Disability insurance – when the insurer refuses the EU pension
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If the disability insurance does not pay
Disability insurance protects against the existential risk of being unable to work on the general labor market due to health reasons. Unlike... Disability insurance It does not depend on the last job held, but on whether gainful employment is still possible at all.
If the insurer refuses to pay the agreed pension or suspends benefits during a review process, the financial security of many policyholders is at risk. The monthly pension from the disability insurance is intended to compensate for the complete loss of income.
Rogert & Ulbrich, as lawyers specializing in insurance law, represent policyholders nationwide against their insurers. Our firm has experience in the areas of occupational disability and incapacity insurance and reviews claims. Benefit rejections, including medical reports and contract clauses.
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3When does a conditional incapacity for work exist?
Incapacity for work exists when the insured person is permanently unable to pursue employment on the general labor market for health reasons. The decisive factor is not the previous occupation, but the remaining capacity to work.
Many insurance policies stipulate that less than three hours of work per day are possible. The decisive factor is the medical prognosis. A mere temporary inability to work is not sufficient; the limitation must be expected to be permanent.
Even serious illnesses do not automatically lead to recognition of disability. The insurer regularly assesses whether simple tasks – such as working from home – are still considered reasonable. Disputes often arise in these areas and should be reviewed by a lawyer specializing in insurance law.
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Distinction from occupational disability insurance
Disability insurance focuses on whether the last specific occupation can still be performed. Incapacity insurance, on the other hand, assesses whether any economically valuable activity is still possible.
For policyholders, this means a significantly stricter review process. Those who can no longer perform their previous job do not automatically meet the requirements for disability insurance.
Our lawyers examine each case individually to determine whether the insurer has correctly considered the differences between occupational disability and incapacity for work, and whether the rejection of the EU pension is legally tenable.
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.
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Eligibility requirements and medical assessment
The insurer's obligation to provide benefits is contingent upon the fulfillment of the criteria defined in the insurance policy. These criteria are based on the general terms and conditions of insurance as well as medical reports.
The focus is not on the diagnosis itself, but on the specific remaining earning capacity. The policyholder generally bears the burden of proof and the burden of demonstrating the existence of incapacity for work.
In legal proceedings, independent experts are frequently appointed. A lawyer specializing in insurance law oversees this process, critically evaluates expert opinions, and ensures that medical findings are correctly interpreted from a legal perspective.
Waiting periods and start of insurance coverage
Many disability insurance policies include waiting periods. While the insurance contract is already in place, coverage only begins after a certain period has elapsed.
Disputes often arise between insurers and policyholders as to whether the waiting period constitutes an exclusion of risk or a postponement of the insurance start date. This classification has significant implications for the burden of proof.
A legal review by a specialized law firm in insurance law is regularly recommended in these cases.
Verification by the insurer
Even after a disability has been recognized, the insurer is entitled to regularly review the eligibility requirements. As part of this review, the insurer requests current medical records or commissions new expert opinions.
If the insurer concludes that the incapacity to work no longer exists, it can discontinue pension payments. This often causes considerable uncertainty for policyholders.
Our lawyers support review proceedings and examine whether the cessation of benefits is lawful.
Contestation, withdrawal and pre-contractual notification obligation
Insurers often invoke a breach of the pre-contractual duty of disclosure. If health-related questions in the application were answered incompletely or inaccurately, the insurer can contest the contract or withdraw from it.
The legal consequences range from a contract adjustment to the insurer being completely released from its obligation to provide benefits. Whether a challenge or a withdrawal is effective depends on numerous factors, in particular the policyholder's subjective knowledge.
An insurance lawyer checks whether the conditions for terminating the contract actually exist or whether the insurance company is still obligated to provide benefits.
Practical examples from disability insurance
In one case, the insurer refused to pay the disability pension, claiming that the insured was still capable of performing simple tasks. After a court hearing, it was determined that the remaining work capacity was less than three hours per day. The disability pension was granted.
In another case, the insurer cited an alleged breach of the duty to disclose information when submitting the application. After legal review, it was proven that there had been no fraudulent misrepresentation. The insurer remained obligated to pay out.
10 Questions & Answers about Disability Insurance
Have your benefit denial legally reviewed now.
If your disability insurance refuses payment, suspends benefits, or contests the decision, you should not accept it without question.
Have your case reviewed by an insurance lawyer. Arrange an initial consultation with our firm and clarify what claims you are entitled to under your insurance policy.
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