December 4, 2023 – If a policyholder fails to state in his occupational disability insurance application that he was on short-term sick leave years before due to a mental stress disorder caused by his work, the insurer has the right to withdraw from the contract. The Saarbrücken Higher Regional Court decided this in its judgment of November 16, 2022 (5 U 8/22).
A man took out occupational disability insurance in November 2013. When submitting his application, he answered no to the question of whether he had been examined or treated for illnesses or mental disorders in the last ten years.
Concealed sick note
That turned out to be wrong. In 2018, the insured person applied for an occupational disability pension. As part of the benefits check, the insurer learned that the man had been on sick leave for two weeks in 2009 due to psychological stress caused by his work.
The insurer therefore refused to pay the requested pension due to a pre-contractual breach of the notification obligation. At the same time he declared his withdrawal from the contract.
The Saarbrücken Higher Regional Court, which dealt with the case in the second instance, rightly found this to be the case. It dismissed the appeal against a lower court ruling dismissing the man’s lawsuit as unfounded.
Mental health treatment should have been reported
The judges were convinced that the plaintiff had objectively answered the application question regarding the treatment of a mental disorder incorrectly. He should have known that his answer was not true.
The fact that the medical diagnosis that led to the sick note may not have been a “real” illness is irrelevant. Because even if one would not assume a mental illness, a workplace-related stress reaction should at least be viewed as a psychological disorder.
The plaintiff would therefore have had to declare any related medical treatment when applying for insurance.
Court does not allow “tactical sick note” to apply
The judges considered the plaintiff’s claim that he was not actually ill but had taken sick leave for tactical reasons because of an impending change of employer to be irrelevant.
“It is obvious that stress reactions treated by a doctor are relevant for the risk assessment when concluding an occupational disability insurance contract.” The insurer was therefore right to withdraw from the contract with the result that the plaintiff was not entitled to any benefits despite his occupational disability.
2023-12-03 23:06:18
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