Die Private Krankenversicherung im Fokus des Verfassungsrechts

Starting with the question as to the extent to which the state may interfere with economic interests at all, a brief historical overview is given through to the regulations currently in force. The Basic Law (Grundgesetz) remains neutral on this issue so that the question cannot be discussed as to whether regulations are at all conceivable and admissible but how far these can go. The noteworthy parameters of the German law on intensifying competition in the statutory health insurance system (GKV-WSG) are then highlighted: the collision of the reform of private health insurance law with the reform of the entire insurance contract law as well as the length of the individual provisions and the correlating remark of member of parliament Merz in the Cicero magazine according to which no single member of parliament had even a rudimentary understanding of he was actually deciding on. From the point of view of substantive law, the main “diseases” of the GKV-WSG are strikingly shown, including in particular the creation and design of the basic rate as well as non-terminability etc. Finally reference is made to the double balancing act with which the private health insurance system is confronted: on the one hand the statutory health insurance system with its allocation principle and the private health insurance system with it superior principle of equivalence that wakens the desires of 4/5 of the German population who live in a poorly functioning system; on the other hand the field of tension between individual and collective consumer protection, i.e. between the high standards which are to be created for individuals which are then ultimately to be borne by the collective.     

Die Überwachung des versicherungsaufsichtsrechtlichen Risikomanagement durch den Aufsichtsrat

§ 64a VAG intensifies control of insurance undertakings through their supervisory board concerning risk management. These extended duties and the new risk management specific qualification standards will result in higher liability risks for the members of the supervisory board. However, the new law does not ensure that the supervisory board is supplied with the information necessary to comply with these requirements. Particularly information of the supervisory board of insurance undertakings in a group is seriously insufficient. On the other hand the Federal Financial Supervisory Authority in its MaRisk VA Circular concedes rights to information to the supervisory board which conflict with the basic conception of corporate law, e.g. permanent direct contacts between the supervisory board and staff of the risk management function. Insurance undertakings can react to the new challenges by professionalizing the supervisory board, establishing audit committees, internal limitation of the admissible maximum number of supervisory board’s seats and/or by purchasing D &; O insurance.     

Die Nutzung des Internet durch österreichische Versicherungsunternehmen

This paper compares the internet activities of Austrian insurers within a survey of all members of the Austrian Insurance Association. The analysis is structured according to potential interests of new customers, existing customers, the external sales force, financial intermediaries, investors, the general public, job searchers, and suppliers of inputs. Austrian insurers use the internet primarily for a general presentation of their company and products as well as for linking interested customers to their conventional sales force. Few insurers integrate their relation to suppliers, job searchers, investors, or their external sales force into their homepage. A full business transaction including binding quotes and full contracting through the internet is only provided by few insurers for selected products. Consequently, few cross border internet activities can be found.     

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.     

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.     

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.     

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.     

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.     

Europäische Streitbeilegungsmechanismen bei Meinungsverschiedenheiten zwischen nationalen Versicherungsaufsichtsbehörden

In the course of the reconstruction of the European financial supervisory framework all level 3-committees (namely CEIOPS for the insurance sector) were re-established as fully-fledged authorities of the European Union. These authorities are granted authority to take decisions with immediate effect towards national supervisors. The European Financial Supervisory Authorities, however, form but the upper level of the European micro-prudential supervisory system. The day-to-day supervision of the financial markets will remain to be vested in the national supervisory authorities. By retaining a system, in which the financial supervision takes place primarily at the national level, one also remains to be faced with problems, where insurance undertakings or insurance groups act under the jurisdiction of several national supervisors. Disagreements between these supervisors will, thus, remain to be commonplace. In order to dissolve such disputes, the European legislator has provided for a formalised dispute resolution procedure in granting EIOPA a power to settle disagreements.     

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.     

Über verschiedene explicite Lösungen des Problems von der Berechnung des effektiven Zinsfusses bei Anleihen

Abstract

Das Problem der Berechnung des effektiven Zinsfusses bei Anleihen ist bekanntlich mit dem Probleme der Lösung einer Gleichung n-ten Grades identisch.     

Die Wirkung der Produktpräsentation auf die Abschlussentscheidung und die Entscheidungszufriedenheit bei Versicherungsprodukten

For insurances sales and communication it is important to know, how the context of presenting products influences purchasing decision and customer satisfaction. Within an experimental study we analyzed the influence of presentation (one vs. multiple products, sequential vs. simultaneous presentation, and three vs. two products). The results show that customers are more likely to buy an insurance product if they are exposed to multiple products rather than to only one product, though decision satisfaction suffers if multiple options are presented. Practical implications and limitations are presented and future research opportunities are discussed.     

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 Umsetzung der europäischen Compliance-Vorgaben im österreichischen und deutschen VAG 2016

As member states of the European Union both Austria and Germany adopted the provisions of the Solvency II Directive in their national supervisory law. So this European Directive leads to a more convergent, consistent level of regulation and supervision a comparing view on the implementation of the Directive in both countries, Austria and Germany, really seems interesting. This paper compares the Austrian and German Supervisory Law in special respect to the current compliance-regulation in this countries.     

Die stochastische Modellierung von Großschäden für den Einsatz in internen Risikomodellen der Schadenversicherung

Along with individual corporate management and regulatory matters for instance within EU regime Solvency II, Internal Risk Models are very important for major general insurance companies. Of crucial importance in building these internal models, is the stochastic modelling of large claims and in particular, the selection and parameterization of suitable probability distributions for the amount and number of claims based on empirical data. To this end, in practice, a visually-based methodology is more appropriate and workable than strict mathematical approaches. Based on a practical case study, this paper provides some insight into a visually-based methodology for internal risk models.     

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.