Discontinuation in the review procedure under § 174 VVG
The insurer pays your occupational disability pension, then announces after a review that it will discontinue it. That does not discharge it from liability yet. § 174 (1) VVG requires it to set out, in text form, the change from which it derives that discharge. Under § 174 (2) VVG the discontinuation takes effect at the earliest on expiry of the third month after you receive that statement.
When the insurer may discontinue the pension
The right to check at intervals whether the disability continues sits in your policy conditions, in the review clause of the supplementary cover or the occupational disability conditions. The law governs the second step: from when an established change discharges the insurer from payment. § 174 (1) VVG ties that discharge to a statement in text form.
If that statement is missing, the obligation to pay remains in place. The pension then keeps running, even if the insurer has long since decided internally, which is why our review starts with the notice itself.
Deadline and form of the discontinuation notice
The statement under § 174 (1) VVG must set out the change from which the insurer derives the discharge, and it must be made in text form. The point of reference is the condition the insurer relied on when it accepted the claim under § 173 (1) VVG. Without that statement, the obligation to pay remains in place.
The timing is likewise fixed by law. Under § 174 (2) VVG the insurer is discharged at the earliest on expiry of the third month after receipt of the statement. Your contract may not depart from §§ 173 and 174 VVG to your disadvantage, § 175 VVG.
Referral to another occupation
A referral must be agreed in the contract. Under § 172 (3) VVG the policy may make it a further condition of the obligation to pay that you do not pursue, and could not pursue, another occupation that you could take up given your training and abilities and that matches your previous standard of living.
The first thing we check is therefore your referral clause. We read it alongside the discontinuation notice and check whether the named occupation meets all three criteria of § 172 (3) VVG.
Comparable standard of living and income
§ 172 (3) VVG names your previous standard of living as the benchmark. The law sets no fixed percentage for an acceptable loss of income; what counts is the comparison in your individual case.
So document, with tax assessments and payslips, what you actually earned in the years before the claim was accepted, gross and net. Set that alongside where the insurer’s income figure comes from. Both belong in the file before you respond.
Medical and professional reasonableness
Under § 172 (2) VVG, the point of reference for the disability is the occupation you last carried out, in the form it took without the health impairment. Every referral is measured against that picture.
So demand a specifically named occupation with a job profile, requirement profile and working hours. Every claim needs a source. Where the requirement profile departs from your medically documented limitations, put that discrepancy in writing.
Duties to cooperate in the review procedure
Your obligations come from two sources. Under § 31 (1) VVG the insurer may, once the insured event has occurred, demand any information required to establish the insured event or the extent of its obligation to pay. Further duties, such as to undergo a medical examination, sit in the policy conditions.
Discharge from liability does not follow automatically from a breach. § 28 (2) to (4) VVG requires intent or gross negligence, causation, and a prior notice in text form.
Duty to provide information and undergo examination
Answer specific questions specifically, and keep a record of what you sent and when. Under § 213 (1) VVG the insurer may collect health data only from the bodies named there, only to the extent the information is required to assess its obligation to pay, and only with your consent.
It must inform you before any such collection, and you can object, § 213 (2) VVG. § 213 (3) VVG lets you demand, at any time, that consent be sought separately for each individual item collected, which lets you replace a blanket release from medical confidentiality.
Duty to notify changes
Whether you must report an improvement or a new occupation on your own initiative sits in your policy conditions. § 31 (1) VVG governs only the insurer’s own request for information, so read your clause before you write.
The framework of § 28 VVG applies here too. Under § 28 (3) sentence 1 VVG the insurer remains obliged to pay to the extent the breach of your obligation was not causative for establishing the claim. That does not apply where the breach was fraudulent, § 28 (3) sentence 2 VVG.
Further information
These topics may also be of interest:
This information does not constitute legal advice in an individual case.
