Protecting yourself against the consequences of occupational disability with insurance makes perfect sense. However, protection only exists if the questions about previous illnesses were answered correctly when the insurance was taken out.
A primary school teacher demanded occupational disability insurance benefits from the defendant insurer. He submitted the benefit application at the end of May 2020. Reason: He could no longer work in his last job as a teacher due to psycho-vegetative exhaustion, an adjustment disorder and a depressive episode.
30-day illness was concealed in the insurance application
He had already undergone psychotherapy and rehabilitation measures. The defendant insurance company examined the case. The medical information obtained showed that the teacher was on sick leave for a month in 2010. The first eight days because of post-traumatic stress disorder and then because of back pain.
Violation of the pre-contractual notification obligation – insurance company withdraws from the contract
The defendant insurance company then declared its withdrawal from the contract in accordance with Section 19 (2) VVG. By concealing the illnesses in 2010, the man violated his pre-contractual obligation to disclose. If he had stated these circumstances in the insurance application, the insurance cover would not have been provided under normal conditions and possibly even not taken over, the insurance company argued.
In the application for the insurance, which was taken out on February 1, 2012, the primary school teacher answered these questions, among others, with “no”:
- Question 8: “Do you currently have permanent impairments, illnesses or mental disorders, e.g. “For example, depression, anxiety, eating disorders, suicide attempts, or have you been counseled, examined or treated for this in the last ten years?”
- Question 10: “Have any treatments, consultations or examinations been carried out by doctors, other practitioners or in hospitals in the last five years? When? Why..?”
- Question 11: Do you have or have you had any illnesses, health or functional disorders, impairments or complaints in the last five years?
The teacher argued that he had answered question 8 correctly because it meant that there were permanent psychological impairments. Question 10, on the other hand, was far too broad and was not answered incorrectly because the back problems remained undiagnosed and were therefore irrelevant.
Higher Regional Court: Answering the health questions incorrectly was fraudulent deception
The man was unsuccessful at the Dresden Higher Regional Court (OLG). The court ruled that he had fraudulently misled the insurance company by objectively answering questions 8, 10 and 11 in the insurance contract incorrectly.
The man answered question 10 objectively incorrectly because he did not specify simple treatments regardless of their results. This question is not an inadmissible global question.
No inadmissible global question from the insurance company about health status
A certain level of abstraction in insurance questions is unavoidable in order to inquire about the relevant risk circumstances.
In addition, the incorrect answer to question 10 is also relevant because the circumstances that the plaintiff concealed were not to be classified as insignificant by him from the outset.
Conclusion:
The effective challenge of the contract by the insurance company means that the insurance contract is to be viewed as void from the outset (§ 142 BGB). The plaintiff can therefore no longer derive any rights from the insurance contract at issue.
(OLG Dresden, judgment of October 10, 2023, 4 U 789/23)
2024-01-18 06:33:30
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