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Health issues in disability insurance

Important to the health issues


Resulta ng larawan para sa health issues

  • Limited period of health issues
    The health issues in the application for disability insurance cover the previous five to ten years.
  • To answer truthfully and conscientiously
    Do not forget any supposed “little things”. Indicate only the diseases and treatments that are specifically asked for.
  • Take time for answering
    Take the questionnaire home after the broker’s visit or appointment with the fee consultant and do not fill it in on the spot.
  • Ask the family doctor / doctors for your medical records
    This will let you know what health information is stored about you.
  • Have copies ready
    Collect copies of examination results and medical records in order to be able to prove your information in case of doubt.
  • Have the medical record corrected
    Ask doctors for corrections in the medical record if treatments are listed there that have not occurred.

Millions risk inability to work: Around one in four employees has to give up their profession prematurely for health reasons. Lucky in bad luck, if before a disability insurance was completed. In order for the agreed pension to flow, the insurance application must necessarily have been completed correctly.

Because who has answered health questions wrong, goes out in doubt, empty. “There are often quarrels about health issues,” says Professor Wolfgang Römer. As a neutral mediator, the insurance ombudsman mediates daily in disputes between the customer and the insurance company.

Background: Before the insurers offer protection against occupational disability, they subject their customers to a detailed and detailed health check. In addition to age, gender, height, weight, occupational risks (toxins, accident risk) and lifestyle habits (smoking, sports), they are also interested in all pre-existing conditions, chronic conditions and accidents. If the company can later prove that the customer has concealed health problems in the insurance application, they do not have to pay in case of emergency.

This even applies if the occupational disability has nothing to do with the secretive diseases, the Higher Regional Court of Karlsruhe ruled in a recent ruling (Case 12 U 391/04). It was about a woman who undercut the application heart valve defects and high cholesterol and later could no longer work due to a fall.

Take time to answer the health questions

In order not to suddenly stand in retirement without disability, you should answer the health questions thoroughly and conscientiously – under no time pressure! Those who fill out the application together with an insurance agent should check the entries carefully.

What are health issues?


Resulta ng larawan para sa health issues

Health questions are a health questionnaire that policyholders must answer for applying for insurance. On the basis of these questions, an insurance company determines the risk that it incurs in securing the applicant.

The risk ultimately determines the amount of the insurance premium. In addition, insurance companies can use the health questionnaire to restrict or exclude certain benefits. It is also possible that insurance companies reject a claim completely because they are too high insurance risk due to the answers in the health questionnaire.

In these cases, health issues are asked

Health issues are usually used in private personal insurance. If you wish to take one of the following insurances, you must first complete the questionnaire:

  • Disability insurance
  • Disability Insurance
  • Endowment policy
  • Term life insurance
  • Private health insurance
  • Private supplementary health insurance: sickness allowance insurance, long-term care insurance, glasses insurance

The health issues are particularly important in the conclusion of occupational disability insurance, because the insurance has to assume high costs in the case of benefits.

Questionnaire is determined by the insurer

How extensive the health issues ultimately turn out depends on the insurance. The questionnaire can be determined by the individual insurers themselves. Ultimately, they also have to take the risk.

You have to specify this for health issues

In principle, insurance companies can ask you about everything that is necessary in their eyes in order to determine as accurately as possible a disease risk. As a rule, questions about genetic testing are an exception.

For private health insurance, existing test results should not be given. However, life insurers can also demand proof of health status with high cover amounts. As policyholder, you are subject to disclosure under Section 19 of the Insurance Contracts Act.

You must therefore provide information on the following facts:

  • Diseases: Here, the insurer wants to know which diseases have led to a doctor’s visit. Most companies refer to a period of between five and ten years. As “diseases” usually all states are taken that differ greatly from the normal state of health and were in need of treatment. The diseases can be physical or psychological.
  • Complaints: These may be physical or mental health impairments that have affected work ability. This can be a lumbago that was not treated by the doctor but was still there. The indication of complaints is usually not completely clear, because there are usually no medical records for these symptoms.
  • Disorders: The so-called “disorders” include all health impairments that are not yet a disease, but can not be classified as irrelevant. These include, for example, disorders of the musculoskeletal system as a result of an accident or severe wear of the intervertebral discs.
  • Medicines: Policyholders must tell the insurer exactly what medicines they have been prescribed over the last five to ten years and what medicines they need to take on a regular basis.
  • Allergies: The health questionnaire requires precise information about allergies.
  • Weight and age: Of course, these two factors also play an important role in the application.
  • Addictions: The health questionnaire usually also contains information on cigarette or alcohol consumption. In addition, you must specify whether you were already addicted.
  • Infections: You are required to provide information on infectious diseases such as HIV, hepatitis or other diseases.
  • Surgery: All operations, either outpatient or inpatient, are recorded in the questionnaire.
  • Condition of teeth and jaw: Depending on the insurance rate, you must also provide information about your teeth.
  • Information about rejections: As a rule, insurers ask if they have already been refused insurance. You can also retrieve this information via the HIS.

