What the Higher Regional Court of Saarbrücken has decided regarding proof of mental illness in occupational disability insurance
Depression can lead to occupational disability, but the diagnosis alone does not automatically entitle someone to an occupational disability pension. This was confirmed by the Higher Regional Court of Saarbrücken in its ruling of December 10, 2025 (Case No. 5 U 80/24). The decisive factor is how the illness specifically affects the individual's professional duties. Rogert & Ulbrich can help you build a solid case for this.
The case: CEO with depression fails in his lawsuit
The plaintiff was the commercial director of a family-owned gas station and automotive business. Following a stay in a psychosomatic clinic in 2016, he was continuously on sick leave for over two years. He stated that he suffered from moderate to severe depression, dysthymia, somatoform disorders, lack of motivation, and anxiety. He later took up internships and employment at other companies.
He claimed benefits from four supplementary occupational disability insurance policies with two insurers. They rejected his claims, arguing that the required occupational disability had not been proven and pointing to a possible reorganization of his business and his ability to perform other commercial tasks. The regional court dismissed the claims after obtaining a psychiatric expert opinion. The Higher Regional Court of Saarbrücken upheld this decision.
Is your disability insurance company questioning the impact of your depression? Have them review what evidence is missing in your case.
Why diagnosis alone is not enough
According to Section 172 Paragraph 2 of the German Insurance Contract Act (VVG), a person is considered occupationally disabled if, due to illness, injury, or a decline in physical or mental capacity exceeding that expected for their age, they are wholly or partially unable to perform their most recently held occupation, as it was structured before any health impairment, and this inability is expected to be permanent. Many contracts additionally require a specific degree of occupational disability, often 50 percent.
The Higher Regional Court of Saarbrücken emphasized that occupational disability requires a medically sound prognosis indicating that the insured person is likely to be permanently prevented from working. While the expert witness confirmed a moderate depression, insufficient treatment data and a lack of evidence of specific functional impairments meant that no reliable conclusions regarding occupational disability could be drawn.
Even the sick notes from the family doctor were of no help. Incapacity for work and occupational disability are different terms. The requirements for occupational disability are stricter.
A diagnosis describes the illness, not its consequences in the workplace. It is precisely these consequences that you must document.
Treatment and proof: What the court clarified
The court also clarified that the existence of occupational disability does not depend on whether the illness is treated professionally. Insured persons are therefore not obligated to undergo a specific therapy in order to retain their entitlement.
In practice, however, treatment plays a crucial role. Without conclusive findings, therapy reports, or specialist assessments, it becomes difficult for the expert to determine the occupational limitations. This is precisely where the plaintiff failed in the case at hand. Without a documented course of events, it is almost impossible to ascertain when, how frequently, and to what extent the symptoms impacted daily work.
Those suffering from mental illness should therefore ensure that treatments and symptoms are medically documented. This applies particularly to specialist medical or psychotherapeutic treatments.
Without conclusive medical findings, proving occupational disability due to depression is extremely difficult. Ensure you have complete and thorough documentation from the outset.
This is the evidence required by disability insurance in cases of mental illness.
For a successful disability insurance claim due to depression, medical documents should describe as specifically as possible which abilities are impaired. The following are particularly helpful:
- Specialist medical findings: Reports from psychiatrists or psychotherapists including diagnosis, severity, and course.
- Hospital and rehabilitation reports: Dismissal reports often contain an assessment of professional performance.
- Functional limitations: Information on concentration, resilience, motivation, decision-making ability and social interaction.
- Course and prognosis: A medical assessment of whether the limitations are likely to be permanent.
- Job description: A detailed description of your daily work routine, including the demands on concentration, resilience, decision-making, and customer contact.
- Comparison: A plausible connection between the complaints and the specific professional requirements.
A doctor's note does not replace this comparison of symptoms and professional requirements. Further information on the procedure can be found on our website. Lawyer specializing in disability insurance.
Do not submit your disability insurance application with incomplete documentation. An incomplete application can be difficult to correct later.
Special considerations for self-employed individuals and managing directors
In the case at hand, the insurers also cited a possible reorganization of the business. In the case of self-employed individuals and working partners, insurers often examine whether the insured person can restructure their business in such a way that they relinquish the health-damaging tasks and take on others.
Such a reorganization must be operationally sensible and economically feasible. Furthermore, it must not lead to a permanent, noticeable loss of income. In cases of mental illness, this question is often particularly difficult because the limitations affect not only individual tasks but also, for example, the overall ability to lead and make decisions.
Self-employed individuals and managing directors applying for disability benefits should therefore explain from the outset how their business is organized, which tasks they personally perform, and why reorganization is not possible or reasonable. Information on typical points of contention can be found on our page about... Claims denied by insurers.
Is your insurer demanding a reorganization of your business? Have it checked whether this is even reasonable.
What insured people with depression should do now
The ruling by the Higher Regional Court of Saarbrücken demonstrates the importance of careful preparation when applying for disability benefits in cases of mental illness. The court did not question the illness itself. The claim failed due to a lack of evidence demonstrating the specific impact on the applicant's ability to work.
Therefore, ensure you have continuous specialist medical or psychotherapeutic support and have your symptoms documented. Ask your therapists to describe not only the diagnosis but also the functional limitations. Create a detailed description of your daily work routine, ideally including a breakdown of how much time you spent on each task.
If your insurer has already rejected your claim, we will review the medical justification and the expert opinion obtained. Often, gaps in the documentation can still be filled or the expert's assessment can be challenged on professional grounds.
Was your disability insurance company rejecting your claim due to depression? Have the rejection reviewed before you give up.
Rogert & Ulbrich – Your lawyers in insurance law
Rogert & Ulbrich represents insured individuals nationwide against disability insurers, including in cases of mental illness. The firm is managed by Dr. Marco Rogert and Tobias Ulbrich and has already handled over 40,000 cases. Insurance law We know what insurers and experts look for in cases of depression and other mental illnesses.
We review your insurance policy, existing medical records, and a description of your professional activities. We pursue your claims against the insurer out of court. If necessary, we also represent you in court.
Is your disability insurance company rejecting claims due to depression or constantly demanding new documents? Get in touch and secure your claims.
