Incorrect health claims: Patients face serious consequences

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Incorrect health claims: Patients face serious consequences

When taking out insurance, many people dread the necessary health check. Because who has health problems or pre-existing conditions, often has to accept higher contributions. Therefore, some policyholders do not answer truthfully. If the dizziness flies up, but threatens consequences.

People with pre-existing conditions often find it harder to get a contract than some healthy people with some insurances such as occupational disability insurance or private health insurance. Depending on how serious their problems are, some insurers reject them as customers. Too great is the risk that, for example, secondary diseases occur that require expensive treatment.

If the company still accepts the patient, it usually requires a risk premium to the annual contribution . To avoid this, some sufferers deliberately misrepresent their health status. But that can have dire consequences for you.

Result of the risk assessment influences the contribution amount

Before taking out additional provisions such as term life insurance or occupational disability insurance, interested parties are initially faced with a risk assessment. To do this, they have to answer a few questions about their state of health as well as indicate what pre-existing conditions they have had in recent years. From the respective information, the company calculates the annual contribution or decides whether to accept the potential insured person.

In the case of misinformation, insured persons often have no entitlement to benefits

Basically, interested people should answer questions about their health completely and truthfully . Because at the latest in the benefit case, the insurance learns whether the patient had pre-existing conditions. If the customer has provided false information, the company may refuse to pay for the treatment.

According to a judgment of the Higher Regional Court of Frankfurt am Main, for example, a patient who needed an operation for a kidney stone had to pay for it herself. She had concealed her private health insurance that she was already being treated for urethral disease a few months earlier.

Worse patients bring more money to doctors and health insurances

Some patients do not even know that they have made false statements to the insurance company, as they are not aware of certain entries in the medical record. In addition, doctors sometimes get a better fee from the health insurance companies , if they make their patients on paper sicker than they are. Anyone who sits down with his doctor can detect and correct such false diagnoses.

The Healing and Aids Act, which came into force in March, is intended to counteract this – but so far has been unsuccessful. According to Welt am Sonntag, the additional payments to physicians would now run on a different type of framework contract.

Obtain assistance in completing the questionnaire

The health issues for insurance should be answered by patients with a doctor. This one has the best knowledge about her health. This way false information can be avoided , for example because the customer alone does not know what to answer.

Misrepresentations can even lead to litigation

In addition to a refusal to pay threaten victims even worse consequences. Thus, the insurer can obtain that the contract is considered obsolete since the beginning of the term. Then the policyholder has to repay all services received until then. According to the Association of Private Health Insurance, three scenarios are usually conceivable:

  • If the patient has not acted willfully or negligently, as he has given the wrong information, the company has a special right of termination of one month.
  • If insured intentionally or grossly negligently gave misinformation, the insurance company may withdraw from the contract and reverse it.
  • With a fraudulent deception, the provider can challenge the contract , so that it is considered void from the beginning.

Frequently, such disputes over false health information between insurers and customers in court. There the judge has to decide if the company was intentionally deceived.

With an anonymous request insured can explore their chances

Interested parties who are unsure whether an insurer accepts them or which terms they will receive, have the option of an anonymous risk pre-request. An insurance expert submits an application for a contract in which all previous illnesses are listed. However, information about the customer name is missing. Depending on the company’s response, the candidate can estimate how his chances of concluding a contract are .

On the other hand, if the request is not made anonymously, it may happen that all data is stored in the so-called HIS risk file, so that other providers also have access to it. These can then include the decision of other companies in their own risk analysis.