{
  "id": "clause-doctors-orders",
  "type": "clause",
  "languages": {
    "en": {
      "id": "clause-doctors-orders",
      "lang": "en",
      "type": "clause",
      "title": "Doctor's Orders Clause",
      "shortDefinition": "The doctor's orders clause required insureds under disability policies to follow medical instructions, and is now largely absent from modern policy wordings.",
      "synonyms": [
        "Medical cooperation obligation"
      ],
      "linesOfBusiness": [
        "Life",
        "Disability"
      ],
      "jurisdictions": [
        "DE"
      ],
      "tags": [
        "Disability insurance",
        "Policy Conditions"
      ],
      "relations": {
        "relatedTerms": [
          "clause-abstract-referral",
          "term-incapacity-for-work",
          "term-obliegenheit"
        ],
        "partOf": [],
        "appliesTo": [
          "cov-berufsunfaehigkeitsversicherung"
        ],
        "regulatedBy": [
          "reg-vvg-de"
        ],
        "relevantFor": [],
        "insurableVia": [],
        "mitigatedBy": [],
        "comprises": [],
        "alternativeTo": [],
        "complementedBy": []
      },
      "attribute": null,
      "profile": null,
      "coverageProfile": null,
      "clause": {
        "kind": "condition",
        "origin": "de-market",
        "favours": "insurer",
        "negotiability": "negotiable",
        "standardWordings": []
      },
      "legalBasis": [
        "DE: section 242 BGB (good faith)",
        "DE: section 307 BGB (transparency requirement for standard terms)"
      ],
      "standards": [],
      "reviewStatus": "expert-reviewed",
      "reviewedBy": "Guido Hesse, Hesse Group Holding AG",
      "lastReviewed": "2026-09-04",
      "version": "0.2.0",
      "updated": "2026-09-03",
      "generated": {
        "by": "cursor-agent/claude-sonnet-5",
        "at": "2026-09-03T00:00:00.000Z"
      },
      "verified": [
        {
          "by": "human:ghesse",
          "at": "2026-09-04T00:00:00.000Z",
          "method": null
        }
      ],
      "staleAfter": null,
      "url": "https://hgh.ch/lexikon/en/knowledge/clause/doctors-orders-clause/",
      "alternateUrl": "https://hgh.ch/lexikon/de/wissen/klausel/arztanordnungsklausel/",
      "body": "## Purpose\n\nThe doctor's orders clause is a provision in disability insurance policies requiring the policyholder to follow medical instructions in order to improve their health and thereby reduce the degree of disability.\n\n## Effect and limits\n\nUnder this clause, if the policyholder fails to follow the medical instructions, the insurer has the right to reduce or entirely withhold the disability benefit. Policyholders generally must undergo safe treatments with a good prospect of improvement; courts, however, regard compulsion to undergo risky procedures such as surgery as unreasonable.\n\n## Negotiation and practice\n\nThe doctor's orders clause is legally contested; courts have increasingly ruled in favor of policyholders in disputes, in particular for lack of transparency under section 307 BGB. As a result, the clause is now largely absent from current policy wordings and has been replaced in newer contracts by more differentiated medical cooperation obligations."
    },
    "de": {
      "id": "clause-doctors-orders",
      "lang": "de",
      "type": "clause",
      "title": "Arztanordnungsklausel",
      "shortDefinition": "Die Arztanordnungsklausel verpflichtete Versicherte in der Berufsunfähigkeitsversicherung, ärztlichen Anordnungen nachzukommen, und ist in modernen Bedingungswerken kaum noch enthalten.",
      "synonyms": [
        "Mitwirkungsobliegenheit (medizinisch)"
      ],
      "linesOfBusiness": [
        "Leben",
        "Berufsunfähigkeit"
      ],
      "jurisdictions": [
        "DE"
      ],
      "tags": [
        "Berufsunfähigkeitsversicherung",
        "Vertragsbedingungen"
      ],
      "relations": {
        "relatedTerms": [
          "clause-abstract-referral",
          "term-incapacity-for-work",
          "term-obliegenheit"
        ],
        "partOf": [],
        "appliesTo": [
          "cov-berufsunfaehigkeitsversicherung"
        ],
        "regulatedBy": [
          "reg-vvg-de"
        ],
        "relevantFor": [],
        "insurableVia": [],
        "mitigatedBy": [],
        "comprises": [],
        "alternativeTo": [],
        "complementedBy": []
      },
      "attribute": null,
      "profile": null,
      "coverageProfile": null,
      "clause": {
        "kind": "condition",
        "origin": "de-market",
        "favours": "insurer",
        "negotiability": "negotiable",
        "standardWordings": []
      },
      "legalBasis": [
        "DE: § 242 BGB (Treu und Glauben)",
        "DE: § 307 BGB (Transparenzgebot bei AGB)"
      ],
      "standards": [],
      "reviewStatus": "expert-reviewed",
      "reviewedBy": "Guido Hesse, Hesse Group Holding AG",
      "lastReviewed": "2026-09-04",
      "version": "0.2.0",
      "updated": "2026-09-03",
      "generated": {
        "by": "cursor-agent/claude-sonnet-5",
        "at": "2026-09-03T00:00:00.000Z"
      },
      "verified": [
        {
          "by": "human:ghesse",
          "at": "2026-09-04T00:00:00.000Z",
          "method": null
        }
      ],
      "staleAfter": null,
      "url": "https://hgh.ch/lexikon/de/wissen/klausel/arztanordnungsklausel/",
      "alternateUrl": "https://hgh.ch/lexikon/en/knowledge/clause/doctors-orders-clause/",
      "body": "## Zweck\n\nDie Arztanordnungsklausel ist eine Klausel in der Berufsunfähigkeitsversicherung, die den Versicherungsnehmer verpflichtet, ärztlichen Anordnungen nachzukommen, um die eigene Gesundheit zu verbessern und dadurch den Grad der Berufsunfähigkeit zu mindern.\n\n## Wirkung und Grenzen\n\nBefolgt der Versicherungsnehmer die ärztlichen Anordnungen nicht, hat der Versicherer nach dieser Klausel das Recht, die Berufsunfähigkeitsleistung zu kürzen oder ganz zu verweigern. Gefahrlose, aussichtsreiche Heilbehandlungen muss der Versicherte in der Regel befolgen; ein Zwang zu risikobehafteten Eingriffen wie Operationen gilt nach der Rechtsprechung dagegen als unzumutbar.\n\n## Verhandlung und Praxis\n\nDie Arztanordnungsklausel ist rechtlich umstritten; die Rechtsprechung hat in Streitfällen zunehmend zugunsten der Versicherten entschieden, insbesondere wegen mangelnder Transparenz nach § 307 BGB. In der Folge ist die Klausel in fast keinem aktuellen Bedingungswerk mehr enthalten und wurde in neueren Verträgen durch differenziertere medizinische Mitwirkungspflichten ersetzt."
    }
  }
}