Basic disability insurance – when the insurance company does not pay out in the event of loss of basic abilities
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When basic skills are lost – and the insurance company blocks the claim
Basic disability insurance is designed to provide coverage if fundamental skills for daily living are lost due to illness or accident. Unlike... Disability insurance It does not depend on occupational disability or the specific professional activity, but solely on the loss of defined basic abilities.
If abilities such as walking, seeing, hearing, speaking, or using one's hands are permanently impaired, this can have significant financial consequences. It is all the more serious if the insurer refuses to pay out or does not recognize the claim.
Rogert & Ulbrich, represented as lawyers in Insurance law Nationwide, policyholders are confronted by their insurance companies. Our law firm reviews the content of the insurance terms and conditions, medical documents, and the justification for the insurance claim. Rejection of benefits carefully.
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3What is a basic disability insurance policy?
Basic skills insurance is a private insurance policy that pays a monthly pension in the event of the loss of certain contractually defined basic skills. For many policyholders, it represents an alternative or supplement to occupational disability insurance.
While occupational disability insurance focuses on the inability to continue practicing the last occupation, basic skills insurance examines exclusively whether specific abilities have been permanently lost.
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Which basic skills are covered by insurance?
Which basic abilities are protected is determined solely by the specific terms and conditions of the policy. These typically include physical abilities such as walking, climbing stairs, kneeling or bending, sensory abilities such as seeing or hearing, and sometimes also cognitive abilities.
The specific definition of these abilities varies considerably between insurance companies. For example, the ability to "walk" might mean being able to cover a certain distance without interruption. Other insurers focus solely on independent mobility.
Therefore, the precise content of the insurance terms and conditions is always crucial. An insurance lawyer will examine whether the insurer has correctly applied the contractual definitions.
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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Distinction from occupational disability
Many policyholders confuse basic skills insurance with occupational disability insurance. Occupational disability depends on whether the last job held can no longer be performed to at least 50 percent.
With basic disability insurance, the specific occupation is irrelevant. Even those who are still able to work can be entitled to benefits if an insured ability has been lost.
Our lawyers will advise you comprehensively on the differences between basic disability insurance and occupational disability insurance.
Eligibility requirements in basic disability insurance
The insurer is obligated to provide benefits if an insured basic ability is permanently lost or lost for the contractually defined minimum period. Often, the policy requires an impairment lasting at least six or twelve months, or a limitation that is expected to be permanent.
The loss must generally be confirmed by a specialist physician. Specific medical findings are decisive, not merely subjective complaints.
A lawyer specializing in insurance law checks whether the medical records meet the contractual requirements.
Role of aids in performance testing
A key point of contention is the question of whether the loss of an ability also exists if it can only be exercised with the help of technical or medical aids.
Some insurance companies explicitly cover assistive devices. Others assess whether their use is reasonable. Whether an ability is considered "lost" even though it can be partially compensated for with assistive devices depends on the specific contract.
This requires a precise interpretation of the terms and conditions by a lawyer specializing in insurance law.
Burden of proof and presentation
In principle, the policyholder bears the burden of proof for the loss of the insured basic abilities. They must provide suitable medical documentation demonstrating that the contractually defined conditions are met.
If, however, the insurer invokes an exclusion, it must prove the conditions for that exclusion.
Especially in unclear medical situations, structured legal support from a specialized law firm in insurance law is advisable.
Contestation and withdrawal by the insurance company
As with other private insurance policies, the insurer can also invoke a breach of the pre-contractual duty of disclosure in the case of basic disability insurance. If health-related questions were not answered completely or accurately, the insurer risks contesting or rescinding the contract.
Whether these measures are effective depends on numerous legal issues. An experienced lawyer will examine whether the insurance company is entitled to withdraw from the contract.
Practical examples from basic disability insurance
In one case, the insurer rejected a claim due to the loss of the ability to "climb stairs," claiming that the insured could still manage individual steps. After legal review, it was determined that the contractual definition required a specific number of steps, which was no longer met. The insurance company then recognized the claim.
In another case, service was refused with reference to a possible assistive device. Upon interpretation of the contract, it turned out that there was no obligation to use this assistive device.
10 Questions & Answers about Basic Disability Insurance
Have your benefit denial legally reviewed now.
If your basic disability insurance refuses to pay out or cites exclusions, you should not accept the decision without question.
Have your case reviewed by a lawyer specializing in insurance law and clarify what claims you are entitled to under your insurance policy.
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