Only after we took action, our client now receives 1,125 euros a month from his disability insurance – without initiating lengthy legal proceedings. He reported to his insurance company (neue leben Lebensversicherung AG) and claimed that he had been unable to work as a health care professional because of the most serious spinal problems since the beginning of 2018.
Allegation: Client did not report illnesses
However, the insurance company did not answer him as he had hoped. “Instead of recognizing the obligation to provide benefits, the insurance company instead declared the contestation of the contract due to fraudulent deception – it also withdrew from the contract,” reports attorney Penteridis, who handled the case.
“The insurance company accused our client of having lied about his state of health when the contract was signed in 2010,” explains Penteridis, who is a specialist lawyer for insurance law. The consequence of a challenge: It is pretended that the contract did not exist from the start – if the challenge is effective.
Result of our advice: Client did not lie
Our client came to our office for advice. “I was able to quickly establish that the challenge cannot be effective,” explains the lawyer who works nationwide. The specific allegations of the insurance company were: The information provided by our client’s doctors would have shown that he suffered from shoulder and pelvic obliquity and had splayefoots. In addition, he would have repeated loin pain on the left side from the age of 16.
In addition, he was in the emergency room in 2006 because of severe back pain. An acute lumbago was found there, which should be treated with medication and heat treatment. If the complaints persist, a radiological investigation should be carried out. After all, he was unable to work for almost a week because of cervical root problems.
Wrong information from the insurance agent
In conversation with the client and after reviewing the extensive documents, Penteridis, who is also a specialist lawyer for medical law, was able to determine: The client had not lied at the time. “The pelvic inclination and splayfeet were only diagnosed in 2011 and thus to Conclusion of the contract – he informed the insurance agent about the other illnesses and complaints, ”the lawyer said. “However, the representative replied that the issues were minor so that they should not be disclosed. This information was wrong. The insurance company must be responsible for this false information, ”explains the lawyer, who is also a specialist lawyer for social law.
Insurance now pays 1,125 euros a month
We have described this to the insurance company. However, she continued to reject the claims without responding to our arguments. It was only when we again emphatically pointed out the legal situation that the insurance company declared its obligation to provide benefits. “Our client has now received an additional payment of almost 35,000 euros,” says Penteridis happily. “The insurance not only pays the monthly pension of 1,125 euros, it has also taken over the statutory legal fees”.
The case proves: Have a lawyer review decisions made by insurance companies. It is best to contact a lawyer specializing in insurance law. Iwork in our office three specialist lawyers for insurance law – and we are also specialist lawyers for medical law, which can be helpful for such cases.
Melzer Penteridis Kampe Rechtsanwälte PartGmbB
Photo: @ Pixabay.com / moerschy
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