After consulting L & P Luber Pratsch Rechtsanwälte Partnerschaft, the state health aid paid two thirds of the treatment costs incurred after the insurance company had previously refused to recognize the insured event.
Our client suffered from ametropia in the form of hyperopia, astigmatism and presbyopia. This disease was treated and remedied in 2017 at the Munich Eye Center with an implantation of multifocall lenses. He then applied for benefits from his private health insurance, the state health aid. He was all the more concerned when the insurance company refused to pay on the grounds that there was no medical need for the implantation of lenses.
The policyholder then turned to the law firm L & P Luber Pratsch Rechtsanwälte Partnerschaft, which specializes in insurance law, for help. The specialist lawyer for insurance law, attorney Aylin Kempf, came to the conclusion, after an intensive examination of the documents, that the refusal to provide benefits is likely to be incorrect in law.
After the insurance company refused to reach an agreement out of court, legal action was initiated before the Constance Regional Court. The court hired an expert to examine the medical necessity. In his report and several supplementary reports, the latter stated that the policyholder had no claim. “The expert opinion was obviously wrong because the expert ignored the case law of the Federal Court of Justice despite several references” stated the specialist lawyer for insurance law, attorney Aylin Kempf. “We therefore arranged for the expert to be summoned. At the hearing we finally succeeded in persuading him to explain that the operation carried out on our client was medically necessary and therefore an insured event. ”After the amount of the claim remained disputed, the parties finally agreed on a settlement , which provided for a payment equal to two-thirds of the claim.
“For our client, this comparison represents a positive outcome, even if the maximum goal has not been achieved. For us as lawyers at L & P Luber Pratsch Rechtsanwälte Partnerschaft, this confirms once again that well-founded and comprehensive case processing is a success leads. It also shows that the rejection of benefits from insurance companies is regularly vulnerable and that a positive result can be achieved for the clientele, ”says Aylin Kempf, happily.
About the firm
L & P Luber Pratsch Rechtsanwälte Partnerschaft is an owner-managed specialist law firm that operates exclusively in the fields of insurance law and capital market law.
We represent insurance customers and injured investors nationwide and, with our office in Munich and consultation days in Berlin, Hamburg and Cologne, we have the option of providing personal support to our clients nationwide. Our lawyers can look back on numerous successes before German courts. The central element of our mandate processing is the joint mandate support by the partners of the law firm. Only through joint processing of mandates and observance of the four-eyes principle can the best possible mandate processing and a personal and trusting lawyer-client relationship be guaranteed. We reject assembly line support and the use of young professionals.
Our credo lies in the trusting cooperation with our clients. You can rely on our expertise and many years of professional experience. We attach great importance to the concept of service. We have access to a wide network of experts and thus offer our clients expert support for their claims.
The focus of client processing is always the personal relationship between our clients and us. We are personally available for our clients at any time and are available to them as a direct contact for questions. Thus, our clients do not have to be afraid of being left alone, but can rely on our professional work. We have been used to competing against big banks and insurance companies for many years. The many litigation wins by our lawyers show: Our success proves us right!
Contact
L & P Luber Pratsch Lawyers Partnership
Munich: Morassistraße 18, 80469 Munich, Tel. 089.999 533 450
Hamburg*: Neuer Wall 63, 20354 Hamburg, Tel. 040.356 763 58
Berlin*: Kurfürstendamm 21, 10719 Berlin, Tel. 030.221 869 95
Cologne*: Richmodstrasse 6, 50667 Cologne, Tel. 0221.969 864 13
* Consultation day by telephone arrangement
Fax 089.999 533 459
Mail [email protected]
Web www.lp-rechtsanwaelte.com
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