Insurance doesn’t pay? You can do this – even without a lawyer

Damage reported, no response?

Here’s what to do if the insurance doesn’t pay

Damage has occurred, but the insurance company is silent? With these steps you can get things moving – even without a lawyer if necessary.

Damage has occurred, but there is no response from the insurance company. Or does she refuse payment? Many insured people are then left at a loss. How can you apply pressure without immediately going to a lawyer?

In everyday life, many insured people do not even know what they are actually insured against. At the latest in the event of damage, you should read the insurance contract carefully and check whether the policy even covers the damage that has occurred – and to what extent.

“If the contractual terms and conditions are written in legal German that is difficult to understand, chatbots like ChatGPT can help the reader understand the text,” explains Oliver Brand, legal scholar at the University of Mannheim.

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Important: Many insurance companies – such as building insurance – do not cover damage if the damage was caused by gross negligence. For example, if you forget to turn off the stove and a fire occurs, you are often not entitled to a replacement.
However, you can also protect yourself against damage caused by gross negligence. According to Brand, a corresponding clause can often be agreed upon later.

If the damage is actually insured but the insurance company does not contact you, you should first contact the responsible clerk. A short, factual question is enough. “This can be done by telephone or email,” says Brand. In this way, many misunderstandings can be quickly cleared up.

If the problem persists, advice centers can help, such as consumer advice centers or the Association of Insured Persons. “Insurance advisors can often give practical advice on how to proceed,” says Brand.

If the insurance company’s review continues, you should give your provider a written deadline – ideally 14 days. This puts those responsible under pressure. “Setting a deadline like this creates clarity and documents that you are taking the matter seriously,” advises Brand.

If the situation remains deadlocked, you can contact the insurance ombudsperson. It mediates free of charge and out of court in disputes between insured persons and insurance companies.

“A legal dispute should only be considered when all out-of-court options have been exhausted,” emphasizes Julia Alice Böhne from the Association of Insured Persons. Legal proceedings are lengthy and expensive, but the conflict can often be resolved in this way.

The head of the ombudsman’s office is Sibylle Kessal-Wulf. Insurance clerks and fully qualified lawyers work there and examine complaints in almost all insurance lines.
“However, the insurance ombudsman is not responsible for private health insurance,” explains Böhne. There is a separate arbitration board for this.

To lodge a complaint you will need copies of the following documents:

• Insurance certificate
• Insurance conditions
• Correspondence with the insurer
• Damage report, photos, reports and other evidence

Böhne recommends using the complaint form on the ombudsman’s website. “The average duration of the procedure is around three months – depending on the complexity of the case.”

And how binding is the decision? “If the amount in dispute is up to 10,000 euros, the decision is binding for the insurer,” says Böhne. For larger sums, this is a recommendation, but is often also taken into account. Consumers, on the other hand, are not bound by the decision and can take further steps.