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28. 09. 09 / Munich - On vacation to be sick or have an accident is a nightmare. Especially when it later dispute with the medical insurance is. You should know the latest case law.
For seven weeks, a couple wanted in Sri Lanka to make an Ayurveda treatment. But on 15 Day of the trip was the husband ill and had to be hospitalized in a clinic. Not until the seventh week he was released.
The holiday was gone - but the couple believed, at least financially to have everything under control by medical insurance. This bill, however, they had made without the insurance. The company pointed out that the insurance cover, there is only six weeks and refused to take over the hospital costs for the last few days. In fact, essential in the case of a health insurance in view of the fine print.
Often there are limitations that one does not count. The two tourists in Sri Lanka were lucky. The district court decided Coburg namely, not that that matters, how long did a trip as a whole.
What matters is that the insured within the insurance period of six weeks had become ill ( Az: 32 S 11/ 08) . Dispute over the scope of services often employed by the courts. Was the verdict of the Higher Regional Court of Hamburg, the insurance company can exclude in pregnancy only services related to childbirth.
For other inquiries she had to pay ( case no 9 U 152/ 99) .
To dispute are also known to regularly prior to travel diseases. insured unless the three risk " acute unexpected illness, injury and death" are the insurance must bear the view of the Munich District Court in each case, the costs that are associated with the death of the insured - even if at a known prior to departure disease dies.
You may only exclude the cost of treatment ( case no 14791/ 06 223 C) . Have very serious chronic illnesses.
The district court denied Bielefeld, for example, any performance by insurance ( reference: 4 O 100/ 92) in such a case. Dispute is also common, when a return is necessary on medical leave from the country. This was the Administrative Court that the mere expectation of the tourists at home in familiar surroundings will recover faster, the insurance company does not undertake to meet the costs ( ref: 1 C 9977/ 96) . In another case, an insurance company wanted to pay to be transported from Antarctica only from the nearest place that adduced by a comparable quality of care in Germany. The Frankfurt court ruled, however, she must pay the transport to Germany ( Az: 7 U 186/ 99) .
The health insurance refuses to be wrong to assume the cost of transport, the customer, following a decision of the District Court Munich even be entitled to compensation ( ref: 6 S 20960/ 06) . Coincidentally, both said the Supreme Court in Karlsruhe ( Az: III ZR 235/ 99) and the Supreme Court in Munich ( Az: 29 U 2875/ 99) a " xenophobic" regulatory void in the small print.
According to the clause should not apply regardless of residence abroad as a country of nationality of the insured person has. To ensure the protection of health insurance in this country would be gone. The courts saw it as an unfair disadvantage in Germany resident foreigners. If insured services must take advantage of, is called for in the settlement correctness. Already a false document can cost the entire insurance coverage.
So at least the district court ruled Munich in the case of a holidaymaker who had cheated several documents under a false statement ( file number: 34 S 521/ 06) .
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