After several OLG judgments, the Federal Court of Justice was called and found: Most of the increases are inadmissible. Of the BGH (Az. 9 U 138/19) With its judgment of December 16, 2020 put the discussions about the legality to a temporary end.
The contributions of AXA insurance, the second largest private health insurance company, were wrongly increased. The insurer made gross mistakes in the reasons for the increases and violated legal regulations. The customers of many health insurance companies can now expect premium repayments.
In January 2021, the Cologne Higher Regional Court’s insurance senate already found drastic words in another procedure for the letters of motivation with which AXA had informed its customers about the increase in premiums. The judges in Cologne judged AXA’s customer information as “contradictory” and “misleading, if not factually incorrect”.
In principle, the BGH confirmed this view. Inadequate customer information is a violation of the Insurance Contract Act – which can result in four-digit repayment claims for many insured persons. In the event of a premium increase, the policyholder must be able to understand why his premium is increasing. However, the insurers bypass a proper justification and leave it to empty phrases. The BGH clearly complained that the customer could not do anything with such meaningless explanations. This ruling is therefore likely to deal a severe blow to private health insurers – and trigger massive claims for repayment.
“Since AXA used the criticized premium adjustments with the same content for millions of customers, the judgment is of fundamental importance and may trigger a wave of repayments,” says Ilja Ruvinskij, specialist lawyer for banking and capital market law and partner of the Cologne law firm KRAUS GHENDLER RUVINSKIJ, who recently made several Could reach judgments against private health insurances before higher regional courts.
The current proceedings before the BGH concerned premium increases as of January 1, 2014 and January 1, 2015. On the basis of the ruling, the plaintiff will receive back the contributions that he had paid due to these increases in addition to the previously applicable contribution. “However, the meaning of the judgment extends well beyond these two years. For other insurance companies, too, this most likely means that contributions made in recent years will have to be reimbursed, ”said Ruvinskij. Agencies / nd
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