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.