Der Kausalitätsgegenbeweis des Versicherungsnehmers

According to Section 28 para. 3 of the revised German VVG (Insurance Contract Law), a policyholder may prove that his breach of duty did not cause a disadvantage for the insurer by means of so-called causality counter-evidence. In contrast to the former provision, this possibility obtains even in case of an intentional breach. Therefore, in the future, causality counter-evidence will increase in importance—especially with regard to notice and information duties and duties to keep subjective risks to a minimum. However, the new provision does not impose an unfair burden on the insurer: if the causality counter-evidence is successful, the insurer must pay only the actual costs required under the contract. The insurer’s interest in prevention is protected insofar as the introduction of causality counter-evidence is generally precluded in case of malice.     

Deux conférences sur la théorie des probabilités

Abstract

Dans les pages suivantes, nous nous occuperons de quelques questions qui concernent Ie problème général de l'addition des variables éatoires independantes.     

Eine Analyse ultimaten Verhaltens als Erklärungsansatz des moral hazards

For the insurance industry the moral hazard poses an incalculable risk. Changes in the behaviour of the insuree can lead to higher claims settlements and thus to higher premiums for the insured collective. Asymmetrically allocated information gives the insured individual the possibility to profit from the idea of common protection in a way that impairs insurer and the collective on the whole. Based on the homo oeconomicus model, economic concepts, first and foremost the agency theory of new institutional economics have made attempts to provide solutions for this management problem. However, behavioural economic experiments have demonstrated that the homo oeconomicus model does not fully succeed in describing the realities. As a result, the solutions proposed in these economic concepts have to be rated inadequate.The moral hazard is inherent in the conflicting realm of cooperation and defection, behaviour patterns that have evolved during the history of development of human behaviour. Ultimate behaviour analyses of these patterns do offer the opportunity to understand why humans behave in specific ways based on man's evolutionary origins and sources. Consequently, ultimate behaviour analyses could provide a solid foundation for the development of a framework giving insurers the possibility to exert influence on the insuree's behaviour and thus to assist in successfully impacting the moral hazard.     

Aufdeckung von Versicherungsbetrug bei Kfz-Schäden mit Hilfe des Benford-Tests

The German Insurance Association estimates a yearly amount of damage of € 1.5?bn to German motor vehicle insurance companies because of systematic fraud by insurance holders. It is supposed that about 10% of submitted claim applications contain manipulated data, therefore insurance companies are forced to complete a detailed and cost intensive case-by-case review of each single application. An alternative method to detect fraud in empiric data is the method of digital analysis based on Benford’s law. The Benford method uses a mathematical law of specific logarithmic distribution attributes of first digits. According to this approach, the data of a Benford set confirm with the expected digit distribution, if the data is not manipulated, whereas fraudulent interventions lead to a deviation from Benford’s law. Hence, until now there has not been any investigation whether the Benford method can also be applied on insurance data. The present article analyses a dataset consisting of more than 120,000 damage claim applications to answer this question as well as to identify the impact of specific characteristics on the probability of fraud contained in claim applications, such as the repair of the vehicle in a franchised or an independent workshop, the vehicle brand or the examination by insurance companies experts. Indeed it could be shown that Benford’s Law is only applicable on second digits of insurance data, but delivers very strong results here: All results of the considered characteristics could be verified by plausible arguments. For this reason insurance companies can benefit from making use of the Benford method to identify those claim applications with a high probability of fraud, which should then be reviewed in more detail so that resources can be allocated in a much more cost efficient way.     

Über die Berechnung der Leibrente bei Veränderung des Zinsfusses

Abstract

1. In dieser Zeitschrift haben die Herren Steffensen ¹ 1918, Häft. 1–2, S. 82–97. , Meidell ² 1918, Häft. 3–4, S. 180–198. und Palmqvist ³ 1921, Häft. 3, S. 152–178. Näherungsformeln zur Berechnung der Veränderung der Leibrente bei der Veränderung des Zinsfusses veröffentlicht.     

Prognose des Abwicklungsergebnisses mittels Chain-Ladder-Verfahren für abhängige Run-Off-Portfolios

In the present paper we analyse how the estimators from Merz u. Wüthrich (2007) could be generalised to the case of N correlated run-off triangles. The simultaneous view on N correlated subportfolios is motivated by the fact, that in practice a run-off portfolio often has to be divided in subportfolios, so that the homogeneity assumption of the claims reserving method on each subportfolio is satisfied. We derive an explicit formula for the process-variance, the estimation-error and the prediction error made by the forecast for the claims development result with the Chain-Ladder method. We illustrate the results by an example.     

