PKV: BGH declares million premium increases to be ineffective

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In this otherwise dreary Advent season, there is a ray of hope for those with private insurance.

On Wednesday, the Federal Court of Justice (BGH) in Karlsruhe declared some of its contribution increases to be partially ineffective.

Millions of policyholders are therefore most likely entitled to a part of their contributions.

Specifically, it is about a customer of Axa who had sued the premium increases in the Ecora 1300 tariff because the insurer had not given sufficient reasons for them.

The Karlsruhe judges declared the premium increases in 2014, 2015 and 2016 to be ineffective.

An Axa customer from the El-Bonus tariff had also sued.

However, here too the judges made it clear that the contribution increases up to and including 2016 were not sufficiently justified.

You are therefore ineffective.

He was referred back to the lower court for a substantive examination.

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The sometimes dramatic increases in private health insurance contributions are a constant excitement.

Again and again there were doubts that everything was going well.

Most recently, some insureds sued because the trustees who review these increases are not independent.

Numerous regional courts agreed with them and declared the increases to be ineffective, but the Federal Court of Justice saw it differently and ended the dispute.

But the private health insurers remain vulnerable.

In fact, in earlier years in particular, they did not bother to adequately justify their increases.

They were often content with a few sentences.

In the eyes of the Karlsruhe judges, however, this is not permissible and the increases are therefore ineffective.

The insured get back the money paid too much.

"The judgments are the first supreme court decisions in which the policyholder has been awarded repayment claims due to the ineffectiveness of premium adjustments," says Berlin lawyer Knut Pilz, who represents 1,500 clients who are suing private health insurance.

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"Since Axa health insurance has justified the premium adjustments by means of standardized, identical accompanying letters to its policyholders, the judgment is of fundamental importance for all policyholders of Axa." Other insurers who have acted similarly in the past are also affected.

The judgment here should be transferable to many cases.

Against this background, the final judgment is likely to have fundamental importance.

However, the judgment is not a sure-fire success.

Every privately insured person who wants to get his or her rights has to sue for it.

It is still unclear for which years the premium increases are actually ineffective and which tariffs are affected.

If you believe the Axa, the explanations were sometimes different in detail - at least until 2016. Basically:

The further behind the premium increases, the greater the chances for consumers.

Ten years ago, premium increases were hardly justified by most providers.

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How well the lawsuits are worthwhile depends very much on the individual case.

And a reversal also has disadvantages: the insured has to repay the tax advantage or possibly the employer's contribution that has been received too much, and he also loses retirement provisions.

And the premium is increased again immediately after the reversal - and then less capping funds may be used, so that it could be significantly more drastic.

Finally, in the Karlsruhe case, 60 percent of the court costs stuck with the consumer.

Legal protection insurance is therefore almost imperative so that the claimant actually benefits.

In any case, it is not worth filing a lawsuit against premium increases that have occurred in the past three years.

The insurers have long since made improvements here.

Axa also says: “We see our view confirmed that our notifications about premium adjustments, which we have been sending out since 2017, meet the formal requirements defined by the BGH.

The BGH has also decided that these contribution adjustment letters will cure the situation.

Thanks to the reasons that we have been sending to our customers since 2017, they have an effective premium adjustment. ”Axa always calculates the premium adjustments carefully and correctly in accordance with the clearly defined legal requirements.

In the meantime, more than 20 expert opinions in other proceedings have confirmed the material correctness of the Axa premium adjustments.

"Our customers can be sure that they are paying a correctly calculated price for the contractually agreed services - in the past as well as in the future."