When does private accident insurance pay?
A fall and a few weeks in a cast don't automatically trigger a big payout. The central benefit is usually the disability benefit: an agreed amount of money for a permanent physical or mental impairment following an insured accident.
According to § 180 VVG, an impairment is permanent if it is expected to last longer than three years and no change in this condition is expected. This is a forecast. Therefore, you should not wait three years before filing a claim; the contractual deadlines can end much earlier.
The cause must also fit the definition.
The legal starting point is an event that suddenly affects the body from outside and involuntarily causes damage to health. Tariffs can expand this definition of accident, for example for certain injuries caused by increased physical exertion or personal movement. An illness alone does not generally become an accident.
Disability capital
A one-off service can, for example, be used for necessary renovations or additional support. The amount and requirements result from the basic amount, degree of disability and tariff.
Search, rescue and recovery
Such costs may be covered as an additional benefit. Compare maximum amounts, conditions, and how they differ from benefits provided by other insurance policies.
Help in everyday life
Certain tariffs provide for household help, driving services or other assistance after an accident. Check whether a service is organized or just a sum of money is paid and how long the help lasts.
Further cash benefits
Accident pensions, immediate benefits or daily hospital benefits require a suitable agreement. Each building block has its own triggers. A long list of benefits is no substitute for adequate disability benefits.
Being legally insured does not cover all activities.
Statutory accident insurance is linked to certain activities, such as work, school or an insured route. A private policy can also cover recreational accidents. The difference is not simply between working days and weekends or between indoors and outdoors.
Statutory accident insurance
It provides statutory benefits for insured work-related and commuting accidents as well as occupational diseases, for example treatment, rehabilitation, and, under certain conditions, cash benefits. Home office activities may also be covered.
Other insured activities are possible, such as certain voluntary tasks or assistance. Mandatory or voluntary insurance can be available for self-employed people.
Private accident insurance
It provides coverage according to the agreed contract and can include work and leisure activities around the clock, often worldwide. Sports, activities, and other exclusions must still align with your daily life.
Private disability benefits can exist alongside statutory benefits. The calculation follows its own rules.
Treatment after a recreational accident does not remain unpaid simply because the statutory accident insurance is not responsible. That's what she can do Health insurance be responsible within the respective performance framework. The additional financial need due to permanent consequences is a different question.
The schedule of benefits determines the amount of the payout.
The schedule of benefits assigns a percentage to specific body parts and sensory organs for total loss or total loss of function. In cases of partial impairment, the assessment is made proportionally. The values may vary from one tariff to another.
A diagnosis alone does not reveal the payout amount. It depends on the remaining function, the medical diagnosis and the conditions. There are additional evaluation rules for impairments outside the table. A pre-existing impairment can also be relevant.
This is how the degree of disability affects the basic amount.
Assumed basic sum: 100.000 Euro. The invoice shows an insured degree of disability without progression, previous disability, involvement of illnesses or other deductions. It does not evaluate an injury.
This is the degree of disability as defined by insurance law. It is not the official government-assigned degree of disability.
In the case of 0 percent disability, there is no disability benefit in this calculation.
No promise of performance and no medical assessment. The determination and conditions in the specific case are decisive. The selection will not be saved or sent.
What does progression do?
Progression increases the benefit at higher levels of disability beyond the simple prorated calculation. The percentage in the tariff name usually describes the benefit in the event of total disability. The path to it is shown in a table.
100.000 Euro basic sum, different maximum performances
- Without progression
- 100.000 €
- 225 % progression
- 225.000 €
- 350 % progression
- 350.000 €
These values apply to the presented agreements in the event of total disability. For 20 or 50 percent disability you need the specific progression table; intermediate values cannot be determined from the maximum value alone.
Therefore, compare the actual euro amounts for several degrees of disability. A high progression cannot arbitrarily compensate for a base sum that is too low in cases of minor impairment. Two offers with the same maximum amount do not necessarily provide the same benefits for 20 or 50 percent disability.
What role do pre-existing conditions play?
If illness or disability contributes to the accident consequences, the contract may provide for a reduction. The threshold for the contribution share and the extent of the reduction depend on the tariff. A pre-existing functional impairment and the contribution of an illness are distinct assessment criteria. Read both rules, especially if you already have health restrictions.
Your comparison
Compare the benefits table, not just the maximum amount.
Set the basic amount and progression, then check the benefits for different degrees of disability and the exclusions.
For whom is accident insurance useful?
First, consider which financial problem you want to solve. For the permanent loss of your earned income, the Occupational disability insurance the more comprehensive test because illnesses also play a role. Private accident insurance can supplement it, but does not replace it.
If you cannot get suitable occupational disability protection, this distinction does not disappear. Accident insurance can then cover part of the risk, but generally leaves illness-related restrictions open.
Children
Daycare centers and schools provide statutory protection for specific activities, not for every hour of the day. Private accident insurance can supplement this. However, also compare how the consequences of serious illnesses would be covered; pure accident insurance fundamentally excludes them.
Seniors
After an accident, specific help with shopping, household tasks, or transportation can become important. Check the duration of benefits and the organization of assistance, as well as age limits, future premium changes, and the impact of pre-existing conditions.
