Important Insurance Terms
Death and incapacity to work
Illnesses and consequences of accidents for which you were medically counselled or treated during the 12 months before insurance coverage commenced are not insured. However, this only applies if the insurance claim arises within the first 24 months after the contract is concluded and if it is directly or indirectly connected with such illness or consequence of accident.
In an event of unemployment, the waiting period amounts to the time which must pass after concluding the contract until insurance coverage applies. That is, unemployment commencing during this time is not covered. (This includes the time after the waiting period has expired).
Example: contract concluded per 1 January 2011: waiting period is 6 months
= no coverage for unemployment commencing during the time from 1 January 2011 to 30 June 2011 inclusively; this means that unemployment after 30 June 2011 is not covered.
Note: Waiting periods may commence anew if insurance coverage is changed.
Qualifying periods are equivalent to a deductible; they consist of the time which must always pass after a case of claim before a benefit is paid out, whereby incapacity for work or unemployment must have been uninterrupted.
Example: incapacity for work/unemployment commences on 1 January 2011: qualifying period is 3 months
= benefit entitlement as of the fourth month, no earlier than 1 April 2011
Prerequisites for insurance benefits
Incapacity for work
When is a person incapable of working?
The insured person must be ill and submit an attestation to his/her incapacity for work, or
The insured person must be at least 50% and probably permanently incapable of practising his/her occupation as a result of illness, physical injury or cachexia (which must be medically evidenced). A person is not incapable of working if it can be reasonably expected that he/she is capable of another occupation which corresponds to that person's skills, abilities and life situation, or
The insured person must be basically incapable of pursuing a regular occupation of at least 20 hours per week to earn his/her livelihood due to illness, physical injury or cachexia.
Note: There is no coverage for incapacity to work if the insured person is already incapable of working when insurance coverage commences.
Unemployment for non-independently working persons (employees)
The insured person must have been employed uninterruptedly for a specific time (see the General Terms and Conditions) by one and the same employer. During the time of insurance coverage, the insured person must become involuntarily unemployed and not be active in exchange for remuneration.
An involuntarily unemployed person is deemed to be
One who has been dismissed by his/her employer
One who has prematurely resigned on justified grounds
One whose company has been shut down by a trustee in bankruptcy
The insured person must draw unemployment benefits or emergency assistance from the Austrian Employment Exchange [Arbeitsmarktservice - AMS]. Benefit entitlements are not affected if the insured person draws no emergency assistance due to lack of need (e.g. if the person's spouse/life-partner's income exceeds the limit).
The insured person must be actively seeking work.
Unemployment for independents
The insured person must be independently working uninterruptedly for one and the same company or business operation for 24 months at the time when unemployment commences, pursue no other gainful occupation and have sustained his/her livelihood and any statutory maintenance obligations with the income from that work.
An insured person is unemployed if, during the period of insurance coverage, he/she ceases his/her independent work for economic reasons, pursues no other gainful occupation, is registered as unemployed with the Austrian Employment Exchange and is actively seeking work.
This translation is for purposes of explication only and no legal expectation of completeness can be derived therefrom, nor can it constitute grounds for a claim, nor reasons to demand data, notifications or declarations from the insurer in this language.