To ensure that differences of opinion between you and your private health or long-term care insurance can be resolved without lengthy legal disputes, the insurers have set up an out-of-court arbitration procedure. The ombudsman helps you to settle differences quickly and unbureaucratically.

HINT: Before you can contact the Ombudsman's Office, you must first address your complaint directly to your insurance company. This gives the company the opportunity to reconsider or better justify its decision. Often, correspondence or a personal conversation can completely avoid a dispute.

Mediation and consultant disputes

The Ombudsman's Office is also responsible for complaints against insurance intermediaries if the disputed facts relate to the successful or attempted mediation of private health and long-term care insurance. You can also contact the ombudsman if you have disputes with insurance consultants in connection with the conclusion of insurance contracts.
Preconditions

• The applicant is a natural person in an existing or terminated insurance relationship.

HINT: If you are insured with the Postbeamtenkrankenkasse (PBeaKK) or the Krankenversorgung der Bundesbahnbeamten (KVB), the ombudsman can only accept complaints relating to compulsory long-term care insurance.

• A complaint lodged by the insured with the insurance company concerned was unsuccessful.
• The insurance company concerned must have joined the ombudsman procedure.

Exceptions

Conciliation by the ombudsman is not possible in the following cases:

• the conflict has already been settled by an out-of-court settlement
• the conflict was or is already the subject of arbitration proceedings at another ombudsman's office or at the Federal Financial Supervisory Authority (BaFin).
• an application for legal aid was dismissed because the action had no prospect of success
• the dispute is dealt with in a court before or during the conciliation proceedings or is brought to court by the applicant during the conciliation proceedings