Questão jurídica principal
Whether the insured’s psychiatric condition excused the delayed IV application under the exception to the twelve-month backpayment limit.
Decisão extraída
The condition did not amount to the kind of incapacity required for the exception; the insured remained able to recognize and act upon the need to claim benefits.
Fundamentação extraída
Urteilsunfähigkeit requires a severe, enduring impairment of insight and ability to act. The medical reports showed personality disorder traits and emotional instability, but not a lasting loss of awareness or practical ability to initiate an IV claim, even if claiming was difficult.