If the contributions are rising says the not Insured. Currently, however, a number of court judgments of millions of private patients hope for repayments.
Because a clever lawyer discovered a weak point in the System. The last word is not spoken: this Wednesday the dispute with the insurance at the Karlsruhe Federal court of justice (BGH) controls on the decision-in-principle. The ruling could already be in the afternoon announced. (Az. IV ZR 255/17)
What is it about?
The plaintiff costs in the case of Axa, a disease and a sickness daily allowance insurance and is fighting against increases in its tariffs in the years 2012 and 2013. It is argued by a good 1000 euros, plus interest. It is not the man to any error in the calculation. He holds the increases of formal reasons for ineffective: to The premium adjustments participating Trustee was not – as required by law, regardless.
What role will the Trustee play?
your consent is necessary if a private health insurance (PKV) to raise contributions or to reduce. For the recalculation, there are precise rules, and the Trustees reviewed whether the basis of calculation are correct. To protect the Insured against unjustified increases in premiums. Because of the necessary special knowledge, only very few experienced actuaries are eligible for the task. At the beginning of June 2018 only 16 Trustees were, according to the Federal Ministry of Finance, industry, currently, 43 private health insurance. Even therefore, one and the same Trustees over many years, often check to make all the adjustments in all the Rates of a certain insurance.
Why could that be now the Problem?
the Trustees, who approved the contribution increases by the plaintiff, considered, until his death in 2014, for approximately 15 years, all of the Axa-rates. For this mandate, the man referred to, as in the process disclosed, in the years 2010 to 2013, around half of its entire annual income of Axa, which corresponds to sums of between approximately 106 000 and well 149 000 Euro. The plaintiff does not trust him, therefore, He was of the Axa economically dependent.
Why has the case of so great importance?
Only the district court, the regional court of Potsdam, gave the plaintiff a right, the increases declared null and void and of him, the more money awarded. They were oriented to a provision for auditors: This may not relate to the securing of their independence over several years, more than 30 percent of their income from the same company. A number of courts have joined this line. The Berlin lawyer Knut fungus that is responsible for the Karlsruhe plaintiff and even otherwise, most of the processes, has filed claims to more than 600 lawsuits against various insurers, including DKV and Allianz. In the first instance, he had won about 85 cases and lost one, says Pilz. No judgment is final.
what is the response of the insurer?
The Axa believes that it has complied with the statutory regulations. Because the Trustee was, as it is prescribed in advance by the Supervisory authority Bafin on its independence tested and approved. Bafin itself also has 2017 critical to a Trustee solely because of his income under “General suspicion”. For accountants there are “substantial differences”. A judgment of the higher regional court (OLG) Celle makes the industry hope: The judges were of the view that the independence games only with the approval of the Trustee, a role that civil courts could overturn increases in case of Doubt, no contribution. The PKV-Association calls for a Reform, also to expand the circle of Trustees.
What does all this mean for the Insured?
the Federal court of justice Confirmed the Potsdam decisions, and could also have other private health insurance due to the questionable independence of the Trustee’s claims. According to Pilz it is concerned with sums of between 2000 and 10 000 Euro, in individual cases, more, provided, that the claims are not time-barred. The question, however, would be whether the Insured’s benefit only, Because the companies would have to compensate you for your losses, Yes, possibly in the form of higher contributions.