What happens to accident insurance when a care level is assessed in Germany?
In short
It depends on your policy terms. What happens is set out in the contract: many German policies treat a person with care level (Pflegegrad) 4, older ones with care level 3, as uninsurable. When such a care level is assessed, the accident insurance ends and premiums paid since then are refunded. The model terms AUB 2020 no longer contain such a clause. Care levels 1 and 2 are usually no problem.
Premiums for seniors in Germany from published examples and worked examples.
Example
Typical range
Senior accident insurance from age 60 or 70
about EUR 120 to 460 a year
Refund when uninsurable, EUR 30 a month, care level 4 for 8 months
EUR 240 back
Prior disability: arm already impaired by a tenth, fully after the accident
70 minus 7 percent, so 63 percent disability
Premiums from publicly quoted examples, as of July 2026.
The worked examples follow the model terms; your contract may set other thresholds.
Worked example
Mother, 82, assessed at care level 4
Her daughter has paid EUR 30 a month for years for her mother's accident insurance. In March care level 4 is assessed, in November the mother falls.
Policy terms
uninsurable from care level 4
Cover
lapsed from March
Benefit for the fall in November
none
Refund March to November
about EUR 240
The family gets the premiums back but nothing for the fall. Under AUB 2020 without the clause, the accident would have been covered.
What the uninsurability clause means
Many German accident insurers state in their terms that people permanently in need of substantial care are uninsurable. This refers to care levels under the long term care insurance (section 15 of Social Code XI, SGB XI). Once such a care level is assessed, cover lapses automatically, even if you keep paying.
The insurer must refund premiums from the date the person became uninsurable. An accident after that date is no longer covered. This hits older people hardest, for whom a fall is especially serious.
Which care level counts under which terms
The threshold is not uniform. Older terms exclude from care level 3, many current ones from care level 4. The insurance association's non binding model terms, AUB 2020, have dropped the clause entirely. Which version applies to you is shown in your policy schedule.
So with a care level and accident insurance, always check two things: which set of terms you agreed and which care level has been assessed.
Care level under section 15 SGB XI
Meaning
Effect in many accident policies
1
minor impairment of independence
contract continues
2
considerable impairment
contract continues, some assistance services dropped
3
severe impairment
contract ends under older terms
4
most severe impairment
contract ends under many terms
5
most severe impairment with special care needs
contract ends under many terms
A care level caused by an accident
It is different if the accident itself leads to the care level. The accident happened while the person was still insurable and is therefore covered in principle. The disability benefit is based on the lasting harm, often boosted by progression in severe cases.
Whether the contract then continues, and how benefits after the lapse are handled, is set by the clause. Read the wording carefully before any deadlines pass.
Previous conditions and care needs when calculating benefits
Even without an exclusion clause, existing impairments can reduce the benefit. If a body part was permanently impaired before the accident, this prior disability is deducted (clause 2.1.2.2.3 AUB 2020).
If illnesses contributed at least 25 percent to the consequences, the disability degree is cut by that share (clause 3.2 AUB 2020). For people in care with arthritis or osteoporosis this is common.
When accident insurance no longer makes sense
At care level 4 or 5 the person usually lives with permanent care, and the long term care and health insurers cover much of what follows a fall. A policy that lapses anyway only costs money.
At care level 1 or 2, a policy with assistance services can still be useful if it does not exclude them. Whether it does is in the terms.
Step by step
Find the policy schedule and check which set of terms applies.
Search the terms for uninsurable persons and care level.
Compare the assessed care level with the threshold.
If it is above, inform the insurer and ask for the premium refund.
At care level 1 or 2, check whether assistance services still apply.
Checklist
Policy schedule with the version of the terms
Care fund decision with date and care level
Clause on uninsurable persons read
Assistance services and their limits checked
Premium payments stopped from the date of uninsurability
Common mistakes
Paying on for years after care level 4 and believing you are covered
Assuming any care level ends the insurance
Not checking the version of the terms, though old and new differ widely
Questions and answers
Frequently asked
Do I have to tell my accident insurer about the care level?
Your contract governs this.
Report it anyway once it reaches the threshold, so you do not pay for cover that has lapsed.
Can I take out new accident insurance with a care level?
With care level 1 or 2 often yes.
Above the threshold in the terms, insurers do not accept new applicants.
Does accident insurance pay if the accident causes the care level?
In principle yes, because the accident happened before the care level.
Still check how your terms treat benefits after uninsurability begins.
Are there tariffs without a care level clause?
Yes, the model terms AUB 2020 have none.
Whether a specific tariff does without one is stated in its terms.
