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Insurer reduces payment for breach of duty: what is allowed

Insurance contracts contain duties, such as timely loss reporting or truthful statements. If you breach them, the insurer can reduce the payment or be released from it. But not every breach leads to loss: it depends on fault and causation.

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Your chances of getting your money back

In case of an intentional breach of duty, the insurer can be released from the benefit; in case of gross negligence it may only reduce proportionately according to the severity (§ 28 VVG). In case of simple negligence it generally remains fully liable to pay.
If your breach of duty had no influence on the loss or the obligation to pay (lack of causation), the insurer remains obliged to pay anyway, except in case of fraudulent deception.

What you should do now

  1. 1

    1. Clarify the accusation

    Which duty is said to have been breached (late report, false statement, lack of cooperation)?

  2. 2

    2. Classify the fault

    Was it intent, gross or only simple negligence? This determines whether and to what extent a reduction is permitted.

  3. 3

    3. Check causation

    Did the breach of duty have any effect at all on the loss or the assessment? If not, the benefit remains in place.

  4. 4

    4. Object

    Object to an excessive reduction in writing and demand a comprehensible justification.

How to spot the scam

  • The insurer is released across the board without checking fault and causation.
  • Simple negligence is portrayed as gross.
  • A breach of duty without consequences is used as an occasion for a complete refusal.

Frequently asked questions

What is a breach of duty?

The breach of a contractual duty, such as late loss reporting, incorrect statements or lack of cooperation. It can lead to a reduction or release from the benefit, but only under certain conditions (§ 28 VVG).

May the insurer therefore not pay at all?

Only in case of intent. In case of gross negligence only a proportionate reduction is permitted, in case of simple negligence it generally remains fully liable to pay. A flat complete refusal is often attackable.

What does lack of causation mean?

If your breach of duty had no influence on the occurrence of the loss or the obligation to pay, the insurer remains liable to pay despite the breach, unless you deceived fraudulently.

Take action now

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General information for self-help, not legal advice (RDG). In case of a high loss or uncertainty: contact a consumer advice center or a lawyer.