Health issues are seen as a minefield, especially in occupational disability insurance. Incorrect or incomplete information can ultimately lead to the insurer invoking a breach of the obligation to notify in the event of a claim and withdrawing from the insurance contract, as past judgments have shown.
Even with intermediaries, the often strict exclusion policy of the insurer when filing a BU application does not necessarily meet with approval. This is shown again by a survey by the brokerage cooperative VEMA among its members. The majority of those surveyed stated that two thirds of the customers making the application had previous illnesses that had to be reported. Given this number, it is hardly surprising that 88 percent of brokers work with advance inquiries. Around half of them approach the appropriate insurer directly and describe the customer’s health situation.
Back and spinal disorders are the most common
The most common of the diseases to be reported are diseases of the back, the skeleton or the musculoskeletal system – half of the customers reported complaints here. Mental illness follows in second place with 31 percent. On the other hand, chronic diseases (16 percent) or a body mass index (BMI) that is too high or too low play a rather subordinate role with three percent. However, if customers have restrictions in these categories, more than 40 percent of brokers do not experience any single insurer on the market as particularly accessible or willing to negotiate.
Brokers perceive the providers a little more openly when it comes to previous illnesses of the psyche or the back / musculoskeletal system; the examination of individual cases with regard to the possibility of risk surcharges and fair exclusions still seems most realistic in the experience of the broker. Nevertheless, 28 percent still confirm that insurers have little or no willingness to cooperate in this category. The problem that VEMA found: already misaligned feet or sports injuries, such as ligament tears and cartilage damage, sometimes led to rejection by the insurers.
The VEMA brokers rated the Alte Leipziger as the most accessible in all categories, followed by Allianz in second place. Only in the area of mental illness were the experiences of the VEMA brokers with Volkswohl Bund Versicherung better.
BU pension is not granted in every fifth case
VEMA is currently promoting making the collective solution the standard. It would also be an “enormous relief for brokers if they no longer had to decide whether each cold had to be reported because theoretically it could come from an allergy”, according to the broker cooperative.
It happens again and again that insured persons who have paid into the BU insurance for years end up in a nasty surprise when their application for benefits is rejected. In 21 percent of the cases, a BU pension applied for is not approved, according to a study by the rating agency Franke und Bornberg. The legal rule is that the customer has to answer the health inquiries exhaustively – only impairments that are obviously insignificant or that will soon pass may be left out of the answer. However, whether it is actually just a minor ailment or an impairment that has to be stated often has to be negotiated in court.
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