Stadtland C, Seidelmann S, Wandl U
Aus der Abteilung für Forensische Psychiatrie, Ludwig-Maximilians-Universität München.
Versicherungsmedizin. 2007 Mar 1;59(1):26-8, 35-6.
A policyholder claiming an annuity benefit on the grounds that, he is no longer able to pursue his occupation must meet certain obligations vis-à-vis the insurer, e.g. duty to mitigate the loss, duty to cooperate with the insurer. These obligations are often curtailed by the claimants' rights. Physicians and providers of expert medical opinions frequently do not share this opinion. Where medical and legal considerations intermingle and, potentially, conflict, there is great uncertainty as to whether, and to what extent, an insurer may require a claimant to undergo medical treatment. Before deciding on whether or not to grant an annuity, the insurer generally calls in medical experts to assess the policyholder's actual degree of disability and offer an opinion on whether and, if so, by what medical means that disability might be mitigated or remedied. Expert medical opinions are often decisive in such cases. The present article discusses the extent to which a claimant's loss-mitigation and cooperation obligations towards the insurer are enforceable; in this context, a number of court decisions are quoted. In addition, the authors define the requirements that an expert medical opinion must meet.
以无法继续从事其职业为由申领年金福利的投保人必须对保险公司履行某些义务，例如减轻损失的义务、与保险公司合作的义务。这些义务往往会受到索赔人的权利的限制。医生和提供专业医学意见的人常常不认同这一观点。当医学和法律考量相互交织且可能产生冲突时，对于保险公司是否以及在何种程度上可以要求索赔人接受治疗存在很大的不确定性。在决定是否给予年金之前，保险公司通常会聘请医学专家来评估投保人的实际残疾程度，并就是否以及如果可以的话通过何种医学手段减轻或治愈该残疾提供意见。专业医学意见在这类案件中往往具有决定性作用。本文讨论了索赔人对保险公司的减轻损失和合作义务在何种程度上具有可执行性；在此背景下，引用了一些法院判决。此外，作者还界定了专业医学意见必须满足的要求。
