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What counts as an accident in private accident insurance in Germany?

In short

What counts as an accident in private accident insurance in Germany? Under § 178 VVG, an accident means an event acting suddenly on your body from outside that involuntarily damages your health. Policies usually extend this by four cases, such as increased physical exertion and rescue efforts. Wear and tear and illness are not accidents.

What counts as an accident in private accident insurance in Germany?

What it costs

What a recognised accident pays: disability benefit under the limb scale (Gliedertaxe) of the model terms with a EUR 100,000 basic sum, without progression.

ExampleTypical range
Hand completely unusable, 55 percentEUR 55,000
Hand impaired by two tenths, 11 percentEUR 11,000
Thumb completely unusable, 20 percentEUR 20,000
Foot completely unusable, 40 percentEUR 40,000
Same damage without an accident, for example from wearEUR 0

As of November 2026.

Accident definition per § 178 (2) VVG, extensions, exclusions,

limb scale and deadlines from the GDV model terms AUB 2020, as of June 2025.

Your policy terms may differ, often in your favour.

Progression and higher limb scales increase the amounts depending on the tariff.

Worked example

Four injured hands, four answers

Each time the hand remains impaired by two tenths. Under the limb scale that is 11 percent disability, EUR 11,000 with a EUR 100,000 basic sum. The only thing that matters is how it happened.

Tripped over a root while jogging, broken wristaccident under § 178 VVG: EUR 11,000
Caught a toppling cupboard, torn ligament in the wristincreased exertion: EUR 11,000
Pulled a dog out of the ice, frostbite on the hand knowingly acceptedrescue effort: EUR 11,000
Wrist worn out after years on an assembly linenot an accident: EUR 0

The same impairment pays EUR 11,000 or nothing. How it happened decides, so it belongs in the claim report straight away and in detail.

What the law says

§ 178 (2) of the German Insurance Contract Act (Versicherungsvertragsgesetz, VVG) defines an accident, in English roughly, as a health impairment the insured person suffers involuntarily through an event that acts suddenly on their body from outside. Involuntariness is presumed until the contrary is proven. The GDV model terms AUB 2020 (Allgemeine Unfallversicherungsbedingungen) adopt the first sentence almost word for word.

Statutory accident insurance (gesetzliche Unfallversicherung), run by the employers' liability insurance associations (Berufsgenossenschaften), uses a similar but separate definition from the Social Code: events limited in time that act from outside. Private accident insurance (private Unfallversicherung), on the other hand, covers you around the clock, including leisure time and at home, and follows only the law and your policy terms.

The four features checked one by one

Every feature must be present. If one is missing, it is not an accident, even if the injury is serious. The table shows where cases fail in practice and where they do not.

FeatureWhat it meansTypical borderline case
suddenthe event acts within a short time, not over weeks or yearsarthritis or wear from years of strain: not an accident
from outsidesomething outside the body acts on it, such as the ground, an object, water, an animalheart attack or slipped disc with no outside cause: not an accident
involuntaryyou did not want the damage to your healthinjury knowingly accepted during a rescue: only through the extension in the policy
damage to healtha physical injury or impairment has occurreda fright without injury: no claim

What the policy also counts as an accident

The AUB 2020 model terms extend the definition by four cases. First, increased physical exertion (erhöhte Kraftanstrengung): if a joint in your limbs or spine is dislocated, or a muscle, tendon, ligament or capsule is strained or torn, because you used more force than in normal daily activities, this counts as an accident. The yardstick is your own physical condition. Meniscus and spinal discs are expressly excluded.

Second, health damage from escaping gases if you were exposed to them unknowingly or unavoidably, up to a duration named in the policy. Third, accidents under water: involuntary drowning or suffocation and diving related injuries such as a damaged eardrum. Fourth, injuries you knowingly accept while rescuing people, animals or property. This last case in particular would not be an accident under the law alone, because it is not involuntary.

Who has to prove what

The law presumes only one thing in your favour: that you did not hurt yourself on purpose. If the insurer wants to dispute that, it must prove it. You, on the other hand, must show that a sudden event from outside acted on you at all.

That is why the account of what happened matters so much. "Sudden pain in my shoulder" does not describe an accident. "Something tore in my shoulder as I lifted the full crate of drinks" describes increased exertion. Write down what happened on the same day, name witnesses and tell the doctor how it happened so it appears in the report. If your German is limited, write the account in English as well and ask the doctor to record the cause clearly.

An accident, but still no payout

Even if there was an accident, an exclusion may apply. Under the model terms, accidents caused by disturbances of consciousness, for example from alcohol, medication or a circulatory problem, and by strokes and seizures are not covered. The same goes for psychological reactions, most infections and damage to spinal discs unless the accident caused more than 50 percent of it.

If illness or wear contributed, the insurer reduces the payout by that share, under the model terms from 25 percent contribution. Better tariffs set a higher threshold or drop some exclusions. If you already have occupational disability insurance (Berufsunfähigkeitsversicherung) and no risky hobbies, accident insurance is often not the first policy you need: it never covers illness, the most common cause of lasting impairment.

Step by step

  1. Write down what happened on the same day: what, when, where, which movement, who was there.
  2. Tell the doctor clearly that it was an accident and how it happened.
  3. Report the accident to the insurer, even if the consequences are still unclear.
  4. Check in your own policy terms which extensions of the accident definition apply.
  5. If an impairment remains, have the disability confirmed by a doctor and claim it within 15 months.

Checklist

  • Increased exertion included in the accident definition
  • Checked whether the tariff also includes meniscus or your own movements
  • Threshold for contributing wear at 25 percent or better
  • Accidents from heart attack or stroke: exclusion removed or limited
  • Rescue efforts and accidents under water expressly covered
  • Disability deadlines in your calendar

Common mistakes

  • Only mentioning pain to the doctor without saying how it happened
  • Assuming every sports injury is automatically an accident
  • Not reporting a fall after dizziness at all instead of letting the insurer check
  • Letting the 15 months for medical confirmation pass

Questions and answers

Frequently asked

Is twisting your ankle while walking an accident?

Often yes, if uneven ground or an obstacle was involved, because then something acts from outside.

If a ligament tears with no outside cause, only a tariff that includes your own movements helps.

Do I have to prove I did not hurt myself on purpose?

No.

§ 178 VVG presumes involuntariness.

If the insurer claims intent, it must prove it.

Is a torn meniscus when standing up an accident?

Not under the model terms, because the meniscus is not covered by increased exertion.

Some tariffs expressly include it.

Is drowning an accident?

Under the model terms yes, involuntary drowning and suffocation under water expressly count as

accidents.

If a disturbance of consciousness caused it, the exclusion still applies.

What about an injury during a rescue?

If you knowingly accept an injury to rescue people, animals or property,

you are covered under the model terms, even though the injury was not involuntary.

Is the definition the same as for statutory accident insurance?

No.

Statutory accident insurance defines accidents separately in the Social Code and only pays for

insured activities, for example at work or on the way to work.

Sources

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