The insurance company may also request more detailed information on each question in the health questionnaire. These include specific names of diseases, names of treating physicians and results of examinations.

Resulta ng larawan para sa health issues

Ask questions in advance about the health questionnaire

On the homepages of the insurance companies, you can usually find out about the respective tariff conditions as well as possible health issues. However, insurance companies usually only issue their questionnaires when you make a specific application. It is not recommended to answer the questions quickly!

Wrong information: what can happen?

In the case of insurance contracts, the policyholder is subject to the so-called “disclosure obligation” in accordance with Article 19 of the Insurance Act:

19 VVG

“Until the submission of the contract, the policyholder shall inform the insurer of any known risk circumstances that are relevant for the insurer’s decision to conclude the contract with the agreed content and for which the insurer has requested in text form. If the insurer asks the policyholder for a contract, but before the acceptance of the contract questions within the meaning of sentence 1, the policyholder is also obliged to report. “

A pre-contractual obligation to provide information exists if you deliberately conceal information about the illness or treatment. For example, you commit a breach of contract by failing to report abdominal surgery or regular back pain.

The obligation to notify includes not only all illnesses that were in need of treatment, but also the symptoms that you regularly suffer and that, for example, have led to incapacity to work.

Possible consequences in case of incorrect information

Policyholders must always expect consequences in case of false information, irrespective of whether the information given was inadvertently or unintentionally.

  • Amendments to the terms and conditions: If an insurer finds that your information in the questionnaire was incorrect, it may adjust the terms of the contract because of the higher risk and, for example, exclude benefits or increase the contributions. It is also possible a refund of already performed services.
  • Termination: In the case of deliberate fraud, the insurer has the right to terminate the policy. You will then also have to reimburse services that you have already received.

If the insurer has changed or terminated the contract, you have the option to file an objection or withdraw from the contract yourself.

Confidentiality does not apply

By signing the insurance application, you will release all doctors you have treated from confidentiality. The insurance will therefore quickly discover any false information or errors.

Anonymous trial application or risk request

With the help of an insurance broker, you can ask an insurance company for an anonymous trial application with your health questions. In this way, you can compare offers that are specifically tailored to your health. In the case of a refusal, this is not entered in the HIS, a credit bureau for risks for insurers.

Period influences conflict potential

Unfortunately, it happens again and again that some intermediaries are frightened by uncomfortable information out of concern for their commission. In the case of pre-existing conditions or chronic complaints such as back problems or allergies, it is advisable to enclose a copy of the medical record with the attending physician.

Some companies want to be informed about the disease history of the past ten years, others are content with five. As a rule of thumb, the shorter the period, the lower the dispute potential!

Additional check in case of emergency: Many customers are sure to know as soon as the company has accepted the application. “Often a costly error,” Professor Römer knows: “Whether the health questions were answered correctly, the insurance usually checks only if they should pay in case of damage.” Was cheated or flogged when completing the customer pays for years in vain for free premium ,

Limitation period for incorrect information at 10 years

The limitation period for false information is ten years. Within this period, the insurance company has the right to re-examine your information and to take action in case of errors. It often happens that the insurance only checks all information from the health questionnaire again in the case of benefits. If you have made incorrect or incorrect information many years ago, you can expect a refusal of insurance benefits.

There are exceptions

If the application is incomplete or if there are obvious contradictions between individual statements, the insurance company must immediately complain – or pay later anyway. Incidentally, insurance customers can not rely on medical confidentiality. With the signature under the insurance contract the doctor is released from it.

Insurance without health issues

There are various personal insurance such as disability insurance, which is also offered without health issues. In these cases, insured persons with previous illnesses can nevertheless benefit from the insurance cover. However, they then have to reckon with higher premiums or exclusions.

Simplified health issues are also possible with endowment life insurance or disability insurance. The questionnaire is shortened significantly. In this case too, insured persons must pay higher premiums.

In addition, there is the possibility of a shorter polling period for policyholders under the age of 30. In this case, for example, the health issues only relate to diseases of the previous three years.