Die Aufdeckung des tatsächlichen Schädigungspotentials eines versicherten Risikos und das Institut der Gefahrerhöhung

Against the background of the rapid spread of new technologies such as nanotechnology to name only one, third party insurers are faced with a multitude of challenges. The reason for this is the typically totally unknown damage and thus liability potential of these technologies. In this context special focus is on the aggravation of risk and the question whether the rights included in §§ 24 f. of the German Insurance Contract Act should be granted to the insurers in the event of any future revelation of the actual damage potential. This must, however, be answered in the negative since here only the risk of an initial and not the risk of a subsequent disruption of the equivalence mandate as assigned to the insured as per §§ 23 ff. of the German Insurance Contract Act applies.     

Über die Berechnung der Leibrente bei Veränderung des Zinsfusses.

Abstract

Herr K. A. POUKKA hat in einer unter dem gleichem Titel erschienenen Arbeit¹ fü die zum Zinsfuss i+h zu berechnende Leibrente eine Näherungsformel. abgeleitet, welche sehr zufriedenstellende Resultate gibt. Die Formel wird aus der Reihenentwicklung gewonnen, für welche Herr POUKKA eine Ableitung mitteilt.     

Die Arglistanfechtung des Versicherungsvertrags bei fehlender textförmiger Nachfrage nach Gefahrumständen

The article treats the issue of disputing an insurance contract for reasons of malice in the event of an insurance company failing to comply with the requirements pertaining to the risk-issue-conversation provided by the VVG. According to §19 Abs. 1 VVG, the policy holder is merely required to answer questions about risk issues that are presented to him in writing and timewise before the policy holder has submitted his offer respectively in the time frame between submission of the offer by the policy holder and the acceptance by the insurance company. It is contentious whether an insurance company that has violated §19 Abs. 1 VVG may nevertheless dispute the insurance contract for reasons of malice in case of misrepresentation or omission of information on part of the policy holder. The article argues for an application of §241 Abs. 2 BGB in conjunction with §123 Abs. 1 BGB in addition to §19 Abs. 1 VVG—and thus in favor of an insurance company’s possibility to dispute the insurance contract. The protection of the policy holder’s rights is not an issue in the problem of applying the correct provision. They must rather be considered when determining the requirements of the contract dispute.     

Die arglistige Täuschung des Versicherungsnehmers nach Eintritt des Versicherungsfalls – zugleich Beitrag zu §28 Abs. 3 S. 2 VVG –

The author adresses the differences in legal consequences of conditions subsequent to the insurance policy on the one hand and the self-contained legal implications of fraudulent misrepresentation prior to conclusion of the contract on the other hand. He suggests revising the narrowly defined causality criterion in order not to limit the legal consequences of false information given by the policy holder based on causal criteria. If so, legal consequences could be applied when the policy holder acted in bad faith. Then, he introduces the various case groups of willful misrepresentation using property insurance to illustrate them.     

EIOPA – Eine Überschreitung des europäischen Rechtsrahmens und die sich daraus ergebenden praktischen Konsequenzen

The EIOPA (European Insurance and Occupational Pension Authority) is a regulatory EU-body, which was founded on the 1st of January, 2011. The EIOPA was established as a result of the financial crisis that took place in 2007/2008, and it is part of a newly created EU-financial system. This essay deals with questions around the legality of the EIOPA, and looks into its legal basis and the scope of its authorities, which are limited by the case law of the European Court of Justice, as well as European and constitutional principles. When considering these aspects, the regulation, on which the EIOPA is based, seems to be partly incorrect. This essay therefore deals with the legal consequences of such faultiness.     

Zum Treuhänder des Sicherungsvermögens unter dem neuen Versicherungsaufsichtsgesetz – Auswirkungen der Solvency II-Umsetzung

This paper is about the consequences of the transposition of the Solvency II Directive into the new German insurance supervisory law (VAG 2016) on the trustee for monitoring of the guarantee assets. The trustee of the guarantee assets is a national security mechanism to protect policyholders in case of insolvency of their insurance undertaking. The previous German Regulation of Investments (AnlV) is not valid any more for insurance undertakings falling under Solvency II since 01.01.2016. Instead of legal investments rules insurance undertakings are now obliged to have a (written) internal investment policy, which is also the basis for monitoring of guarantee assets by the trustee. Challenges arise because of the clash of the accounting view (German local GAAP) and the market valuation view of Solvency II. Our analysis contributes to a better understanding of the interplay between unchanged legal provisions and the new economic, risk based perspective of Solvency II.     

