Disability insurance helps to financially compensate for a loss of income in the event of a long illness – or at least to cushion it. If the serious case of disability occurs, it is important that the insurer pays quickly. This is not always the case. Experience has shown that occupational disability protection is one of the more complicated types of insurance, and this also applies to the application for benefits. Customers should follow a few rules so that the pension works. The insurance experts at Stiftung Warentest clarify.
Application for disability
In a first step, customers can inform their insurer about the event of disability, for example by telephone, e-mail, post or using an online contact form. But before that, they should consider whether they feel capable of communicating and answering questions from the insurer themselves, or whether it makes sense to seek support at an early stage. Insurers typically send applicants a claims form to fill out. If you have no medical or legal knowledge, you may feel overwhelmed with the insurance questionnaire, which can be 6 pages or 20 pages. Support is available from specialist insurance lawyers, independent insurance consultants and some consumer advice centres.
Evidence, expert opinions, job profile
For a well-founded application, insurers usually need several documents:
Statement of the cause that is responsible for the disability. Opinion from the attending specialists (degree of incapacity, probable duration of incapacity, cause, start and type of complaints, prognosis of the course of the complaints). Documents about the profession and the professional position. Description of the job last practiced. Based on a detailed description, the insurer can see which activities were possible on healthy days and which can no longer be practiced. It is helpful to describe the daily routine in hours or – depending on the activity – in minutes. Non-Disclosure Release. In some cases, when the insurance policy was taken out, the applicant gave the insurer his consent to interview doctors and health insurance companies. Insurers need their approval at the latest when they apply for a pension. There are two variants: the blanket and the individual release from confidentiality. The advantage of an individual agreement: The policyholder knows exactly whom the insurer wants to contact, because the insurer has to obtain an individual authorization for each piece of information. Insurers often argue that this causes a delay in claim processing. “That has not been confirmed in practice,” says insurance consultant Rüdiger Falken from Hamburg. Everything in writing. In connection with the benefit case, everything should always be done in writing, not by telephone. Then there is no dispute as to whether information was transmitted in a timely manner. Applicants should make copies of all documents.
Arbeitsunfähigkeit, Krankentagegeld, Erwerbsminderung
There are often other questions to be answered in connection with an occupational disability, such as: What about the transition from daily sickness allowance insurance to an occupational disability pension? What role does a certificate of incapacity (AU) play for the application? How does it interact with an application for a disability pension from the pension insurance scheme or an application to the trade association for occupational illness?
The application process can quickly become overwhelming
Insured persons can do a number of things to ensure that an insurer recognizes their occupational disability. In order to communicate with the insurer on an equal footing and avoid pitfalls, Professor Christian Armbrüster from the Faculty of Law at Freie Universität Berlin recommends: “In case of doubt, policyholders should seek legal advice when applying for benefits.” Some consumer centers and independent insurance consultants also offer help. Anyone who has taken out a disability policy through an insurance broker will usually receive support here as well. In an interview, lawyer Jürgen Hennemann explains what is important in the application.
Don’t have disability insurance yet and are thinking about taking out important protection? Here you will find our test from 2021, lots of tips and a checklist that you can use to check a contract offer step by step.
Insurer checks the documents
If the applicant’s documents are not convincing, the insurer may request additional documents or commission another expert opinion. The decision on an application for benefits takes between three and four months on average, according to a survey by the General Association of Insurers (GDV) among its member companies. Obtaining medical assessments in particular takes time. A decision-making process can also take much longer, test.de knows from reader feedback and expert discussions. When the insurer makes a final decision on the application for benefits, there is either an acknowledgment, as it is called in insurance German, or a rejection. In this case, insured persons should seek legal advice with a view to suing the insurer.
The chance of winning in court is 50/50
There is a 50:50 chance of winning a legal dispute against the insurer and still enforcing the pension. This is confirmed by a legal opinion in which Finanztest evaluated 143 court decisions.
© Stiftung Warentest