Resulta ng larawan para sa health issues

Disability insurance without health issues

A judgment of the Federal Court of Justice (BGH) has opened the way for a BU without health issues with a ten-year waiting period.

The verdict was about a man who had not indicated Parkinson’s disease in the health questionnaire. Because of this illness, he was later unable to work, so the insurance had to afford. She initially denied the performance, as she fraudulently suspected deception. However, the widow of the late deceased man complained against it. The case ultimately went up to the BGH. There the woman got right. The reasoning of the court: The ten-year period for an appeal had expired, even though the benefit claim had already occurred earlier.

On the basis of this judgment, considerations have now developed to introduce an occupational disability insurance without any health check. On the other hand, policyholders must take account of a ten-year waiting period within which they do not enjoy insurance cover.

The time has come for this product to be available. To date (as of October 2016) there is no corresponding provider.

questions and answers


Resulta ng larawan para sa health issues

What is the procedure for not forgetting anything essential and answering insurers’ health questions correctly?

Contact all the doctors you have visited in the last five to ten years and ask them to send or copy your medical records. Also, take time to answer the questions. The more details you can specify, the better.

Can not the insurer simply obtain all the information for the client when making the application?

For the insurer, getting all the data would mean a huge amount of administrative work, which is already provided by the questionnaires. So he would first have to identify all the doctors for whom you were to the examination. For this, the insurance company would each require a release from you. Paragraph 19 of the VVG further simplifies the work of insurance companies, since you are then responsible for the right information.

What should I pay attention to when completing the health questions?

Answer all questions in detail and with all important details. However, answer only to the questions asked and not beyond.

What are not open health issues?

Non-open health questions can be answered with a yes or no. For example: Have you had surgery in recent years?

What are simplified health issues? What are the advantages and disadvantages of these?

Simplified health issues mean a much stripped-down list of questions in which only key health questions need to be answered. For the policyholder this is an advantage, as he has less to reveal to his health. One disadvantage is usually higher premiums. For the insurance company, the shortened health issues mean less administration. In return, they take a higher risk that they pay with risk premiums.

Do I have the right to request or view my medical records to find out which diseases have been treated?

No matter where you have been treated, you have a right to receive or view your medical records. These include, for example, doctors, naturopaths, psychologists, speech therapists, physiotherapists or hospitals.

Where can I get help or information if I have questions?

If you have questions about your health questionnaires, you can contact the Consumer Centers or get help from an insurance broker.


Dread Disease Insurance: You have to know that

A Dread Disease Insurance is a personal insurance policy that pays a fixed amount to the insured person in the event of a serious illness or other serious health event. For which illnesses or events the benefit claim applies, the insurance contract is recorded.


Resulta ng larawan para sa dread disease

Dread disease insurance as an alternative

The Dread Disease Insurance is useful for those who can not take out disability or occupational disability insurance because of their previous illnesses. This is especially true for severe conditions such as cancer. It should be noted, however, that Dread Disease Insurance does not apply to mental illness.

Among other things, the insurance product can be used by self-employed persons who wish to additionally secure their company in the event of a serious illness.

In the United Kingdom and the United States, this insurance product has been on the market since the 1980s and is therefore more widespread there. In Germany, marketing authorization for the Dread Disease insurance was granted in 1993. Today, there are six different insurers offering the special insurance product:

  • Canada Life
  • Gothaer
  • Nuremberger
  • Zurich Life
  • Cardea Life
  • the Bavarian

Many insurers have similar building blocks in the portfolio, which are then only available together with other risk insurance linked.

Difference to other private pension insurance

Dread Disease Insurance differs from other private pension plans such as disability, disability or basic disability insurance. Thus, the agreed insurance amount in the case of benefits is paid immediately and completely and not converted into a pension.

In addition, the policyholder receives the insurance amount very quickly, even if there is no chance of recovery. It therefore does not matter, for example, whether the policyholder is still fit for work or not. The clinical picture that triggers the benefit claim is clearly defined in the policy.


Resulta ng larawan para sa disability

Disability insurance

In principle, the classic occupational disability insurance in the field of private pension insurance is the best because most powerful product. With the BU all health causes can be secured, which lead to incapacity for work. These also include mental illnesses.

Disability Insurance

The disability insurance is an equally useful supplement to the statutory disability pension. It is also useful when a consumer can not use BU and also covers any illness that causes disability.

The insurance benefit takes the form of a pension. Thus, when it comes to safeguarding the workforce in relation to many different health and mental factors that affect them, BU and disability insurance are beneficial to Dread Disease Insurance.

