The Federal court of justice (BGH) has declared an investigation on contribution increases in the private health insurance to be legal. Such increases could not only be explained, therefore, null and void because of a statutory Trustee is probably not independent. The court overturned a verdict that had sentenced an insurance company to Contribution refunds (Az. IV ZR 255/17).
A privately insured had filed a complaint against increases in contributions to the Axa-insurance in the years 2012 and 2013. It was a sum of about 1,000 euros. The district court and the regional court of Potsdam, explained that the increases were invalid and condemned the insurance company to Contribution refunds. The district court reasoned that the examination of the Changes used Trustee was not of the company independently. It is a legal requirement that such auditor must agree to a contribution change.
The civil courts will not have to check its independence in the view of the BGH. If the Trustee is appointed in accordance with that, there is no such separate examination, decided the Federal judge. You referred to but the fact that the civil courts would have to examine in a dispute between the Insured and the insurance companies quite a the legality of the contribution increases. Thus, the interests of the Insured are safeguarded.
It would be contrary to the purpose of the statutory regulations, if a contribution increase “would fail, despite the existence of the substantive requirements solely to a lack of independence of the responsible Trustee,” said the Supreme court. The rules for the adjustment of the contributions were mainly used, the insurance benefits could be permanently fulfilled. The law does not authorize increases to the insurer, under certain conditions, but obliging him to do so.
experts call for a different procedure
The Association of Private health insurance was pleased about the judgment. “The Federal court has confirmed that since 25 years well-established procedures for the Trustees for participation, according to the insurance supervision act is in conformity with the law,” said managing Director Florian Reuther. He called on the legislature to Reform the rules to ensure also in the future have a “credible process” and to avoid contribution of jumps.
the Federal government of the Insured’s requested Changes. The independence of the Trustees is not settled “a long time finally,” said Association spokesman Axel Kleinlein. For the insurance industry, according to the Association of “a significant Problem”, as only 16 actuary could take on the task.
The Greens Finance expert Gerhard Schick appealed to the German Federal financial Supervisory authority (Bafin) and the Federal government, to provide for a better Review. The current review of the independence of the Trustee by the Bafin as a Supervisory authority “is currently not much more than a pure formality”. It does not leave a “little perplexed, if a court feels for the Review of the administrative practice of responsible”.
