Relapse and late effects clause

Purpose

The final extent of accident-related health damage cannot always be determined conclusively straight away; a relapse or a consequence that only emerges later can subsequently change the degree of disability. The relapse and late effects clause gives both the insurer and the life insured the ability to have a previously fixed disability benefit reassessed within a set period if health materially changes.

Effect and limits

Reassessment is usually tied to a three-year period from the date of the accident, after which the disability benefit once determined becomes final. Within that period, either an increase or a reduction of the benefit can be requested, depending on whether health has worsened or improved. A causal link between the change and the original accident is always required; deterioration due purely to age or unrelated to the accident falls outside the clause.

Negotiation and practice

For claimants with an uncertain recovery trajectory, for example complex joint or spinal injuries, it is advisable to note the deadline and obtain a timely medical review before it expires, so as not to lose any right to reassessment. In practice, insurers exercise the right less often than policyholders, since justifying a reduction is comparatively burdensome.

The reassessment period is set out in Germany’s Section 188 VVG as a default statutory maximum, from which policy conditions may depart in the policyholder’s favour. Switzerland and Austria have no directly comparable statutory rule; the three-year period has instead become established there as a market standard within the relevant policy conditions.