Health, Life and Personal Accident Insurance
In health insurance, the scope of coverage, waiting period, pre-existing condition, contracted institution, pre-authorization, exclusions, renewal and the lifetime renewal guarantee matter; in life and personal accident insurance, the definition of the risk, the beneficiary, the health declaration, the cause of death or disability and the compensation calculation matter.
In this scope:
- Pre-authorization and payment denials in private and supplementary health insurance
- Allegations of pre-existing disease and incomplete declaration
- Disputes over renewal, waiting period and the lifetime renewal guarantee
- Treatment abroad and travel health insurance
- Beneficiary and sum insured claims in life insurance
- Credit-linked life and personal accident insurance
- Death or disability compensation resulting from a personal accident
- Group health and group life policies
- Processing of health data, confidentiality and information duties
are assessed. Fault in healthcare services and liability for medical practice require a separate legal review.
Related practice areas: Health Law; Medical Malpractice, Physician Error and Hospital Liability
Liability and Professional Liability Insurance
Liability insurance secures the insured’s legal liability to third parties within the scope and limit of the policy. The injured party’s right of direct claim, the insured’s duties of notification and cooperation, the conduct of the defense, authority to settle, costs, serial losses and the conditions of recourse are examined according to the policy and the type of insurance.
Main areas:
- Employer’s liability insurance
- Financial liability to third parties
- Product liability and product recall
- Professional liability insurance
- Compulsory financial liability for medical malpractice
- Directors’ and officers’ liability insurance
- Environmental pollution and hazardous substance liability
- Private security, elevator, coastal facility and other compulsory liability insurance
- Cyber liability and data breach coverages
- Disputes over defense costs, serial events and aggregate limits
SGK income and pension procedures relating to a work accident fall under social security law; the compensation liability of the employer and other responsible parties falls under employment law; and a coverage dispute arising from an employer’s liability or personal accident policy falls under insurance law. These areas may be present together in the same event, but they do not replace one another.
Health Data and Coverage Review
The denial letter, the relevant policy period and the requested health documents are first assessed together. The same result cannot be applied to every product as regards pre-existing disease, the duty of declaration, the waiting period and the renewal conditions. Health documents should not be uploaded to the general contact form; only the necessary records should be shared by the designated secure method.
Separate liability from the insurance payment
The liability of an employer, a professional or a director and the insurer’s duty to pay under the policy are different reviews. The date on which the claim was first made, the notice conditions, defense costs and additional coverages are checked in particular.