BGH collects exclusion clause in travel sickness insurance
Looking at the fine print can be worthwhile. Even if a clause lists several examples that exclude insurance coverage, it may not hold up legally. For instance, this can be the case with clauses regarding health.
When it comes to insurance clauses, consumers need to understand exactly when insurance coverage is excluded. Therefore, it's worth looking at the details. A broadly phrased clause in an international travel health insurance about excluding coverage for "previously known medical conditions" was considered unclear by the Federal Court of Justice (BGH) in Karlsruhe - and therefore invalid. (Case No.: IV ZR 129/23)
According to the BGH, it's not enough for a clause to be formulated so that an average policyholder understands it. In the case of so-called exclusion clauses, the disadvantages and burdens should be explained as clearly as possible, so that those affected can understand the remaining scope of the insurance.
Examples too vague
The BGH criticized in its ruling that in the specific case, it was not clearly defined which medical condition leads to a loss of coverage. There was only an incomplete list of examples - for instance, if a person had a hospital stay within the last 12 months or received the diagnosis "incurable" and/or "chronic".
This makes it difficult for insured persons to "sufficiently recognize which further 'conditions' are covered by the exclusion and which are not". The examples only partially refer to serious illnesses. Also, no uniform requirements are set for the duration of the illness. Insured persons cannot therefore understand which further illnesses, not covered by any of the examples, would also result in the insurance coverage not applying.
In the specific case, it was about general insurance conditions. The provider had concluded a group insurance contract including international travel health insurance with a bank, benefiting credit card holders.
Consumers should be mindful of the specifics of insurance exclusion clauses, as a vaguely worded exclusion for "previously known medical conditions" in an international travel health insurance was deemed unclear and invalid by the Federal Court of Justice (BGH). To avoid such issues, it's essential to comprehend exactly when insurance coverage is excluded.