QIS4 – Konzeption des europäischen Standardansatzes und Kapitalausstattung für Schaden-Unfallversicherer – Analyse und Beurteilung

The paper examines the updated requirements for risk based capital evaluation within the framework of the European Solvency??II project. The early results for the quantitative impact study QIS4 will be shown and feasible effects on the insurance industry will be derived. In contrast to the previous system, Solvency??II is based on a market value approach which gives incentives to insurance companies to improve their internal risk management and assessment procedures through the enforcement of riskadequate illustration of the overall risk position. Here probability distributions are calculated for each risk categories in the standard approach. For this reason a quantitative term is derived to assess the overall risk position of an insurer which arises from the aggregation of each single risk considering the diversification effect. The extent of uncertainty is predetermined by the legislator. For the acceptance of future arrangements it will be important to answer the question whether these approaches are manageable and adequate.     

Über die Bestimmung des systematischen Fehlers,den man bei der Schätzung gewisser Funktionen apriorischer Wahrscheinlichkeiten aus empirischen relativen Häufigkeiten begeht,mittels einer unendlichen Reihe

Abstract

A. A. Tschuprow hat in seinen beiden Schriften: Grundbegriffe und Grundprobleme der Korrelationstheorie. Leipzig und Berlin 1925. (zitiert als A) und On the mathematical expectation of the moments of frequency distributions. Biometrica Bd. XII. (zitiert als B) die Grundlagen der Theorie der systematischen Fehler in der Wahrscheinlichkeitslehre im Zusammenhang entwickelt. Von ihm wird stets das Schema der Ziehungen aus einer Urne mit pk weissen und qk roten Kugeln (p + q= 1) zugrunde gelegt. Dann ist die Wahrscheinlichkeit, mit N Zügen mit Zurücklegen r weisse Kugeln zu ziehen:      

Deckungsbegrenzungen in Pflichtversicherungen – Die Bedeutung des § 114 VVG 2008 für Verträge über Pflichthaftpflichtversicherungen

Numerous liability insurances are mandatory in order to ensure the indemnification of potential victims. These compulsory insurances are regulated by sections 113 et seqq. of the “Versicherungsvertragsgesetz” (German insurance contract law). The new section 114 aims at protecting the victims' financial interests by specifying the necessary scope of cover of compulsory insurances.However, the statutory interpretation of section 114 provides several difficulties: For example, it prescribes concrete amounts on the hand – and contains a vague blanket clause on the other hand. This study wants to disclose these difficulties, develop specific solutions and reveal the fundamental legal interests which lie behind section 114.     

Die niederländische Gesundheitsreform 2006 – Vorbild für eine weitere Reform des Krankenversicherungswesens in Deutschland?

The health sector of many European countries has been subject of a profound process of change for years. Since the federal elections of 2009 a discussion on the direction of the German health insurance system has emerged. In this context, German neighboring countries like Switzerland or the Netherlands are considered due to their changes in health policy for decades. This work deals with the effects of the recent Dutch health care reform. Due to the combination of the two elements “Bürgerversicherung” and “Kopfpauschale”, it serves as a possible model for further reform in the German health system since its introduction in 2006. Special attention was paid to the consolidation of statutory and private insurance in a general citizens insurance in the Netherlands “three-pillar model”. Because of the medium-term time horizon, financial impacts on state and private households and changes in competition between insured individuals, insurers and providers could be analysed. Especially, positive effects in terms of increasing competition and reducing the two-tier health care became apparent.     

Die EU-Sektoruntersuchung zu den Unternehmensversicherungen: Meistbegünstigungsklauseln in Rückversicherungsverträgen unter Berücksichtigung des Kartellrechts

In the EU-Sector-Inquiry on business insurance the European Commission drew attention to Best Terms and Conditions Clauses (BTC-Clauses) in Reinsurance contracts and found alleged violations against Art. 81 EGV. However, the Commission did not provide a legal classification in detail. The use of BTC-Clauses is mostly favoring cedants, a fact made obvious by the market participants’ reactions to the Commission’s final report. Nevertheless, the implementation of Solvency II standards may decline the use of BTC-Clauses (regarding the harmonization of premiums) because the cedent has to deposit different amounts of equity for his claims depending on the reinsurance company’s rating.