Daily care allowance can also be claimed after years. Image by truthseeker08 from Pixabay.
According to the law, insurance damage must be reported “immediately”. The fact that this term can be interpreted broadly and can also mean “after several years” has now been learned by an insurer from the Higher Regional Court (OLG).
An insurer cannot rely on the late notification of an insured event if the state of health of the insured “made it impossible to report or inform the husband”. In addition, the husband had no knowledge of the contract.
The woman and policyholder suffered a severe stroke in 2012 with paralysis on one side, complete loss of language skills and significant memory impairment, according to the news agency DPA writes. She had taken out care daily allowance insurance from the defendant insurance company in the event that she was in need of extreme care.
No communication
She had “not informed” the husband about the insurance. He therefore only reported the insured event in February 2015 and applied for retrospective benefits from April 2013, which the insurance company refused with reference to the failure to report the claim in due time. The regional court shared this view, the (OLG) Frankfurt did not.
The husband reported the insured event too late through no fault of his own because he had no knowledge of the conclusion of the protection. The monthly contributions of 20 euros would have “given no reason” to “assume that such an insurance exists”.
No conclusions could have been drawn about the type of insurance in the booking text of the account movement, the woman herself was unable to provide information to the husband or the insurance company due to her state of health.
It would have been interesting to know whether there had been letters, e-mails or consultant communications between the insurance company and the household of those affected over the years, which allowed conclusions to be drawn about the existence of the contract.
The judgment of the Frankfurt Higher Regional Court is not yet final (Ref .: 7 U 36/19).
Author: VW editorial team
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