help with PKV painfull saga

10 posts in this topic

Hi there,
seeking for help, once again i have been striked by the German helath insurance.
the story goes like this,
i am a 37 year old student owning a small business married to a german.
i moved to germany at 2012 and signed up for mawista, after 5 years i had to switch and after some research choosed to go for barmenia as they were the cheapest one, i had contacted one of their agents and within a week i have signed a contract, all was communicated in english, the contract in german,
within 3 months my premium went up around 100 euro, from 160 to 260, and on top around 30/40 euro pension, so in the last 20 month i am paying barmenia around 300 euro monthly.
around 8 months ago i had some tooth pain and i have started a tooth treatment - which my clinic was syncing with my insurance and caliming all is gonna be payed by the insurance..
, after paying my first bill of 1,500 i have filed documents to barmenia, i was communicating to my agent but was sent to do it via app , and after some struggle was able to contact via email, this started in jan 2019, after a bunch of mail exchanges and requests and questions from Barmenia, few days ago i got and email that claims my contract is canceled because the info provided at the signing is different from  what i was communicating with them.

in the mail was attached the contract.
in which much of the information was completely wrong, my birth date, my hight and above all the fact that i was before had private incured by bermania,
the agent wrote that i was state insured from 2010 (i moved to germany at 2012!).
i have another bill of 1,200 to pay for my tooth clinic...

i have never failed for any money besides paying monthly  them the money, when signing the contract i had no income what so ever, but couldnt move to the state insurance...
 

the same person that was dealing with my claim is the same person that sent me the mail for canceling the contract!
anyway, i have no idea what to do next besides finding a new health insurance, but i find this so wrong and have no idea what to do besides a lawyer,,
any help would be deeply appreciated, i have attached the last mail i got, and "my agent"(their) wasn't responding.



Ihre Krankenversicherung

 

Sie teilen mit, dass Sie in Deutschland nie gesetzlich krankenversichert gewesen sind und dass Sie dies auch bei der Vertragsunterzeichnung so angegeben hätten.

Der beiliegenden Antragskopie können Sie entnehmen, dass bezüglich der Vorversicherung eine Betriebskrankenkasse für den Zeitraum 2010 bis 30.06.2017 angezeigt wurde. Einen Verweis auf die Mawista Auslandskrankenversicherung ist dem Antrag nicht zu entnehmen.

Aufgrund der nun vorliegenden Informationen müssen wir die grundsätzliche Versicherbarkeit prüfen. Bitte lassen Sie uns dafür eine Bescheinigung der Mawista Versicherung zukommen, aus welcher sich die nachfolgenden Inhalte er- geben:

- Art und Umfang der Versicherung
- Vertragslaufzeit
- Übersicht der abgerechneten Versicherungsleistungen

Bitte lassen Sie uns die Angaben Ihrer Vorversicherung bis zum 17.04.2019 zukommen.

Zudem werden wir uns mit Herrn Pietzold in Verbindung setzen um die Angaben bei dem Vertragsabschluss auch von dieser Seite abzuklären.

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8 hours ago, Witzhummus said:

i am a 37 year old student owning a small business married to a german.
i moved to germany at 2012 and signed up for mawista, after 5 years i had to switch

 

When did you get married? 

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1 hour ago, engelchen said:

 

When did you get married? 

last year jan , got visa for 3 years from feb 2018, my wife has a separate  pkv insurance

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8 minutes ago, Witzhummus said:

last year jan , got visa for 3 years from feb 2018, my wife has a separate  pkv insurance

 

You've got a problem that probably won't be cheap to sort out.

 

If @Starshollow can't help you, he'll be able to recommend a Versicherungsberater who can.

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do you have a copy of the original application so you can cross check the data that the agent entered at the start?

 

how about the original contract that they should have sent when they took over your cover?  If those docs contained faulty information your case is weaker as you had every opportunity to make these mistakes known to the agent and have them corrected asap.

 

on the other hand, if those docs contain the correct information, and now your "contract" says something faulty, you are in a much better position.

 

I'm a bit confused as you say they canceled you, but then they want details about the mawista cover which sounds like a possible reprieve.  I don't understand why they would ask for that if you were fully and finally canceled?

 

 

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The main question will be, if you have any way of proof that you disclosed your prior insurance with MAWISTA to the agent (emails, notes, ideally your wife being present or someone else) ?  If that were the case, the health insurance company has no legal leg to stand on, because an insurance agent is considered to be "eye and ear" of the insurance company under German law..what you told the insurance agent is knowledge the insurance company had (no matter if the agent forwarded this info correctly or withheld it or even changed it).
Without proof you yourself have no legal leg to stand on, I am afraid. if the agent says that you never gave him this info, it is a he-says-she-says-situation and the need to prove your side is right falls entirely upon you (there is no "Beweisumkehr" here, AFAIK).
Be that as it may: you definitely need professional assistance and should not communicate with the insurance company or the agent yourself anymore as you are more likely to hurt your own legal position by doing that. Whether the insurance company is in its right to terminate the contract because of fraud/failure to disclose important info is questionable per se and needs an expert to look over it. Plus, if you can show proof as described above, you have a better position.

I can list to you at least two very good insurance consultants that you can hire. if it turns out the insurance agent was changing/forging the application document in order to make a sale in the knowledge that his insurance company would otherwise reject the application or if there are other good reasons why the insurance company would not have rejected your application even if they had the knowledge and correct date, they will have to pay for your legal costs in the end, too. Of course, if they can legally sustain their cancellation, you'll not get your legal rep. paid for, too.