Disadvantage of dread disease

A possible disadvantage of Dread Disease Insurance is the one-time payment of the insurance amount. If this is to be sufficient for the rest of life as a hedge, it must be set very high. As a result, the rate for the insurance can be much higher than a BU or disability insurance.

Those who can afford it are certainly best protected with a combination of dread disease insurance and disability insurance.

The costs of this special personal insurance depend, among other things, on the age of the insured person, their occupation and the desired insured sum in the event of benefits. In addition, the level of the tariff also depends on whether the policyholder is a smoker or not.

With a sum insured of 300,000 euros for a non-smoking 30-year-old, consumers should count on about 150 euros or more per month.

Services of Dread Disease Insurance

With Dread Disease Insurance, serious illnesses are covered. Depending on the insurance rate, many different diseases are included in the policy.

However, those who are interested in Dread Disease insurance should pay particular attention to the fact that the four most common serious illnesses such as cancer, multiple sclerosis, heart attack and stroke are included in the insurance policy. Usually, these conditions are defined as standard in a dread disease insurance.

However, mental illness and skeletal disorders are always excluded. For example, the benefit does not arise if a policyholder is unable to work due to spinal cord injury due to depression or accidental paraplegia.

The Dread Disease Insurance pays out the agreed sum to the policyholder once in the contractually agreed insured event. The payment is exempt from income tax. However, if the sum is overwritten to third parties, taxes may be incurred.

This applies to the dread disease insurance

Before the insurance is completed, the insured diseases should be very well defined. In addition, the policyholders need to know exactly about the benefit claim.

For example, most insurers pay for cancer at an advanced stage rather than as long as there is still a good chance of recovery.

It is important that the insured ask in case of ambiguity, because often the definitions for laymen are not always clear. The more insured persons are informed, the fewer disputes will occur when requesting the insurance benefit.

Anyone wishing to take out a dread disease insurance must undergo a health examination before graduation. This is important so that the insurer can define both the tariff and the insured diseases.

Policyholders should not conceal any illnesses at this point. Otherwise, the insurer could refuse payment in the event of a claim.

Health checks

If the tariff is adjusted as a result of a wedding or a real estate acquisition, often the renewed health examination.

waiting times

It should be noted in the insurance contract, whether and which waiting periods are set for the payment. For example, some insurers do not pay until six months after a disease, such as cancer, has been detected.

waiting periods

Also important are the defined waiting periods. This period allows insurance from diagnosis to disbursement. Depending on the insurer, it usually lasts between 14 and 28 days. If, as in the case of a stroke, the actual severity can only be determined after a few weeks, it is also possible that the waiting period will be extended.

running time

The term for a dread disease insurance can be set by the insured person. This is usually more than 15 years. It should be noted here that the choice of the term also affects the amount of monthly payments. If desired, the insurance can be taken out by some providers with lifelong insurance cover up to the age of 100 years.

Some insurers also offer a dynamic contribution and benefit increase. This may be useful, for example, if the insurance is already taken out at a younger age and insurance coverage is to increase with increasing age and the increased risk of illness.

Resulta ng larawan para sa dread disease



Unit-linked Dread Disease Insurance

The Dread Disease Insurance is fund linked to some insurance companies. The policyholder bears no risk for losses, but benefits only from a possible fund assets.


What are occupational disability health issues?

In occupational disability insurance (BU), health issues are an important part of the application. Incomplete or untruthful statements may lead to refusal of benefits in the event of disability and further unpleasant consequences for the insured. Disability insurance
Answer health questions correctly.

Before an occupational disability insurance can be taken out, the applicant must first undergo a risk assessment. The insurance company would like to assess the probability that the insured will actually become unfit for work . In addition to the profession, the hobbies and other features, the insurance is particularly interested in the health of the applicant. This is usually raised by very complex and detailed health issues.

Here is a small, exemplary excerpt from Alliance health questions related to the past five years:

Are you or have you consulted, treated, or examined any disease, medical condition or medical condition with doctors, alternative practitioners, physiotherapists, psychotherapists or other non-medical therapists in the following areas:

  • a) Heart, circulation (eg, coronary heart disease, medically diagnosed high blood pressure, stroke, phlebitis)?
  • b) Respiratory organs (eg pneumonia, chronic bronchitis, asthma)?
  • c) Digestive organs (eg stomach, intestine, bile, pancreas, liver)?

Consequences of identified risks in the health examination


Resulta ng larawan para sa health examination

If the insurance company identifies risks to the applicant with the health questions answered, it has various options for reacting to them.

