Support in case of occupational disability and disability benefits
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Lawyer specializing in disability insurance
When someone becomes unable to work, there's usually more at stake than "just" an insurance payout. Often, it's about financial security, ongoing obligations, and the long-term protection of one's life plans. It's precisely in these situations that many policyholders find that their disability insurance doesn't pay out automatically, but instead demands extensive documentation, closely examines their medical history, or even denies a disability pension altogether.
Rogert & Ulbrich Rechtsanwälte supports insured persons in enforcing claims arising from the Disability insurance – from the structured preparation of the benefit application to consistent out-of-court and court representation. Our focus is on a clear strategy, thorough documentation, and communication that withstands scrutiny.
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3When does disability insurance pay out?
Whether a Disability insurance The amount payable depends primarily on the insurance contract and its terms and conditions. Many policies stipulate that a claim must be paid in accordance with the terms and conditions. Occupational disability This applies when the last occupation held can no longer be practiced, in whole or in part, "in good health" due to illness, consequences of an accident or decline in strength – often based on a certain degree (often 50 %) and a minimum duration (e.g. six months retrospectively or prospectively).
The crucial point is that the benchmark is not some general job description, but rather the specific activity, as it was actually performed most recently. This is precisely where one of the most frequent points of contention lies in practice. Anyone who does not describe their duties and responsibilities precisely risks having their disability insurance assess their limitations differently than the insured.
We will take care of your case – quickly & with commitment.
Proving occupational disability: Job description and medical documentation
In BU procedures, two levels interlock:
- Job description (job profile): What tasks characterized the daily work routine? What manual actions, responsibilities, times, routes, physical strains, or mental demands were typical?
- Health limitations: What diagnoses have been made – and, most importantly, what specific effects do these have on this particular activity?
Many Rejections Disputes arise not because "nothing is available," but because, from the insurer's perspective, the connection between the activity and the impairment is not sufficiently documented. Therefore, a clear structure for documents, medical reports, findings, and descriptions of daily work life is crucial.
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
Have your case reviewed now and get in touch directly!
Claim for benefits under your disability insurance: How to avoid typical mistakes
At first glance, the claims application appears to be just a form. In reality, it sets the framework for the entire claims review. Insurers regularly ask detailed questions about complaints, treatments, daily work routine, leisure activities, and the progression of the impairment. Incomplete information, unclear wording, or contradictory timeframes can later be used against the insured – for example, when assessing the degree of disability or when raising objections regarding the pre-contractual duty of disclosure.
We assist in creating a coherent and legally sound application. This includes, in particular, aligning the job description with medical documents to ensure that the disability insurance company does not overlook or misinterpret the relevant aspects.
Typical topics in the performance test are: This includes obtaining medical reports, rehabilitation and hospital records, reviewing diagnoses, and determining whether and to what extent the last activity performed is still possible.
Disability pension application rejected: What's important now
Will the Disability pension A rejection does not automatically mean that there is no claim. Rejections are often based on recurring patterns of reasoning, such as:
- The insurer believes that the required level of occupational disability has not been reached.
- The insurer believes that the last occupation performed should be assessed differently than the insured describes it.
- A different activity is presented as reasonable (referral).
- A breach of the pre-contractual duty of disclosure is alleged.
- The reasons given are a lack of cooperation or "insufficient documentation".
At this stage, the right tactics are crucial: Which points of the rejection are contestable? What evidence is truly lacking – and which requirements are excessive? What deadlines are in effect? And how can the argumentation be structured so that it will hold up in court?
Rogert & Ulbrich reviews rejection letters, expert opinions and the claims file, assesses the legal justification and develops the next steps – from out-of-court procedures to legal action, if necessary to enforce the disability insurance benefit.
Pre-contractual disclosure obligation: A frequent point of contention in cases of occupational disability.
A key objection raised by many disability insurers concerns the Pre-contractual disclosure obligation. Put simply, the issue is whether the health information provided when taking out the disability insurance policy was accurate and complete. Insurers often rely on subsequently requested documents and medical records in this regard.
Important: Not every deviation is automatically "fraudulent" or automatically leads to the loss of insurance coverage. The decisive factors are the specific questions in the application, the knowledge at the time, the relevance, and the legal prerequisites for the rights asserted by the insurer (e.g., rescission or contestation). This is precisely why a sound legal assessment in each individual case is crucial – especially if disability benefits are already at issue.
Expert opinions, examinations and cooperation: What disability insurance can demand
During the claims review process, insured individuals are often asked to undergo examinations or are confronted with expert assessments. At the same time, information is requested – sometimes very extensive. It is crucial here to maintain one's own position while simultaneously fulfilling the necessary cooperation within the framework of contractual and legal requirements.
We provide support in classifying questions, preparing appointments, and structuring documents. The goal is comprehensible documentation that reflects the actual limitations and avoids unnecessary points of contention.
Referral: Can the disability insurance company refer the insured to another profession?
Many insurance policies contain provisions regarding Reference. The process involves examining whether another job can still be performed and whether this job corresponds to the individual's previous standard of living. In practice, this is often highly contentious because it's not just about "any job," but about skills, responsibility, social standing, and income level compared to the previous job.
A solid factual basis is crucial here: What activities were truly formative? Which core tasks are inextricably linked to the profession? What limitations specifically affect these core tasks? We start at this point and develop the argumentation in such a way that the referral is not examined schematically, but realistically.
Review and benefit suspension: When the disability pension is already in effect
Even if the disability insurance recognizes or pays benefits, it may, within the framework of the Follow-up examination Later, it will be checked whether the occupational disability still exists. Insured persons often then receive questionnaires, requests for examinations, or notifications of an intended cessation of benefits.
Here too, the following applies: A suspension of benefits is not "automatically effective," but depends on formal and substantive requirements. We examine the review notice, the justification, the supporting documents, and the comparative analysis – and enforce claims if the suspension of benefits is unfounded.
Our support in the event of disability insurance: From assessment to enforcement
As lawyers specializing in insurance law, we handle disability insurance claims with a clear, proven approach. The focus is always on the individual case: the contractual situation, job description, medical condition, insurer's communication, and litigation risks.
Typical components of our work are:
- Out-of-court enforcement of claims and – if necessary – judicial enforcement of the occupational disability pension
- Review of the insurance contract, terms and conditions and scope of benefits of the occupational disability insurance
- Structuring the job profile and creating a comprehensible job description
- Preparation of medical documents and coordination with the professional profile
- Analysis of rejection letters, expert opinions and referral arguments
10 Questions & Answers about Disability Insurance (BU)
Have your disability insurance claim reviewed now
Whether it's a claim for benefits, a rejection of the occupational disability pension, a referral or a review procedure – every occupational disability case requires a clear strategy.
We check whether the conditions for occupational disability are met, whether the insurer has assessed correctly and what steps are sensible to enforce your claims – out of court or by filing a lawsuit against the occupational disability insurance company.
Have your disability insurance case legally assessed now and arrange an initial consultation.
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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.
