Enforcing your benefit after a rejection
§ 172 Abs. 2 VVG defines occupational disability as the probably permanent inability to carry out, wholly or partly, the occupation last practised. When the claim falls due, the insurer must state in text form whether it acknowledges its liability to pay (§ 173 Abs. 1 VVG). Our lawyers in Augsburg review the rejection decision and sue for your pension.
Why the insurer rejects the claim
A rejection almost always attacks the occupational profile. Under § 172 Abs. 2 VVG, a person is occupationally disabled if they can probably no longer carry out, wholly or partly and on a permanent basis, the occupation last practised as it was structured without the health impairment. If the insurer bases its decision on a different activity, its reasoning fails from the outset.
The second point of attack is the referral clause. § 172 Abs. 3 VVG allows the parties to agree that the insurer pays only if the insured person also does not, and could not, carry out another activity that matches their training, abilities and previous standard of living. Where the policy conditions contain no such clause, any referral by the insurer goes nowhere.
The law names no percentage. § 172 Abs. 2 VVG uses only the phrase “wholly or partly.” Which degree of occupational disability triggers the pension is set out in your policy conditions, and their wording decides the rejection.
Deadlines and duties of the insurer under the VVG
§ 173 Abs. 1 VVG obliges the insurer, after a claim is made, to state in text form when the claim falls due whether it acknowledges its liability to pay. An acknowledgement may only be time-limited once and binds the insurer until that period expires (§ 173 Abs. 2 VVG). A second time-limited acknowledgement is not permitted.
The claim falls due once the investigations necessary to establish it are complete (§ 14 Abs. 1 VVG). If the assessment drags on, § 14 Abs. 2 Satz 1 VVG applies. If the investigations are not complete one month after the insured event is reported, you can demand an interim payment equal to the amount the insurer will probably have to pay at minimum.
The claim becomes time-barred after three years (§ 195 BGB). The period begins at the end of the year in which the claim arose and you obtained knowledge, or should have obtained knowledge but for gross negligence, of the circumstances giving rise to it (§ 199 Abs. 1 BGB).
For as long as the claim you have submitted is pending with the insurer, limitation is suspended until its decision reaches you in text form (§ 15 VVG).
Ombudsman proceedings and litigation for your pension
After a rejection, two routes are open. One leads through conciliation with the Insurance Ombudsman, the other through a claim for benefits before the court. Both require the same groundwork. The occupation last practised under § 172 Abs. 2 VVG must be set out completely and verifiably, supported by medical findings that link the functional limitations to the individual tasks.
Conciliation with the Insurance Ombudsman
The Insurance Ombudsman has been a recognised consumer dispute resolution body under German consumer law since August 2016. The procedure is free of charge for complainants. Where the claim is found to be justified, the decision binds the insurer up to a claim value of €10,000.
For the life insurance line, under which occupational disability insurance falls, the Insurance Ombudsman’s 2024 report states a success rate of 34.4 % for conciliation applications. Most proceedings take less than three months. Filing the application suspends limitation (§ 204 Abs. 1 Nr. 4 BGB).
Litigation before Augsburg Regional Court
For claims arising from the insurance contract, the court with local jurisdiction is also the court in whose district the policyholder is resident at the time proceedings are brought (§ 215 Abs. 1 Satz 1 VVG). Anyone living in Augsburg sues in Augsburg, regardless of where the insurer is based.
§ 9 ZPO values an ongoing pension at three and a half times its annual amount, meaning 42 monthly instalments where payment is monthly. Since January 2026 the Local Courts have had jurisdiction only up to a value in dispute of €10,000 (§ 23 Nr. 1 GVG). Above that, the civil chamber of the Regional Court decides (§ 71 Abs. 1 GVG).
Claims for occupational disability benefits almost always exceed this threshold. Where legal expenses insurance is in place, we obtain confirmation of cover.
Mistakes in the claim and in settlement offers
The insurer’s assessment starts from the occupational profile you describe in the claim. Under § 172 Abs. 2 VVG, the standard is the occupation last practised as it was structured without the health impairment. An imprecise description of your activity shifts that standard against you.
Mistakes in the description of your activity
The description of your activity breaks the working day down into individual tasks with their share of weekly working time: lifting and carrying, screen time, contact with the public, night and shift duties, responsibility for staff. Only this breakdown allows a finding on whether the occupation can no longer be carried out wholly or partly (§ 172 Abs. 2 VVG).
Blanket phrases such as “office work” or “physical work” do not carry this.
Medical findings are just as often missing. Doctors’ reports that only list diagnoses say nothing about functional limitations. Answer any follow-up questions within the deadline set, because under § 14 Abs. 2 Satz 2 VVG the running of the one-month period is suspended for as long as the investigations cannot be completed due to fault on the policyholder’s part.
Checking the insurer’s settlement offers
Some insurers offer a lump sum or a shortened benefit period as a settlement after a rejection. Before accepting, the value of the claim must be established. The basis for the calculation is the agreed monthly pension, the benefit period up to the contractual end age, any agreed pension increase, and discounting to present value.
An accepted settlement replaces the pension claim. It also ends the insurer’s obligation under § 174 VVG, under which the insurer only becomes free of liability once it has set out in text form that the conditions no longer apply, and at the earliest at the end of the third month after that statement is received. We quantify the claim and negotiate with the insurer.
Further information
These topics may also be of interest:
This information does not constitute legal advice in an individual case.
