Doctor from Ostholstein in court: fraud in daily sick pay!

Doctor from Ostholstein in court: fraud in daily sick pay!

A doctor from Ostholstein is on trial for commercial fraud. The allegation is that he applied for daily sick pay from his private insurance company, even though he was working abroad while he was allegedly unable to work. The trial takes place before the criminal judge in Eutin, and gathering evidence is difficult. Although the defendant admits “negligent conduct,” he denies intentional wrongdoing. He sees himself as a victim of private health insurance, which accuses him of fraud, reports the Lübecker Nachrichten ( LN Online ).

In the summer of 2023, the doctor became unable to work after an accident at home. He applied for a daily sickness benefit of 250 euros after a contractually agreed waiting period of 28 days. He backed up his claim with certificates and reports from neurologists and psychologists who confirmed his inability to work. But the insurance company expressed “significant doubts” about the documents submitted because the doctor could not be found at home or in his practice. The insurance company then hired a private detective who discovered that the doctor worked abroad.

Conflicting information and their consequences

The defendant was a partner in a group practice and stated that he had only represented a sick colleague on one day. The situation escalated when the case against him was dropped because the claim to the contrary could not be proven, while the 23,000 euros he had claimed were not paid out. The dispute over the money is expected to continue in civil litigation.

The Lübecker Nachrichten reports on its platform that similar cases in the past have already led to dramatic consequences for other policyholders. For example, a 45-year-old man who had received daily sickness benefit for a long period of time now has to pay back 1.1 million euros to his insurance company, including interest. He claimed that he was unable to work due to mental health problems, although he was secretly studying medicine and successfully completing it. The Hildesheim regional court ultimately decided that the policyholder had deprived his insurance company of the money through fraud. The court supported this by stating that the completed studies refuted the claim of complete incapacity for work ( Insurance law Offenbach ).

In this case, the court rejected the arguments of the defense attorney, who defended medical studies as a therapeutically effective measure for the client's psychological symptoms. In addition to the original amount, the policyholder also has to repay almost 200,000 euros in interest, while a criminal trial for fraud is still pending and the judgment is currently not legally binding.