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Legal protection
Problems with social insurance?
Our expert explains how to get what's rightfully yours.
If you are ill or had an accident, social insurance covers the financial consequences. Unfortunately, there are often legal disputes because benefit claims are rejected. Social insurance expert Peter Fuchs explains how legal protection insurance helps.
Peter, what does social insurance include?
In a nutshell, it includes any insurance policy that provides people and their families with comprehensive protection against risks whose financial consequences they are unable to manage on their own. We’re all aware of the most important ones: social insurance includes both accident, health and disability insurance, as well as retirement provision in the form of AHV and pension funds.
Why are you interested in social insurance law?
Because it is extremely multifaceted and relevant in all phases of life. I am fascinated by the fact that people get a lot of help from their social insurance when they are affected by a particular risk. That said, they also often really have to fight for what they are entitled to – and this is where we come in. Because we are dealing with more and more cases at Fortuna, we have begun to specialise, which means that we are able to resolve a lot of issues with our internal legal service.
What are the kind of cases you’ll never forget?
I mainly recall unusual accidents or events that made headlines. But, when giving advice, we also often encounter tragedies that stay with you for a long time. At the end of the day, we are always dealing with people in genuine trouble. My best memories are always when the people affected get what they are entitled to following social insurance disputes.
Are there a lot of legal disputes?
Unfortunately, yes. When a social insurance provider rejects a decision, we decide how to proceed together with the insured person. We generally advise against initiating legal proceedings at first and try to find other ways. However, quite often, our clients are just after legal advice, such as why their accident insurance refuses to pay certain benefits or what “causality” means in the context of an accident. Or they might have questions about their pension entitlements.
If you have a long-term illness or have had an accident, you lack the strength and money to fight for your rights.
How can legal protection help in that case?
If you have a long-term illness or have had an accident, you lack the strength and money to fight for your rights. Disputing Federal Disability Insurance (IV) decisions can often be very expensive. In such cases, your legal protection insurance provides expertise or commissions an external law firm. The insurance company covers the costs. Fortuna has an extensive network of specialised law firms and our legal protection insurance doesn't really cost that much relative to the cover it provides.
How can you avoid problems with social insurance?
I think one of the most important things is a positive attitude: if something happens to you, you should view the medical or social insurance professionals you are dealing with as partners that have your best interests at heart. You should also make sure to ask questions and resolve any queries you may have. Also, think about the future and don’t just rely on the daily allowances. Keep in mind: make sure to always adjust your insurance cover to your needs as and when they change. And always ask if you are not completely sure about the benefits you’ll be entitled to in a worst case scenario.
Peter Fuchs
Lawyer, Fortuna Legal Protection Insurance
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