  • Refusal : The applicant has no opportunity to be insured against occupational disability with this insurance.
  • Risk premiums : Due to the increased risk of occupational disability, for example due to certain previous illnesses, the insured must also pay higher contributions for his disability insurance.
  • Exclusions: Had an applicant, for example, in the past knee problems, the insurer may offer him a BU policy that excludes a pension payment in the event that he is unable to work due to knee problems.

Responsible handling of disability insurance health issues

Rejection, risk premiums and exclusions by the insurance company are very unpleasant results for the applicant. However, too light a way of dealing with health issues is not a solution: Misrepresentations or the concealment of previous illnesses can lead to the insurer failing to provide occupational disability insurance. In addition, future insurance contracts with other providers are difficult . For occupational disability insurance, therefore, health care must be treated with particular care and attention .

Conserve health history and previous illnesses conscientiously

Before health care issues are addressed for disability insurance, the applicant should thoroughly review his or her own health history. For whether a therapy, a previous illness or an operation was only forgotten or deliberately concealed – consequences may have this misstatement anyway. To be completely sure that he has taken into account all the relevant pre-existing conditions, the applicant should therefore obtain information in advance from his health insurance and his attending physicians .

As a rule, there is a statute of limitations for occupational disability insurance for health issues. Often, illnesses, complaints, and doctor visits are only queried for the past five years, and surgeries and psychotherapies only for the past ten years . The shorter the polling period, the lower the likelihood that the applicant will intentionally or unintentionally violate his or her duty to report in the course of the health check.

Make risk inquiries with different insurers

If the applicant fears being rejected by the insurance based on his or her health history, he / she may have a risk pre-requisition made by an insurance broker . The mediator communicates the critical health information anonymously or under a false name (pseudonymized) to different companies at the same time . If the insured is rejected by a provider on the basis of this information , he or she does not need to fear any further consequences in the course of the risk pre-request, as it can not be personally associated with the incriminating characteristics.

Health questions conscientiously and truthfully answer

If health issues have not been answered in the true sense, there is a breach of duty . The insurance company then has the right, in particular in serious cases, to

  • to withdraw from the contract
  • to withhold the contributions already paid
  • stop the pension payment that may have started.

For example, fraudulent and deliberate misrepresentations in the BU health issues only have a limitation period of up to ten years . If the insurer becomes aware of the misstatements within this period, it may draw consequences. However, applicants should not reveal more than is actually asked . Here it is very important to pay attention to formulations .

The information and information system of the insurance industry

Insurance companies also have the right to save the answers to health questions for each individual in the Insurance Information and Information System (HIS). Among other things, this database contains information about policyholders, insured persons, injured persons and objects as well as witnesses . The purpose of this system is an efficient risk assessment and the fight against insurance fraud , with the aim of protecting the community of insured persons from financial disadvantages.

Each insurance company can thus create data on persons as a precautionary measure or in suspicious cases in this system. Also already known risks and pre-existing conditions are stored here. Here is also an advantage of the anonymous or pseudonymized risk pre-inquiry: An entry in the HIS can not be made by the insurance company, as it has no personal data.

Other insurances that a person applies for have access to this database and can reject new requests based on the information stored . A record can be stored for up to five years. If a new notification is made, this period will be extended to a maximum of ten years . Actual health risks but above all false information can therefore have far-reaching consequences.

Simplified occupational disability insurance Health issues in the application process

Some occupational disability insurances offer simplified health issues when applying. These are fewer and more condensed issues that also affect a shorter period of time . While occupational disability insurance usually covers several pages of health issues, in the simplified form, for example, only three or five questions can be asked, which the applicant must ultimately answer in summary and one-time with a YES or NO.

It should be noted that for the consumer in the BU, the simplified health issues do not always have an advantage . They are often associated with strict conditions, such as a maximum pension amount , a maximum retirement age or the restriction to certain occupational categories . Also, the generalized formulations of simplified health issues may make it difficult for the policyholder to truthfully answer , as he or she may not be reminded of certain milestones in his or her health history.

Rarity: occupational disability insurance without health issues

It is rarely possible to take out occupational disability insurance without health issues and is subject to certain conditions, such as a limited monthly BU pension . For example, the insurance company can waive the BU health issues if the occupational disability insurance is completed as an addition (BUZ) to another insurance , such as a life insurance policy. Some insurers also refrain from health issues if the claimant already has the status of a bonus customer , for example, has already completed a certain number of policies with the company.

In addition, an existing policy may often be retrospectively adjusted for health issues without re-occupational disability insurance if automatic dynamics have been agreed or if the post-insurance guarantee is used.