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Court verdict shocked: 60,000 euros pension for false health information!
Hamm Higher Regional Court rules in favor of a plaintiff: Health questions in occupational disability insurance must be answered precisely.
Court verdict shocked: 60,000 euros pension for false health information!
A recent ruling by the Hamm Higher Regional Court is causing a stir in the insurance industry. On April 4, 2025, the court ruled in the case of a plaintiff who had sued an occupational disability insurer. This was successful against the wishes of the insurer, who accused the customer of having provided incomplete health information. The plaintiff was sentenced to retroactive payment of a pension amount of over 60,000 euros and to exemption from contributions, as pfefferminzia.de reported.
The focus of the proceedings were two specific questions in the application form, both of which the plaintiff answered “no”. The first question (B4.2) referred to examinations or treatments of the respiratory system in the last five years, while the second question (B4.9) addressed diseases of the spine and joints. The insurer stated that the plaintiff had concealed previous bronchitis and a diagnosed scoliosis, which led to the contract being contested.
Detailed reasons for the judgment
The Higher Regional Court found that a one-off acute bronchitis does not fall under the question of “repeated or chronic” illnesses. Furthermore, mention of scoliosis in a 2006 x-ray report was deemed irrelevant as no treatment or counseling had taken place within the five-year query period. This shows how precise and narrow the interpretation of health issues must be in the context of occupational disability insurance.
Another point of contention was the insurer's timely naming of the reasons for the challenge. The court emphasized that these must be specifically explained within the one-year challenge period in accordance with Section 124 of the German Civil Code (BGB). The insurer only referred to past applications during the trial, which was classified as late. Lawyer Tobias Struging commented that the ruling sends an important signal to policyholders to fill out the health questions properly in order to prevent later interpretations by the insurer versicherungswirtschaft-heute.de supplemented.
Overall, the Hamm Higher Regional Court's ruling illustrates the importance of clear, truthful answers to health questions in insurance applications. Policyholders should be aware of the responsibility they bear when answering such questions in order to avoid legal disputes.