An insurance company cannot rely on the belated notification of an insured event and refuse to pay if the health of the insured person made it impossible to report or inform the husband. The Frankfurt Higher Regional Court decided in a judgment published on Monday (Az .: 7 U 36/19). In that case, the husband of a woman who had died in the meantime demanded the retrospective payment of daily care allowance. The verdict is not yet legally binding.
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The woman had suffered a severe stroke in 2012 with paralysis on one side, complete loss of speech and considerable impairment of memory. She had taken out care daily allowance insurance from the defendant insurance company in the event that she was in need of extreme care. The husband, whom she had not informed her about this insurance, reported the insured event in February 2015 and applied for retroactive benefits from April 2013. The insurance refused. The district court had also dismissed the man’s complaint.
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The OLG, however, decided in the appeal that the man had reported the insured event too late through no fault of his own. Rather, he did not know anything about the insurance. The monthly debiting of the contributions in the amount of 20 euros would have given no reason to assume that such an insurance was in place. There was no information on the type of insurance in the booking text. The wife, in turn, who should have reported the insured event, was unable to do so due to the consequences of the stroke and was unable to inform her husband accordingly, according to the court.
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