Doctor's Orders Clause

Purpose

The 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.

Effect and limits

Under 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.

Negotiation and practice

The 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.