How the deadline works, what the medical assessment actually requires, and which exceptions are recognized by the courts.
Is your accident insurance rejecting your disability claim due to a missed deadline? Many policies stipulate that disability must be medically diagnosed and claimed within 15 months of the accident. If this deadline is missed, the claim may be forfeited, even if the disability objectively exists. However, not every missed deadline is detrimental: Rogert & Ulbrich will review whether the insurer is even entitled to invoke the deadline.
What the 15-month period means – and why it is so dangerous
The 15-month period is not merely a limitation period, but generally a prerequisite for entitlement. This means that if the period expires without the disability being medically diagnosed and claimed in a timely manner, the entitlement to disability benefits lapses, even if the permanent impairment is clearly attributable to the accident from a medical perspective.
This is precisely what makes the deadline so dangerous. Many policyholders assume they can assert their claims as long as the statute of limitations hasn't expired. This is a misconception when it comes to disability benefits. From his previous work on the insurance company side, lawyer Dario Kovac knows how quickly insurers raise the objection of missed deadlines in order to completely avoid paying out.
The good news: The time-limit objection is subject to strict conditions. Whether it actually applies is worth examining closely in almost every case.
Is the insurer claiming a missed deadline? Have the objection reviewed to determine its validity before accepting it.
The two deadlines: onset and determination of disability.
Accident insurance policies usually contain two separate deadlines that are often confused:
- Onset of disabilityThe disability must have occurred within a certain period after the accident, in many cases within twelve months.
- Medical assessment and assertionFurthermore, the disability must be medically diagnosed and claimed from the insurer within a further period, typically within 15 months after the accident.
It's important to note that these deadlines depend on the specific terms and conditions of your policy. Newer or higher-value policies sometimes stipulate longer periods, such as 18 or 24 months. The wording of your contract is always decisive. Therefore, the first step is to carefully review your specific insurance policy terms and conditions, not to assume a general deadline.
Are you unsure which deadlines apply to your contract? Have your terms and conditions reviewed instead of relying on a standard value.
What the medical assessment really requires
The medical assessment is the core element of the time limit. This refers to a written medical statement describing a permanent impairment and attributing it to the accident. It must specify which body region or function is affected and that the impairment is expected to be permanent.
According to case law, the requirements must not be excessive. The assessment does not need to specify the exact degree of disability in percent. It is sufficient that it clearly identifies the impairment and its connection to the accident. A general finding without any statement regarding its permanence or the cause of the accident is insufficient.
In practice, claims often fail because the treating physician, while documenting an injury, does not explicitly record its permanent nature and causal link to the accident. It is worthwhile to ensure a complete and accurate description of the injury early on.
Are you unsure whether an existing finding is sufficient as a medical diagnosis? Have it reviewed while the deadline is still open.
Claim against the insurer
In addition to a medical assessment, the policy requires that you submit your claim for disability to the insurer within the specified timeframe. You must therefore inform the insurer promptly that you are making a claim due to a permanent consequence of the accident.
Reporting and claiming are two separate steps. Simply reporting the accident is insufficient; likewise, a medical assessment that is never communicated to the insurer is inadequate. Both must occur simultaneously and within the agreed timeframe.
Errors arise precisely because two prerequisites are intertwined. A clear, documented assertion of the claim protects against the later objection that the claim was not raised in a timely manner.
You reported the accident but didn't explicitly claim disability benefits? Have it checked whether the claim can be made retroactively or salvaged.
Exceptions: when missing a deadline is not detrimental
Missing a deadline does not automatically mean the end of the claim. Case law and legislation recognize several important exceptions:
- Missing deadline noticeThe insurer must inform you of the deadlines for the medical assessment and the filing of claims after you report the accident (§ 186 VVG). If they fail to provide this information or do not provide it correctly, they generally cannot invoke the missed deadline as a defense.
- Timely but belated findingIf the medical assessment was made within the deadline, it may, under certain circumstances, suffice even if it is submitted to the insurer at a later date. The decisive factor is the date of the assessment, not solely the date of receipt by the insurer.
- Insurer's conductIf the insurer settles the claim without raising the objection of the deadline, it may later be prevented from subsequently invoking the missed deadline.
Whether one of these exceptions applies depends on the individual case. Often, the missing or incorrect deadline notice is precisely the point at which a seemingly hopeless rejection is overturned.
Did the insurer never explicitly inform you of the deadline? This could save your claim. Have it checked.
What you should do if the insurer invokes the deadline.
In the event of a rejection due to missing a deadline, a quick and structured approach is crucial:
- Check conditionsDetermine which specific deadlines your contract stipulates and when they begin.
- Check deadline noticeCheck if and how the insurer informed you of the deadlines after you reported the accident.
- Secure medical assessmentObtain all findings and clarify whether a sufficient determination was made within the deadline.
- Document communicationCollect all correspondence with the insurer to document their claims handling practices.
- Meet deadlinesAdditionally, have it checked whether any limitation periods or legal action deadlines are running.
This article is part of our overview of points of contention in private accident insurance. We will discuss in more detail how disability benefits work overall and how the insurer assesses the degree of disability using the scale of benefits for specific injuries in separate articles. You can find an overview of our work on our accident insurance page.
The sooner the objection is reviewed, the better the chances. Have your rejection assessed while there is still time to respond.
Rogert & Ulbrich – Your lawyers in insurance law
Rogert & Ulbrich represent policyholders nationwide in disputes with their private accident insurance companies. Attorney Dario Kovac, who is familiar with insurers' review and rejection strategies from his previous work on the insurers' side, serves as the contact person for insurance law. We combine this insider knowledge with the firm's consumer protection experience from major cases in banking, capital markets, and automotive law. This allows us to engage with insurers on equal footing.
We review your insurance policy terms and conditions, the deadlines, and, most importantly, whether the insurer properly notified you of the deadline. We check whether a sufficient medical report was submitted in a timely manner and evaluate the insurer's claims handling practices. We pursue your claims out of court; if the insurer maintains its rejection, we represent you in court. We involve any existing legal expenses insurance early on and obtain the coverage confirmation for you.
Has your accident insurance company rejected your disability claim due to a missed deadline? Get in touch and secure your rights.
