How do I challenge my accident insurer's medical report?
In short
How to challenge it: first get the full medical report from your accident insurer, have it checked by a doctor and object in writing with reasons. If that fails, the insurance ombudsman is free, and court remains open after that. Your own counter report costs about EUR 1,500 to 5,000 and pays off when more than a few percent of disability are at stake.
What challenging an accident insurance medical report costs in Germany, as of October 2026.
Example
Typical range
Copy of the report under Art. 15 GDPR
EUR 0 for the first copy
Short review of the report by a specialist
about EUR 200 to 600
Independent counter report
about EUR 1,500 to 5,000
Insurance ombudsman
EUR 0
Court appointed expert, fee groups M 2 to M 3
EUR 98 to 131 per hour
Counter report, ombudsman and expert rates come from the listed sources.
The price of a short specialist review is a guide value from quoting practice;
ask for a written fixed price first.
Worked example
Shoulder injury, report says 1/10 of the arm value
After a bicycle fall the shoulder stays limited. The insurer pays 1/10 of the arm value based on its report. A counter report with full range of motion data finds 3/10.
Basic sum
EUR 100,000
Arm value at the shoulder joint
70 percent
Insurer: 1/10 of the arm value
7 percent, EUR 7,000
Counter report: 3/10 of the arm value
21 percent, EUR 21,000
Cost of the counter report
about EUR 2,500
If the counter report prevails, about EUR 11,500 more remain after its cost. With a gap of only 1/20 of the arm value, EUR 3,500, a counter report hardly pays.
Why accident insurance reports are so often disputed
The insurer chooses the doctor, pays them and asks the questions. That does not make the medical report wrong, but it is worth a close look. Most disputes are about three points: the degree of disability under the limb table (Gliedertaxe), the share of pre-existing conditions, and whether a complaint stems from the accident at all.
Typical weaknesses in an accident insurer's medical report are a short examination, missing range of motion measurements, a flat deduction for wear and tear without reasons, and an assessment made before the condition has settled after about a year.
Getting the report and reading it
Ask in writing for the complete report including attachments and imaging results. A report about your health contains your personal data, so under Art. 15 of the General Data Protection Regulation you can request a copy. The insurer normally has to reply within one month.
Read the report with three questions: is the account of the accident correct? Are measurements and findings recorded, or only opinions? Is any deduction for pre-existing conditions explained with a percentage? Wherever the answer is no, you have a point to argue.
A written objection with reasons
An objection without reasons usually gets a short rejection. State exactly which value is wrong and why, and attach evidence: findings from your treating specialist, physiotherapy reports, photos. Set a deadline of four weeks.
Once it has the documents it needs, the insurer must declare within three months whether it accepts a disability claim (section 187 VVG). If liability is established in principle, you can ask for a reasonable advance payment while the amount is still disputed.
Point in dispute
What helps
Degree of disability too low
range of motion from your specialist, comparison with the limb table
Share of pre-existing conditions
records from before the accident, counter report on the share
Complaint said not to be caused by the accident
first findings right after the accident, timeline
Condition gets worse
reassessment up to three years after the accident
Counter report: when it is worth it
An independent medical counter report costs about EUR 1,500 to 5,000 depending on specialty and effort, and you pay it upfront. It is worth it when the gap is large: with a basic sum of EUR 100,000, ten more points of disability mean EUR 10,000, more with progression.
Choose a doctor with experience in private accident insurance, not just a good treating physician. A counter report has to apply the limb table and the policy conditions, otherwise it will convince neither the insurer nor a court later. Legal expenses insurance usually only pays once there is a legal dispute, not for a private report beforehand.
Ombudsman and court
A complaint to the insurance ombudsman (Versicherungsombudsmann) costs you nothing. Up to EUR 10,000 its decision binds the insurer, up to EUR 100,000 it makes a recommendation. You can still go to court afterwards.
In court the judge appoints an independent expert. The hourly rate for difficult causation questions is EUR 131, so a court report soon costs several thousand euros, paid in the end by the losing side. Note: only a lawsuit, a court payment order or a conciliation procedure stops the limitation period, an objection letter does not.
Step by step
Request the full report with attachments in writing.
Check the accident account, findings, measurements and deductions.
Ask your treating specialist for a written statement.
Object with reasons, attach evidence, set a four week deadline.
For a large gap, commission a counter report.
Complain to the insurance ombudsman.
Decide on a lawsuit before the limitation period ends, ideally with a lawyer specialising in insurance law.
Checklist
Complete report with attachments
Your own findings sorted from the first examination until today
Range of motion in the report compared with your own measurements
Deduction for pre-existing conditions explained with a percentage
Limitation period and reassessment deadline in your calendar
Common mistakes
Only phoning and keeping nothing in writing
Believing an objection stops the limitation period
Ordering a counter report from a doctor who does not apply the limb table
Missing the three year reassessment although things get worse
Questions and answers
Frequently asked
Do I have to see the insurer's doctor?
If your policy says so, usually yes.
The insurer normally pays for that examination.
You may bring someone with you and take notes.
How long does a dispute over the report take?
With the ombudsman a few months, in court often one to two years.
If liability is established in principle, you can ask for an advance payment.
Will legal expenses insurance pay for the counter report?
Usually not, because it only pays once there is a legal dispute.
Ask for written cover confirmation first, some policies pay for reports within proceedings.
Can I claim a higher disability later?
Yes, through a reassessment every year for up to three years after the accident.
The insurer must tell you about this right, otherwise it cannot rely on a late request.
Can I write to the insurer in English?
Many insurers accept it, but the policy, the report and any court case will be in German.
A German letter avoids misunderstandings over medical terms.
Is a lawyer worth it?
For medium sums yes, and certainly before a lawsuit.
A lawyer specialising in insurance law (Fachanwalt für Versicherungsrecht) knows the conditions
