Case Details
Client: Hans Schulz
Lawyer: Beatrix Astor
Case Start: 24/04/2021
Case end: 5 Months
Result: Winner
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Summary Of The Case Studies
Hans suffered a heart attack and had to give up work. He contacted his insurer to make a claim under his critical illness insurance policy. After reviewing his claim, Hans’ insurer refused to pay out. They said that Hans’ heart attack did not meet the definition of the policy, so they would not pay out. Hans was dissatisfied with his insurer’s decision and filed a complaint with us. He said he assumed critical illness insurance would cover him if he was seriously ill. He said his heart attack left him in critical condition.
*Insurance does not pay out
*Hans heart attack made him critically ill
*Hans has retired from work
Our Approach And Solution
We have asked Hans’ insurer to send us a copy of Hans’ contract terms and conditions. It turned out it was designed to cover heart attacks of “certain severity”. Along with other factors, this was defined as the seizure causing cardiac enzymes to rise above a certain level. We looked at the medical evidence from Hans’ advisor. It turned out that Hans’ cardiac enzymes were significantly above the values specified in the policy. An echocardiogram test also revealed that the heart attack was “severe” within the meaning of the guidelines. We processed the case immediately and filed a complaint with the court.
Lawyer In this case:
Beatrix Astor
Lawyer, Consultant
After successfully completing her law studies at the University of Bielefeld and at the Heinrich Heine University in Düsseldorf, Beatrix Astor completed her legal clerkship at the Aachen Regional Court in the state of North Rhine-Westphalia, including work at the Aachen Administrative Court
Take the case to court
We are contacting Hans' insurance company to discuss the case and not to send the documents to the court
Hans' insurance pays out
The Outcome of the Lawsuit
It was clear that Hans had suffered a heart attack. The evidence shows that Hans met the policy definition of a heart attack. For this reason, we have decided to uphold Hans’ complaint. The insurance company recognized that Hans’ condition was critical and paid our customer.