers often invoke a contractual clause in the event of an insured event, according to which insurance cover is excluded in the case of pre-existing illnesses. Or it is claimed that the policyholder had made incorrect statements about his state of health when the contract was concluded, which is why the insurer challenges the insurance contract on the grounds of fraudulent misrepresentation. In such cases, a borrower often remains “stuck” on his credit debt even though he may not be able to repay the loan at all.
If your residual debt insurance also refuses to pay, you are welcome to contact us. We will be happy to help you.
Business interruption insurance
Business interruption insurance protects companies from the financial consequences of an unplanned interruption of ongoing operations. This can happen, for example, through fire, storm or theft. In such a case, the insurance basically covers the costs of wages, rents, lost profits and measures to restore operations. In many cases, business interruption insurance supplements two other insurances in the event of an insured event: the commercial building insurance, which, for example, compensates for damage to the building’s substance after a fire; and the so-called business contents insurance, which is intended to pay for the destroyed objects in the building.
There are various forms of business interruption insurance, whereby a main distinction is made between two types of insurance:
(1.) The so-called “small” business interruption insurance is usually concluded in connection with the conclusion of a business content insurance. In the event of an insured event, the insurer pays the policyholder a contractually agreed sum (= sum insurance), the amount of which usually depends on the sum insured under the business content insurance.
(2.) With the so-called “large” business interruption insurance, the policyholder receives compensation from the insurer for the concrete loss from a business interruption (= damage insurance). This amount of compensation is regularly limited both in terms of amount and time (usually the losses up to one year). Common to all business interruption insurances is that they cover various risks, although the concrete insurance cover is based on the contractual agreements. For example, the “small” business interruption insurance usually covers the risks of fire, storm and hail, tap water, burglary and vandalism, while the “large” insurance often also covers the risks of natural hazards (e.g. earthquake), malicious damage, illness or accident of the owner. However, the concrete contractual agreements in the individual case are decisive. Business interruption insurance is usually of great importance to the policyholder. Because in case of, e.g., a business interruption due to a fire or storm it usually takes a relatively long time before an entrepreneur can get his business up and running again and thus generate turnover, even if parts of the damages are covered by a commercial building insurance or a business contents insurance. This is, because during this time his operating costs continue to run, e.g. salaries, rent, electricity etc., which can very quickly drive an entrepreneur to ruin.
In practice, however, insurers often refuse to pay for business interruption insurance or only make partial payments. They claim, for example, that the business interruption was not caused by an insured risk – as is currently the case with business interruptions due to the corona pandemic. In addition, under “big” business interruption insurances, the insurer regularly argues about the concrete amount of loss. In some cases, policyholders are even accused of being responsible for the business interruption themselves, for example in the event of fire.
If you also have difficulties with a business interruption insurance, you are welcome to contact us. We are happy to help you!
Fidelity insurance
Fidelity insurance protects companies from the risk of their employees causing them financial loss intentionally or – if contractually agreed – negligently. Depending on the contractual agreements, financial losses caused to a company by third parties may also be covered. In practice, insurers often refuse to pay for fidelity insurance on the grounds that an employee has not caused financial loss intentionally or negligently. Furthermore, the amount of the insured loss is often the subject of legal disputes.
If you also have problems with a fidelity insurance, please contact us. We will be glad to help you.