BU review
Review of unemployment benefit: Benefits suspended? How to appeal in Augsburg
You are already receiving an occupational disability pension, but suddenly the insurer stops payments – following a review procedure. The good news is that, in a review procedure, the burden of proof lies with the insurer. They must prove that your occupational disability no longer applies. As specialist solicitors in insurance law in Augsburg, we are familiar with the strict requirements for a valid suspension of benefits – and we use this to your advantage.
The occupational disability insurance review procedure – what insurers are and are not allowed to do
The review procedure under Section 174 of the Insurance Contract Act (VVG) allows the insurer to regularly check whether the conditions for occupational disability are still met. However, this right is subject to strict requirements. The insurer cannot simply stop payments – it must follow a formal procedure and provide a clear justification for its decision. In Augsburg, we regularly see cases where the suspension of benefits fails due to formal errors alone.
When the suspension of benefits is ineffective – your strongest arguments
The requirements for a valid termination of benefits are stringent. The insurer must provide you with a clear written explanation of what has changed since the admission of liability and why the occupational disability pension is to be discontinued. Here in Augsburg, we scrutinise every termination notice for errors in form and content – and we regularly find them.
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Verification checklist
Check whether your insurer’s benefit policy is open to challenge.
Reference to other activities – strict limits for the insurer
During the review process, the insurer may refer you to another job that you could perform despite your limitations. However, the requirements for a valid referral are strict. In Augsburg, we assess every referral for reasonableness and comparability – and consistently challenge unjustified referrals.
Similar job and income
The alternative work must be commensurate with your previous position. It must provide a comparable income – as a rule, the reduction in income must not exceed 20% of your previous gross income. Furthermore, the work must be in line with your qualifications and social standing. An engineer cannot be assigned to unskilled auxiliary work, even if they are physically capable of performing it.
Reasonableness in terms of health and professional standards
The work to which you are referred must be reasonable in light of your health – your remaining limitations must not prevent you from carrying it out. At the same time, you must meet the professional requirements or be able to acquire them within a reasonable period of time. The insurer must specify the particular job to which you are being referred and demonstrate that all reasonableness criteria are met. General references to ‘lighter office work’ are invalid.
Your obligations to cooperate – what you need to bear in mind
As a person insured under occupational disability cover, you have certain obligations to cooperate during the review process. Failure to meet these obligations may weaken your case. In Augsburg, we can advise you on how to fulfil your obligations without giving the insurer any unnecessary grounds for criticism.
Duty to provide information and to investigate
You are obliged to provide the insurer with relevant information upon request and to undergo a medical examination. This also includes releasing your treating doctors from their duty of confidentiality. If you refuse to cooperate without good cause, you risk having your benefits withdrawn. However, the insurer must request the examination in a reasonable manner – you are not obliged to accept arbitrary or excessively frequent checks.
Obligation to notify of changes
You must notify the insurer immediately of any significant changes to your state of health or your employment situation. For example, if you take up a new job, you must report this. If you fail to disclose a relevant improvement, this could, in extreme cases, result in the insurer being exempt from paying benefits. Seek advice in Augsburg on which changes you are required to report and how you should word your notification.
Frequently Asked Questions
Further information
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This information does not constitute legal advice in individual cases.
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