OLG ruling: Clear health questions save occupational disability pensions!

OLG ruling: Clear health questions save occupational disability pensions!

The Hamm Higher Regional Court recently made an important ruling regarding health issues in occupational disability insurance, which is of utmost relevance not only for insured persons but also for insurers. The judge's decision sends a clear signal: the exact wording of health issues is crucial. In this particular case, an insurer was ordered to retroactively pay the plaintiff more than 60,000 euros in occupational disability pension, including exemption from contributions. This decision sets an important precedent because it underscores the importance of answering health questions on the insurance application. Asscompact reports that lawyer Tobias Struging points out in this context that clear and correct answers to health questions offer crucial protection against subsequent interpretations by the insurer.

In the specific case, the insurer alleged that the plaintiff had concealed relevant health information in the application. However, the Higher Regional Court found that the insurer's interpretation of the questions was unsustainable. Two central questions played a role in this case: on the one hand, about possible diseases of the respiratory organs, and on the other hand, about diseases of the spine, tendons and ligaments. The plaintiff answered “no” to both questions, which was subsequently seen as decisive.

Decisive judgment of the Hamm Higher Regional Court

The court pointed out that a one-time acute bronchitis should not be reported because the questions specifically asked about “recurrent or chronic” illnesses. Scoliosis also turned out to be irrelevant as it was outside the specified five-year period and no treatment or advice was given. It is also noteworthy that the plaintiff had already submitted occupational disability claims to other insurers in the past, but these had no negative consequences.

During the course of the process, the insurer relied on information that had not been submitted within the one-year challenge period in accordance with Section 124 of the German Civil Code (BGB). The Higher Regional Court emphasized that grounds for challenge must be stated clearly and in a timely manner; General references or additional justifications were considered insufficient. The judgment, dated April 4, 2025, has the file number 20 U 33/21 and is an important example of the legal framework in occupational disability insurance.

Burden of proof of occupational disability

In addition to the current judgment, an earlier judgment by the Hamm Higher Regional Court dated December 11, 2017 (file number I-6 U 92/17) deals with the burden of proof in the event of “inherent occupational incapacity” in occupational disability insurance. This decision makes it clear that the policyholder must provide proof of occupational disability during the term of the contract. This means that ambiguities about pre-contractual occupational incapacity must be taken into account accordingly, including through relevant rulings by the Federal Court of Justice and other higher regional courts.

In summary, it can be said that the recent decisions of the Hamm Higher Regional Court both strengthen the rights of the insured and more clearly define the requirements for insurers. Insured parties should be aware of the importance of their information, while insurers are required to act transparently and fairly.