Sickness benefits from private health insurance
September 17, 2009 | 50,00 EUR | answered by Dr. Dr. Danjel-Philippe Newerla
Hello,
my husband had a severe stroke on 20.11.2008 - he received sickness benefits from the private health insurance until 07.09.2009. Now he is receiving retroactively the disability pension from the statutory pension insurance. Does he have to repay the sickness benefits? He has been self-employed since 01.04.1987 - besides profits from the business, he had no other income. He has paid the minimum contributions to the statutory pension insurance independently!
Kind regards, A.K.
Dear Seeker,
Thank you for your inquiry!
Taking into account the information you provided, I am happy to answer your questions summarily as follows:
Firstly, there may be an obligation to repay under the insurance contract. Such a repayment obligation can indeed be agreed upon within the scope of contractual freedom in the event of a retroactive approval of a disability pension, accident pension, or similar benefits.
Therefore, you or your husband should carefully review the insurance contract for such a repayment clause. You could also (preferably anonymously at first, like saying "I have a general question") call the private health insurance company and inquire directly whether such a contractual repayment obligation exists.
If there is no such contractual repayment obligation, then there would generally be no obligation to repay. However, most insurers have such a repayment clause in their insurance conditions that obligate repayment.
Such a clause is also effective, giving the insurer a right to repayment, as recently decided by the Higher Regional Court of Nuremberg (Case No. 8 U 1479/07).
I wish you success in your further steps!
I would like to finally point out the following: The legal advice I have provided is based solely on the information you have provided. My response is only an initial legal assessment of the situation and cannot replace a comprehensive assessment of the facts. Adding or omitting relevant information can lead to a completely different legal evaluation.
I hope my explanations have been helpful to you. You are welcome to contact me through the follow-up option on this portal or via my email address.
Wishing you a pleasant Thursday afternoon!
Kind regards,
Dipl.-Jur. Danjel-Philippe Newerla, Attorney-at-Law
Heilsbergerstr. 16
27580 Bremerhaven
kanzlei.newerla@web.de
Tel. 0471/3088132
Fax: 0471/57774
