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Cancelling private health insurance

Has your private health insurer announced cancelling the contract? Has your private health insurance been cancelled? Or has the insurer even declared the insurance policy void?

Legal advice is now necessary in order to restore your insurance coverage at the same conditions, if possible.

First of all, be aware of the fact that your situation is not an isolated case. In fact, your situation can be put down to the mass business of private health insurance. Whereas only supposedly simple health questions were asked in the contract, the insurer often checks whether the details are correct in the case of a claim.

Precontractual duty of disclosure regarding health insurance

When concluding private health insurance, questions about previous illnesses are asked in the application (compare: Finanztest, Heft 5/2008 S. 64ff). These answers to these questions are frequently not quite true. Be it by forgetting, the representative making wrong entries or by deliberately concealing something. Sometimes comprehension problems play a role. Incorrectly answered questions can result in the insurer being allowed to cancel the contract and not having to pay in the case of a claim.

As a general rule:
The insuree must inform the insurer about previous illnesses by the time of handing over his contractual statement. However, he is only obliged to inform if the insurer expressly requests him to in writing.

What possibilities the insurer has after discovering a (supposedly) misrepresentation, depends on how "severe" the breach of the so-called precontractual duty of disclosure is:

Innocent or minor breach of the precontractual duty of disclosure

If the insuree has made minor or innocently wrong statements, the insurer can cancel the contract after one month.
An innocent breach can be, for example, being ignorant of an illness that has not shown any symptoms.
A minor breach of the precontractual duty of disclosure is when someone forgets to state that he had tonsillitis twenty years ago, for example.
Every claim that arises within the period of contract is covered by the insurance.
Instead of cancelling the contract, the insurer can also offer an adjusted policy. In this case, either an exclusion of risk or a risk loading, i.e. a higher premium can be agreed upon for the future period of contract.

Breach of precontractual duty of disclosure by intent or gross negligence

Are wrong details made intentionally or by gross negligence, the insurer can not only give notice but also cancel the contract.
Gross negligence means, for example, that the insuree forgets to state a large operation (cancellation only possible if the insurer would not have concluded a contract due to this). Intent means if the insuree remembers the operation but does not mention it (cancellation always possible).
The result is that if the insurer decides to make use of his right to withdraw, he is exempt from his obligation to pay in the case of damage that has already occurred. However, a correlation between the breach of duty of disclosure and the damage arisen must be available for the insurer to be allowed to refuse payment.

Fraudulent breach of duty of disclosure

If the insuree has acted fraudulently when stating details, the insurer can contest the contract.
The insuree has acted fraudulently if he has consciously concealed a previous illness, for example, in order to pay a lower premium.
If the insurer contests the contract, then it is void and the insurer is exempt from payments.

Our task as lawyers:

We check whether the insurer's cancelling was justifiable. The border between minor and gross negligence and between intent and fraud is very difficult in many cases, which is the reason why the health insurance company often makes mistakes. In order to counter this, very precise argumentation is necessary. It would be our pleasure to help you with this and you can rely on our many years of legal experience as lawyers.

Furthermore, in the case of grossly negligent/intentional breach of duty of disclosure, the insurer often maintains that a correlation between the breach and the claim does exist and thus refuses to pay. The insuree often accepts this without protest. Yet, he has the possibility of producing counterevidence, which can negate the correlation.
Even in this case, we would be glad to help to come into your own.

Addendum: insurance policies prior to 1st January 2008

If your policy has not been adapted to the new regulations of the Insurance Act, the above-mentioned applies for a period of transition in a slightly altered form. The insurer can withdraw from the contract in the case of any gross negligent breach and is thus exempt from his duty to perform. It is irrelevant whether he would have accepted the contract, if he had known about the previous illness.

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