Cologne Regional Court: Gothaer has to pay five-figure daily sick pay!

Cologne Regional Court: Gothaer has to pay five-figure daily sick pay!

The Cologne regional court recently ordered Gothaer Krankenversicherung to pay five-figure daily sick pay. This decision sets an important precedent for insured individuals seeking benefits for mental illness. The policyholder had been a private health insurer with Gothaer for many years and had taken out daily sickness benefit insurance.

In 2018, the policyholder suffered from neurasthenia and a recurring moderate depressive episode. In the initial phase, Gothaer Krankenversicherung made solid payments of the insured daily sickness benefit. But after an expert examination that determined the insured person's permanent occupational disability, Gothaer abruptly stopped payments and terminated the daily sickness benefit insurance contract.

Legal dispute before the regional court

Due to the refusal of benefits, the policyholder contacted the law firm L & P Luber Pratsch Rechtsanwälte Partnership. Attorney Christian Luber found that the reasons for stopping payments were legally incorrect. An out-of-court settlement attempt failed, which led to the filing of a lawsuit before the Cologne Regional Court.

The court also ordered an assessment of the plaintiff, which confirmed the original illness and concluded that there was no occupational disability. In this process, the Gothaer daily sickness benefit insurance rejected objections to the report that were not accepted by the court. The result of this legal dispute was the condemning decision of the Cologne Regional Court, obliging Gothaer to repay the daily sick pay and confirming the continued existence of the insurance contract.

Background on daily sick pay and occupational disability

The case sheds light on the often complex issue of daily sickness benefit insurance and the issue of occupational disability. Affected insured persons often have to fight for their claims, especially when mental illnesses come into play. Lawyers and legal experts such as the Kotz law firm often discuss the difficulties that can arise when applying for benefits, with evidence of occupational incapacity in particular often being the focus.

Another example from previous judgments shows that even in cases of bullying and mental illnesses, such as severe depressive adjustment disorder, the courts often examine the insurance companies' arguments. In a case documented by the Kotz law firm, it was decided that daily sickness benefit insurance was not terminated due to occupational disability because the insurance company could not provide the necessary proof of this.

These and similar legal disputes illustrate how important it is for insured parties to actively represent their claims and seek legal advice. The current case against Gothaer underlines the possibility of being successful in difficult application procedures and asserting your own claims.

For more information you can visit the coverage anwalt.de and the analyzes of occupational disability ra-kotz.de see.