Decision: Health behavior-based insurance coverage requires full disclosure.
A disagreement involved the alleged telematics tariff for a disability insurance of Augsburg Generali's subsidiary, Dialog. The contract stipulated that the policyholders must use a smartphone app and join the "Vitality Program," earning points through movement, sport, or doctor's appointments. These points influenced their "Vitality Status," which in turn affected surplus participation and ultimately insurance premium heights.
However, the Hamburg consumer advocate group Bund der Versicherten took legal action. They won: The Federal Court of Justice deemed the contract clause too vague and therefore invalid. The court was unclear as to how the "modification of surplus participation" and the calculation of contributions would occur.
Moreover, the judges in Karlsruhe nullified a clause that assumed unhealthy behavior if the smartphone data from the "Vitality Program" was not transmitted. This was because it unjustifiably blamed the insured for technical or other issues beyond their control, according to the Federal Court of Justice.
Read also:
- The Federation of German Consumer Organizations (Bund der Versicherten) argued that the insurance policy's reliance on health behavior data, such as the 'Vitality Program', lacked clear criteria established by the Federal Court of Justice for modifying surplus participation and calculating contributions.
- The Federal Court of Justice's judgment rendered the insurance contract clause involving the 'Vitality Program' and its impact on premiums invalid due to inadequate clarity and potential implication of unhealthy behavior for non-transmitted data, which could stem from technical or personal reasons.
- The 'Insurance' industry is under increasing scrutiny due to recent court judgments, with the Federal Court of Justice setting strict guidelines for health behavior-based insurance coverage, emphasizing the importance of full disclosure and clear criteria to avoid potential discrimination or violations.