 

Cheerio

 

I am a professional independent insurance broker, financial adviser, and authorised advertiser. Contact me.
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On 4/8/2019, 12:06:26, lisa13 said:

do you have a copy of the original application so you can cross check the data that the agent entered at the start?

 

how about the original contract that they should have sent when they took over your cover?  If those docs contained faulty information your case is weaker as you had every opportunity to make these mistakes known to the agent and have them corrected asap.

 

on the other hand, if those docs contain the correct information, and now your "contract" says something faulty, you are in a much better position.

 

I'm a bit confused as you say they canceled you, but then they want details about the mawista cover which sounds like a possible reprieve.  I don't understand why they would ask for that if you were fully and finally canceled?

 

 

hi lisa, there was not much contact before hand, there was a meet up and i signing, i do remember clearly looking for my former mawista contract number and providing it to the agent,
i need to obtain my old phone as i might have some info o nit that might be useful.

thank you for putting your finger on the fact it's not cancaled yet,
but it's very clear where wind is blowing.

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18 hours ago, Starshollow said:

The main question will be, if you have any way of proof that you disclosed your prior insurance with MAWISTA to the agent (emails, notes, ideally your wife being present or someone else) ?  If that were the case, the health insurance company has no legal leg to stand on, because an insurance agent is considered to be "eye and ear" of the insurance company under German law..what you told the insurance agent is knowledge the insurance company had (no matter if the agent forwarded this info correctly or withheld it or even changed it).
Without proof you yourself have no legal leg to stand on, I am afraid. if the agent says that you never gave him this info, it is a he-says-she-says-situation and the need to prove your side is right falls entirely upon you (there is no "Beweisumkehr" here, AFAIK).
Be that as it may: you definitely need professional assistance and should not communicate with the insurance company or the agent yourself anymore as you are more likely to hurt your own legal position by doing that. Whether the insurance company is in its right to terminate the contract because of fraud/failure to disclose important info is questionable per se and needs an expert to look over it. Plus, if you can show proof as described above, you have a better position.

I can list to you at least two very good insurance consultants that you can hire. if it turns out the insurance agent was changing/forging the application document in order to make a sale in the knowledge that his insurance company would otherwise reject the application or if there are other good reasons why the insurance company would not have rejected your application even if they had the knowledge and correct date, they will have to pay for your legal costs in the end, too. Of course, if they can legally sustain their cancellation, you'll not get your legal rep. paid for, too.

 

Cheerio

 

I am a professional independent insurance broker, financial adviser, and authorised advertiser. Contact me.

thank you for your answer.

i have few questions,
i do remember providing my MAWISTA contract number during my sit with the agent while signing, as well, how can theoretically can i move from state health insurance to a private one wiihtout providing any info to my new health insurance?

in my understanding something vital is missing here , as i know before you sign up any health insurance in germany you need to show who is your last health insurance provider... what am i missing here?

i have set up a meet up with my agent *their agent on monday, i wanna be able to clear up some info from him, but regarding what you say it can only bring harm, till this moment i still havent been able to find any document that states me showing barmenia having a mawista insurance,,

thanks again for your help.
 

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4 hours ago, Witzhummus said:

thank you for your answer.

i have few questions,
i do remember providing my MAWISTA contract number during my sit with the agent while signing, as well, how can theoretically can i move from state health insurance to a private one wiihtout providing any info to my new health insurance?

in my understanding something vital is missing here , as i know before you sign up any health insurance in germany you need to show who is your last health insurance provider... what am i missing here?

i have set up a meet up with my agent *their agent on monday, i wanna be able to clear up some info from him, but regarding what you say it can only bring harm, till this moment i still havent been able to find any document that states me showing barmenia having a mawista insurance,,

thanks again for your help.
 

15

 

Regarding the bold-marked text above: no, you are not required to hand over proof to a German private health insurance when signing up about your membership in public health insurance. They can rely on your info given in the application. If it states here that you have been with public health insurance before, that is all info they have.  On the contrary, you'll need to normally to show proof of your new private health insurance coverage to your old public health insurance in order to make the switch legal. But that, again, is nothing the private health insurance needs to care about...that is up to you with a confirmation provided in writing by the new private health insurance.

 

Cheerio

 

I am a professional independent insurance broker, financial adviser, and authorised advertiser. Contact me.
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18 hours ago, Starshollow said:

 

Regarding the bold-marked text above: no, you are not required to hand over proof to a German private health insurance when signing up about your membership in public health insurance. They can rely on your info given in the application. If it states here that you have been with public health insurance before, that is all info they have.  On the contrary, you'll need to normally to show proof of your new private health insurance coverage to your old public health insurance in order to make the switch legal. But that, again, is nothing the private health insurance needs to care about...that is up to you with a confirmation provided in writing by the new private health insurance.

 

Cheerio

 

I am a professional independent insurance broker, financial adviser, and authorised advertiser. Contact me.

thanks for your answer again,

i have found a proof of me communicating to the agent that i have been a customer of mawista before signing up, actually while finding the proof, was easy to see how much of a *fraud* it is - i dont know how else to call when someone i s misleading you and taking advantage of you being not knowledgeable enough with the system - and after talking to lawyer yesterday i might have a good case here.
  - all our exchange of communication prior to the signing is done in english... but since the moment i became a member, even the the most simple communicaiton is done in german (from his side).

can you share the 2 two very good insurance consultants?

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