The IV. Civil Senate of the Federal Court of Justice has ruled that the policyholder may be entitled to information about past premium adjustments in private health insurance on the grounds of good faith if he is excusably uncertain about the existence and scope of his right. On the other hand, Article 15 (1) and (3) of Regulation (EU) 2016/679 (General Data Protection Regulation - GDPR) do not generally give rise to a claim to copies of the explanatory letters regarding the premium adjustments, including attachments.
Facts and course of proceedings:
The plaintiff contests the effectiveness of premium adjustments in his private health insurance. In his action, he requested from the defendant insurer, among other things, information on all premium increases from the years 2013 to 2016 by submitting documents containing information on the amount of the premium increases and naming the respective tariffs, the cover letters sent to him with reasons, the supplements to the insurance policy, and the supplementary sheets. He made this request as part of a step-by-step action in which he sought, among other things, a declaration that the increases, which still need to be specified more precisely, were invalid and payment of an amount to be quantified after the information has been provided.
The Regional Court dismissed the action. The Court of Appeal partially amended the judgment of the Regional Court and ordered the defendant, among other things, to provide information as requested. To the extent that the action was successful, the defendant's appeal is directed against this.
The Senate's decision:
The Federal Court of Justice has ruled that the action for information is admissible. It is true that the request for legal protection is inadmissible as a step action within the meaning of section 254 of the Code of Civil Procedure, as the plaintiff is not concerned with quantifying a claim but with examining whether a claim exists at all. However, the request for information can be reinterpreted as a claim independent of the staging. The plaintiff also has a legitimate interest in the information requested, as he needs it to check whether past increases in contributions were ineffective and whether he is entitled to repayment claims as a result.
A policyholder may be entitled to information on past premium adjustments on the grounds of good faith. This claim presupposes first of all that he may still be entitled to repayment claims on the basis of earlier premium increases, if these should have been ineffective, as a reason for the request for information. In addition, it is necessary that he no longer has the relevant documents and cannot obtain the necessary information himself in a reasonable manner. If this is the case, it must be decided, taking into account the reasons for this loss, whether he is in excusable ignorance of his right. The policyholder must explain and prove the circumstances relevant to this.
On the other hand, such a right to information does not follow from Article 15 (1) and (3) of the GDPR. A claim to a copy of the entire explanatory letters including attachments cannot be derived from Article 15 (1) of the GDPR, since neither the cover letters themselves nor the attached attachments in their entirety constitute personal data of the policyholder. Article 15 (3) of the GDPR only gives rise to a claim to a copy of the data for which information would have to be provided pursuant to Article 15 (1) of the GDPR, but in principle no claim to the surrender of copies of specific documents. In this regard, the Court of Justice of the European Union ruled in its judgment of May 4, 2023 (C-487/21, NJW 2023, 2253) that Art. 15(1) GDPR defines the subject matter and scope of the right of access and Art. 15(3) GDPR defines the practical modalities for the fulfillment of the obligation; therefore, Art. 15 GDPR cannot be interpreted as granting a right in its first sentence of Paragraph 3 other than the one provided for in its Paragraph 1.
The appeal was partially successful on this basis and led, among other things, to a reversal of the judgment of the Court of Appeal with regard to the claim for information. Insofar as the Court of Appeal has not yet examined all the prerequisites for a claim for information in good faith, the Federal Court of Justice has referred the matter back to the Court of Appeal for a new hearing and decision so that it can make up for this.
Judgment of the BGH dated September 27, 2023 - IV ZR 177/22
Source: Press release of the BGH of 27.09.2023, No. 164/2023
