Accident insurance: Secure disability benefits and consistently enforce claims
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Lawyer specializing in accident insurance
A serious accident can fundamentally change one's life in a matter of seconds. In addition to health problems, those affected often face significant financial uncertainty. Private accident insurance is intended to guarantee financial stability in this situation. In practice, however, it is repeatedly observed that insurers reduce, delay, or completely deny benefits.
The law firm Rogert & Ulbrich represents policyholders nationwide in enforcing claims under private accident insurance. We assess the prospects of success for your claim, support you throughout the proceedings, and consistently pursue legitimate claims both out of court and in court.
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3What constitutes an accident for the purposes of accident insurance?
According to Section 178 Paragraph 2 of the German Insurance Contract Act (VVG), an accident occurs when the insured person involuntarily suffers bodily injury as a result of a sudden external event. The decisive factor is therefore an external event that occurs in a temporally definable manner and is not intended by the insured.
In legal practice, precise distinctions are often crucial. Not every injury automatically constitutes an insured accident. Purely self-inflicted movements without external influence, gradual degenerative changes, or wear and tear are generally not covered. In claims cases, insurers frequently cite alleged pre-existing conditions or age-related changes to reduce their liability.
Especially in cases of herniated discs, shoulder or knee injuries, a thorough analysis is essential. The crucial question is whether the specific event was the primary cause of the permanent impairment. This assessment of causality is regularly the central point of disputes in insurance law.
We will take care of your case – quickly & with commitment.
When does a disability exist?
A prerequisite for receiving disability benefits is that the accident has resulted in a permanent impairment of physical or mental capacity. Disability does not merely mean a temporary limitation, but rather a permanent functional impairment.
The disability must have occurred and been medically certified within the contractually agreed timeframes. Many insurance policies stipulate a 15-month period for medical certification. If this deadline is missed, the claim may be forfeited entirely, even if a permanent impairment objectively exists.
Furthermore, the disability must be clearly attributable to the specific accident. If pre-existing conditions or injuries exist, insurers often attempt to reduce benefits by taking these into account. Whether such a deduction is permissible always requires careful legal review.
If your insurance company is causing problems – talk to lawyer Dario Kovac
Is your insurance company refusing to pay or delaying the settlement? Lawyer Dario Kovac He has been assisting clients with disputes with insurance companies, particularly legal expenses insurers, since 2019. His previous work at ARAG He is familiar with typical rejection strategies from practice.
- Review of your benefit claim
- Consistent enforcement
- No communication with the insurance company
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The role of the scale of compensation for bodily injuries
The so-called scale of compensation for bodily injuries is a key instrument for calculating disability benefits. It defines fixed degrees of disability for specific body parts, for example, in the case of loss or complete functional impairment of an arm, leg, or eye.
In cases of partial functional impairment, a proportional assessment is made. In practice, disputes regularly arise regarding the specific degree of disability, the medical evaluation of the functional impairment, and whether a subsequent reassessment is permissible or necessary. An inaccurate expert opinion can have significant financial consequences.
We critically review medical reports, accompany assessments and ensure a fair and legally sound evaluation.
Typical points of contention with accident insurance
Disputes with accident insurance companies often arise not only about the degree of disability, but also about whether an insured accident even occurred. Insurers argue, for example, that a mere self-inflicted movement, impaired consciousness, or that coverage is excluded due to intoxication.
Other areas of conflict concern alleged breaches of duty, missed deadlines, or the claim that a medical treatment caused the injury. Not every one of these arguments withstands judicial review. The insurer bears the burden of proof for exclusions and circumstances that reduce benefits.
Formal requirements and evidentiary issues
The enforcement of disability benefits often fails due to formal requirements. A proper medical assessment is required, clearly stating the nature of the permanent impairment, the degree of disability, and that the impairment is accident-related.
Mere hospital reports or general diagnoses are usually insufficient. Contradictory statements about the accident can also complicate the process of proving a claim. Early legal counsel helps to avoid formal errors and to strategically prepare for pursuing a claim.
Your insurance company won't pay?
If your claim was rejected or the disability benefit was set far too low, you should not accept the decision without review. A thorough legal analysis is particularly worthwhile in cases of complex medical issues or high sums insured.
We review your insurance policy, analyze expert reports, and develop a clear strategy to enforce your claims. Our goal is a fair settlement – out of court or, if necessary, through litigation.
10 Questions & Answers about Accident Insurance
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Disputes with accident insurers often involve substantial sums of money and frequently concern financial security after a life-altering event. A legally and medically sound analysis of the facts is therefore crucial.
Rogert & Ulbrich has many years of experience in insurance law and in the litigation of complex claims. We analyze insurance terms and conditions in detail, critically review medical reports, and represent our clients nationwide against major insurance companies – both out of court and in court.
If your accident insurance company rejects, reduces, or delays your disability benefits, you shouldn't waste any time. Submit your policy terms and conditions, any previous correspondence, and any existing expert opinions to us. We will conduct a legally sound review of your claim and advise you on the most effective steps to pursue your rights.
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We offer you a professional and comprehensive initial consultation in the field of insurance law. Take advantage of this opportunity and avoid mistakes.
