Can an insurance company reject my claims for benefits if I have pre-existing conditions?
October 17, 2023 | 30,00 EUR | answered by Katrin Sontheimer
Dear Insurance Lawyer,
My name is Eiko Zellmer and I have a question regarding my benefits entitlement with my insurance company. For some time now, I have been suffering from various pre-existing conditions that affect my quality of life. I have submitted a claim for benefits with my insurance, however, my application was rejected on the grounds that my pre-existing conditions are considered exclusion criteria.
This rejection has left me feeling very uncertain and I wonder if an insurance company can actually reject my benefits entitlement due to my pre-existing conditions. I am concerned that due to my health history, I will not receive any support from my insurance, even though I have been regularly paying my insurance premiums.
Can you please explain to me if it is legally permissible for my insurance company to reject my benefits entitlement based on my pre-existing conditions? Are there any possible solutions or actions that I can take to enforce my entitlements? I am grateful for your support and advice on this matter.
Thank you in advance.
Sincerely,
Eiko Zellmer
Dear Mr. Zellmer,
Thank you for your inquiry regarding your claims with your insurance company. It is understandable that you are concerned that your pre-existing conditions may be grounds for the denial of your claims. I would be happy to explain the legal situation regarding the rejection of your claims and possible actions you can take.
First and foremost, it is important to know that insurance companies typically specify certain exclusion criteria in their insurance contracts that may lead to the denial of claims. The most common exclusion criteria include pre-existing conditions that existed before the contract was signed. If your pre-existing conditions are listed as exclusion criteria in your insurance contract, your insurance company may deny your claims on that basis.
In terms of the legal validity of such denial, it depends on whether the exclusion criteria in the insurance contract are clearly stated and comply with legal requirements. In many cases, policyholders have the right to challenge the denial of their claims, especially if they believe the justification for the denial is not valid.
To pursue your claims, I recommend seeking legal advice from an attorney specializing in insurance law. Such a specialized attorney can review your insurance documents, assess the denial of your claims, and advise you on possible legal actions. Depending on your individual situation, various measures can be taken to successfully enforce your claims.
It is important that you gather all relevant documents and information regarding your pre-existing conditions and the denial of your claims in order to receive informed legal advice. Your attorney will then explain to you exactly what steps you can take to defend your claims and, if necessary, enforce them in court.
I hope this information is helpful to you and wish you success in pursuing your claims. If you have any further questions, please do not hesitate to contact me.
Sincerely,
Katrin Sontheimer
Attorney specializing in insurance law
