Das Sachverständigenverfahren im Versicherungsvertragsrecht

The present book deals with insurance determination based on arbitral award of an expert procedure based on sec. 64, 158 1 and 184 of the Statute on Insurance Contracts. From a legal point of view this procedure is an expert arbitrator procedure because after the damaging event an expert committee determines particular facts important for the insurance claim (e.g. the amount of the damage or the causality). These determinations are basically binding on each party if they are not obviously incorrect. With this expert procedure a quick and cost-effective settlement between insurer and insured should be achieved - as also in a coverage lawsuit these determinations had to be ascertained by a certified expert appointed by the court. The expert procedure is provided for almost all branches of insurance by the model terms of the association of insurance companies of Austria. These terms are regularly adopted by the general terms and conditions of insurance of, the insurers. In property insurance, insurance against basic damages and automobile liability insurance is provided that an expert committee has to determine the causality and the amount of damage as well as the insured value of the insured object. In the legal expense insurance two attorneys-at-law have to evaluate whether the proceedings are suitable for the purpose as well as the chances of success of a law suit. In the accident insurance the Chamber of Physicians decides on the kind and size of the consequences of the accident as well as on the influence of invalidity in case of pre-existing illness. In reality the consequence of the provisions of these model terms is that in the absence of knowledge of this procedure the insured and his attorney-at-law respectively often file the coverage suit prematurely. Regularly, the insurer objects the lack of maturity resulting into the rejection of the complaint of the insured. There are many findings of the Austrian supreme court regarding the issues of maturity and renouncement which demonstrate sufficiently the existing unsatisfying situation. The initial idea of a quick and cost-effective damage settlement turns thus into the opposite and the expert procedure proves to be a "trap" for the insured. An absolute unsatisfying situation! The author presents in the general part (II.) all issues regarding the expert procedure relevant for all branches of insurance. In the subsequent special part (III.) the provisions regarding the individual insurance branches are dealt with. Reform proposals for future drafts of model terms and internal terms of the insurers are submitted. According to the view of the author the expert procedure should be a unilateral institution in favor of the insured solving a full range of problems. Further, numerous improvement proposals are made. In the final chapter (V.) sample forms for the appointment of an expert and general guidelines for the expert procedure are proposed. At present, there is no entire presentation of this field of law in Austria. These gap is now closed with the present book. This treatise is especially designed to support practical work but on other hand tries to keep scientific standards. Austrian and German publications and cases are - if reasonable - considered until July 2000.