Self-employed and physical professions
The activity must be correctly stated. Also clarify what legal or voluntary accident protection already exists. A one-off disability benefit does not automatically cover every temporary break from work.
Sports and active leisure
Describe your sports and how you practice them specifically. An occasional outing may be treated differently than competitive sports. Also pay attention to extensions for self-movement and effort as well as rescue and recovery costs.
How much does private accident insurance cost?
Age, professional activity, agreed benefits and the number of insured persons influence the premium. The sum insured, progression and additional modules must be identical in the comparison; otherwise you will see different prices for different levels of protection.
An accident pension can significantly increase your premium and typically requires a specific level of disability. Assess whether this feature suits your needs or if a higher lump-sum payment better covers your expenses. The same applies to daily allowances and other add-ons.
With accident insurance with premium refunds, risk protection is combined with a savings process. Therefore, don’t just compare the costs and conditions with those of pure accident insurance. A repayment does not automatically make the protection more economical.
Before taking out the policy, the limb tax, progression table, participation rules, deadlines and exclusions should be considered together. You answer health questions according to the exact wording. Also check which changes to your occupation or other material risk information you need to report later.
The accident report alone does not ensure every deadline.
After an accident, several deadlines may run concurrently: the deadline by which disability must have occurred, the deadline for medical confirmation, and the deadline for filing a claim. These timeframes vary by contract. A blanket monthly figure would be unreliable here.
Report the accident promptly, secure your documents, and ask for the remaining requirements in writing. If permanent consequences are possible, speak to the treating practice in good time about the necessary assessment. A general doctor's letter does not automatically meet all of the insurer's requirements.
Report accident
Record the event, time and course in a comprehensible manner. Observe the contractual reporting obligations.
Note deadlines
Record the onset of disability, medical diagnosis and claim separately in the calendar.
Clarify documentation
Obtain required medical documents in a timely manner and submit them via the secure route provided.
Review benefits
Verify the assessment, disability rating scale, progression, and any potential deductions. Ask for clarification if any calculations are unclear.
If you want to financially protect relatives in the event of death, read this too Term life insurance. An accidental death benefit is narrower. For travel, there can also be a International travel health insurance be important, for example for treatment and repatriation on their own terms.
Häufige Fragen: Private Unfallversicherung
Does private accident insurance make sense?
It can make sense if permanent accident consequences would result in high additional expenses that your reserves do not cover. Before doing so, check your general income protection. Occupational disability insurance can also cover illness; accident insurance generally only covers insured accident consequences. The two policies address different financial problems.
When does accident insurance pay disability benefits?
If an insured accident causes permanent impairment and the contractual requirements are met. This includes deadlines for the onset of disability, its medical assessment, and filing the claim with the insurer. An injury that heals without permanent consequences does not normally trigger this lump-sum payment.
How much money is there for a broken bone?
No disability benefit can be derived from the diagnosis alone. The decisive factors are the permanently remaining functional impairments and the contract conditions. If the fracture heals completely, there is usually no disability claim. Separate compensation for pain and suffering, an immediate benefit or daily hospital benefit is only available if the tariff provides for a suitable benefit.
What does 350 percent progression mean?
With a corresponding agreement, the disability benefit reaches 3,5 times the basic amount at 100 percent disability. 100.000 Euro basic sum then becomes 350.000 Euro. The progression table shows how high the benefit is for lower levels of disability. You cannot therefore simply multiply each degree of disability by 3,5.
Is the joint tax the same everywhere?
No. It assigns percentages to the complete loss or inability to function of certain body parts and sensory organs. Insurers can agree on different values. In the event of a partial functional impairment, the assessment will be proportionate; Other contractual rules apply outside the table. The degree of disability is not the same as the official degree of disability.
Do children need their own accident insurance?
Statutory insurance in daycare or school does not automatically cover every leisure activity. Private accident benefits can supplement this gap. However, they do not generally capture the consequences of serious illnesses. Therefore, also compare what financial risk you actually want to insure against for your child. A family plan must explicitly include each desired child.
Does private accident insurance cover worldwide and around the clock?
This is the intended scope for many policies, including for leisure accidents. Nevertheless, the terms and conditions remain decisive. Certain sports, occupational risks, war events or other exclusions may limit coverage. Search and rescue costs and medical repatriation must be checked separately and should not be equated with disability benefits.
Does accident insurance replace term life insurance?
No. An agreed accidental death benefit only applies under the special circumstances following an accident. Term life insurance is generally not limited to this cause of death. If you want to protect a loan or your family's livelihood, check the more comprehensive death protection separately.
Your comparison
Also review the lower disability levels.
Compare the payout from the same basic sum for 20, 50, and 100 percent disability. The progression can only be assessed using the benefit table.
Sources and Status
Content last updated: . General information, not individual insurance, legal or tax advice. The respective contract and the statutory requirements apply to acceptance and benefits. Sample calculations are not tariff offers.
- Consumer advice center: Benefits and limitations of private accident insurance (opens in a new tab)
- § 178 VVG: Accident definition and agreed accident benefits (opens in a new tab)
- § 180 VVG: Permanent accidental disability (opens in a new tab)
- § 2 SGB VII: Activities and persons legally insured (opens in a new tab)
- § 8 SGB VII: Work and commuting accidents (opens in a new tab)