Disability insurance: What happens if your disability is not recognized?
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Incapacity for service – an existential blow for civil servants
Retirement due to disability is not merely a legal measure for civil servants, but often a massive disruption to their personal and financial life plans. Leaving active service permanently alters their income structure, pension entitlements, and often their career prospects.
While occupational disability insurance is intended to bridge precisely this gap in coverage, in practice it turns out that insurance companies do not automatically provide benefits. Often, additional checks are carried out, clauses are interpreted restrictively, or objections are raised that are hardly comprehensible to the affected civil servant.
Especially during this phase, a sound classification is important. Insurance law Crucial. Rogert & Ulbrich represent civil servants nationwide in enforcing their claims under occupational disability insurance – both out of court and in court.
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3Incapacity for service in the sense of civil service law
Incapacity for service is defined by law. A civil servant is considered incapacitated for service if, due to their physical condition or health reasons, they are permanently unable to fulfill their official duties. The decisive factor is the employer's decision, which is regularly based on an official medical report.
Unlike occupational disability insurance, the focus here is not on the abstract ability to work, but on the specific assessment under civil service law. This distinctive feature makes occupational disability insurance a separate, complex area within insurance law.
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Disability insurance as a special form of protection
Disability insurance is essentially a special form of occupational disability insurance tailored specifically to the needs of civil servants. Its purpose is to compensate for the difference between the reduced pension benefits in the event of early retirement and the previous income.
The crucial factor is the contractually agreed-upon incapacity for work clause. It determines under what conditions the insurance company must pay out and whether the employer's decision is binding for the insurer.
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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Genuine and spurious incapacity for service clauses – a key decision
The distinction between a genuine and a spurious occupational disability clause is of considerable importance. With a genuine occupational disability clause, retirement due to general occupational disability is generally considered binding proof of the occurrence of the insured event. The insurance company cannot then typically challenge the employer's assessment of the employee's health on its own.
The situation is different with a non-genuine disability clause. In this case, the insurer can conduct its own medical assessment despite the employee's retirement. The retirement then merely constitutes a rebuttable presumption. It is precisely in such situations that extensive medical and legal disputes frequently arise.
The question of whether probationary or temporary civil servants are covered by insurance depends solely on the specific insurance terms and conditions. A blanket assumption is not permissible.
Alternative use and limited incapacity for service
Before retirement, the employer regularly checks whether alternative employment is possible or whether there is only a limited incapacity for service. These civil service law assessments have a direct impact on the occurrence of the insured event.
As long as alternative employment is legally possible and reasonable, retirement can be postponed. Similarly, limited fitness for duty can lead to the civil servant remaining in service, albeit with reduced working hours. In both cases, the question arises as to whether and to what extent the occupational disability insurance must already provide benefits.
The interface between civil service law and insurance law is particularly sensitive here. Errors in the legal assessment can lead to significant financial disadvantages.
Typical Reasons for rejection the insurance
In practice, we encounter recurring patterns of argumentation from insurance companies. They frequently claim that there is no genuine incapacity for work or that the health reasons are insufficiently documented. Sometimes, they argue that the retirement is based on organizational or economic considerations rather than health-related causes.
Objections are also raised regarding the pre-contractual duty of disclosure. Insurers check whether all health-related questions were fully answered in the application. It is not uncommon for them to bring up treatments or complaints from years ago in order to question their obligation to provide benefits.
This is precisely where the importance of a precise legal review becomes apparent.
Experience in insurance law and nationwide representation
Rogert & Ulbrich have been active in insurance law for many years and represent clients nationwide against insurance companies. Our services include both the out-of-court assertion of claims and the enforcement of claims in court.
We are familiar with the typical review mechanisms and argumentation strategies of insurers and, based on this knowledge, develop a structured and consistent approach. Our nationwide representation before local courts, regional courts, and higher regional courts enables uniform and strategically aligned litigation.
Our approach as a lawyer specializing in occupational disability insurance
First, we analyze your insurance contract and examine the specific wording of the occupational disability clause. Then, we evaluate the civil service decision and the insurance company's arguments.
Based on this, we develop an individual strategy to enforce your claims. Depending on the circumstances, this is done either through out-of-court settlement or by filing a lawsuit against the insurance company. The goal is always to secure the contractually guaranteed benefits.
10 Questions & Answers about Disability Insurance
Have your case of incapacity for work legally reviewed now
If your occupational disability insurance refuses benefits or imposes additional conditions, you should not accept the decision without review. For civil servants in particular, long-term income and pension security are often at stake.
Have your case reviewed now by a lawyer specializing in insurance law to clarify what claims you are entitled to under your occupational disability insurance. Arrange an initial consultation and gain legal clarity.
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