Legal accident protection for clinic patients
If one is a patient in a hospital or rehabilitation clinic and has an accident during the hospital stay or on the way there and home, one is normally entitled to benefits from the statutory accident insurance scheme. But there are also numerous exceptions.
According to the Verwaltungs-Berufsgenossenschaft (VBG), anyone who is treated in hospital or in a rehabilitation clinic at the expense of the statutory health or pension insurance can be covered by the statutory accident insurance scheme. However, even here there are numerous cases in which the statutory accident protection does not apply. This depends, among other things, on when and where the accident occurred, who had the accident, but also who is paying for the hospital or rehabilitation treatment.
Patients who receive inpatient or day-care treatment in a hospital or who undergo inpatient or day-care medical rehabilitation and have an accident in the process are covered by statutory accident insurance. However, this only applies if the treatment is covered by the statutory health or pension insurance, as the Verwaltungs-Berufsgenossenschaft (VBG) explains. In addition, it also depends on the circumstances of the accident, to what extent a legal accident protection is given.
Statutory accident insurance provides benefits in the context of hospital and rehab treatment only if the accident occurs during an activity related to the treatment or rehabilitation. Accidents on the way to and from the hospital or rehabilitation facility as part of treatment are also covered by statutory accident insurance.
Statutory accident protection: not for every accident ..
Accidents that happen to a patient in the patient's room or in the hallway of the hospital, for example, if the patient falls out of bed or falls in the hallway, would be legally covered by accident insurance. But also, if he injures himself during a medically prescribed therapy measure on a medical device, this falls under the protection of the statutory accident insurance.
However, there are many activities that are common among hospital and rehabilitation patients, but still do not fall under the statutory accident protection. This includes all activities that can be assigned to the private sphere, such as accidents that occur while shopping at the kiosk, eating in the hospital dining room or using the toilet. Even accidents while showering, unless the showering takes place immediately before a medical examination or after a therapeutic treatment, are not covered by the statutory accident insurance.
Accidents whose cause lies exclusively with the patient, such as a fall due to a circulatory weakness caused by low blood pressure, are also not covered by statutory accident insurance. The same applies to injuries and other damages that someone suffers because of faulty medical, nursing or therapeutic treatments. This includes, for example, injuries resulting from (unsuccessful) medical intervention, the administration of incorrect medication or incorrectly performed therapy treatments such as a rib fracture by a masseur.
… and not for every patient
In addition, there are patient groups that are excluded from the statutory accident insurance in the hospital. This includes women admitted for childbirth, as well as patients undergoing pre-hospital or post-hospital treatment, outpatient preventive services at a health resort, or outpatient (medical) treatment. The same applies to people who go to a hospital solely to have an early diagnosis or assessment performed, or who receive an outpatient preventive measure at a health resort.
Accidents suffered by persons who receive outpatient or inpatient benefits from the social long-term care insurance system or who, as self-payers, bear the costs of medical or therapeutic treatment, are also not covered by the statutory accident insurance system. Patients whose treatment is covered by private health insurance or – in the case of civil servants – by allowances also have no statutory accident cover.
If there is statutory insurance cover, according to the German Statutory Accident Insurance e.V. (DGUV) the VBG responsible for it. However, patients who have had an accident should first contact the appropriate hospital or therapy facility. If there are doubts whether an accident is legally covered or not, this can be inquired at the VBG – the responsible offices can be taken from a free downloadable information flyer of the VBG.
All-round protection through private insurance
As the regulations show, there are numerous accidents for which the statutory accident insurance does not apply. By the way, all leisure time accidents and private activities during work are excluded from the statutory accident protection for employees. And even a small detour as a patient, employee or student means that an accident during this time is not covered by statutory accident insurance.
But even if there is statutory accident insurance, the benefits paid out are often insufficient to compensate for the loss of income and subsequent financial costs in the event of a prolonged inability to work due to an accident or permanent damage to health. In contrast, private accident insurance offers not only worldwide protection, but also round-the-clock coverage. So she pays for accidents, even if they happen in her free time and during private activities.
In addition, benefits such as a certain capital sum or monthly pension in the event of disability, but also salvage and search costs, cosmetic surgery costs and a death benefit can be contractually agreed in such a private accident policy. This can also be used to compensate for missing or legally insufficient benefits. Detailed advice is available from an insurance specialist.