The quota privilege is a legal term that has meaning in the case of damages if the damage to the injured party was initially borne by a community (e.g. statutory or private health insurance , own fully comprehensive insurance , continued payment of remuneration by the employer or employer) (see also under coverage fund ) .
In these cases, the claim for damages of the injured party is regularly transferred to the insurance carrier (insurer, employer, employer), provided that he has compensated for the damage. The problem of the quota priority arises when the claim for compensation against the injuring party is not sufficient to fully satisfy the damage remaining with the injured party and the claim that has been transferred. This is typically the case if the claim for damages is limited due to joint liability of the injured party himself or due to the maximum liability being exceeded.
- The accident victim has a total damage of € 10,000. The health insurance has already taken over € 5,000 of this in treatment costs. The injured party only has a 75% claim for contributory negligence, a total of € 7,500 against the other party involved in the accident.
The quota privilege in this constellation deals with the question of how these 7,500 € are divided between the injured party and the community. If, in the example, the principle of full transfer of entitlement to health insurance were to remain, this would be € 5,000 and the injured party could only claim € 2,500, i.e. only half of the remaining damage.
Legal situation in Germany
Private insurance and continued payment of wages
In most cases, the German law for the protection of the injured party stipulates that he / she is entitled to a quota priority (according to VVG for private insurance, paragraph 3 EntgFG for continued remuneration by the employer and BBG for continued remuneration at Officials). This is expressed in the law by the fact that the claim that has been transferred to the community may not be asserted to the detriment of the injured party. In the example, a private health insurance company , the employer and the employer are therefore only allowed to make a claim of € 2,500 to ensure that the injured party receives full compensation for the remaining damage.paragraph 1 sentence 2
Statutory insurance and social assistance
The legal situation is particularly difficult with statutory insurance and social assistance.
Earlier legal situation
There used to be a quota privilege of the community according to § 1542 RVO ( Reich Insurance Code ). In those cases in which the liability of the injuring party is subject to a sum limit for material reasons, the benefits of his liability insurer were initially used to satisfy the social security agency for its benefits, whereas the injured party himself was only used for his other claims - such as pain and suffering compensation remaining balance was available. This primary satisfaction of the right of recourse of a social insurance agency against the direct claim of the injured party was called the quota privilege of the social insurance agency.
Current legal situation
In a deliberate departure from the earlier regulation, the quota privilege in Book 10 of the Social Security Code (SGB X) was newly regulated and better protection for the victim was introduced. The law distinguishes between the cases of limitation of liability through maximum liability limits, which is regulated in paragraph 2, and limitation through joint liability, which is concerned with paragraph 3.
Maximum liability limit
If the amount of the claim to compensation for damage is limited by law, it is transferred to the insurance or social welfare agency, unless it is necessary to compensate for the damage suffered by the injured party or his or her survivors. In this case, the injured party has full quota prerogative, whereby the transfer of the claim and not its assertion is prevented.
If the claim for compensation for damage is limited by contributory negligence or contributory responsibility of the injured party, according to the "relative theory" partially represented in the literature, the insurance carrier or social welfare carrier from the claim for compensation that is transferred according to paragraph 1 with unlimited liability goes to Share over, which corresponds to the percentage for which the injuring party is liable.
In our example, the entitlement would only pass over 75% of the € 5,000 paid, i.e. € 3,750. The remaining claim would remain with the injured party in the same amount. As a result, the community and the injured party each receive 75% of “their” damage. In this case, there seems to be no quota privilege of one or the other, but both (injured party and insurance) have to accept deductions in the amount of the joint liability quota. On closer inspection, however, the effect of the quota privilege in favor of the injured party becomes apparent: he received € 5,000 from his insurance. Due to his joint liability, his insurance is only reimbursed 75% from the injuring party (€ 3,750). However, this does not mean that the insurance company can claim back the difference of € 1,250 from the injured party. The € 5,000 paid by the insurance company will therefore remain with him and his damage has been reduced to € 5,000. In addition, however, he may demand € 3,750 from the injuring party. In total, he receives 8,750 € for his damage (5,000 € from his insurance, 3,750 € from the injuring party). This corresponds to a rate of 87.5%, although 25% of the liability is also included. This betterment of the injured party is the characteristic of the quota privilege.
According to the prevailing "difference theory", however, there is a different calculation.
In addition, the legal situation is complicated by the fact that there are special rules for special cases. They are:
- The injured party would become a welfare recipient through the subrogation;
- the enforcement of the claim faces actual obstacles; and
- the carrier's benefits do not increase as a result of the damaging event.
- The quota privilege - if you don't know it, you are giving away money! (PDF) juratexte.de - Article that illuminates the function of the quota privilege using the example of traffic accident damage, for which the injured party can claim not only the other party involved in the accident but also their own comprehensive insurer. With calculation examples.
- Calculation of the claims for compensation taking into account the preferential quota after taking out your own fully comprehensive insurance . juratexte.de - Interactive table with the help of which you can calculate the amount of the remaining claims against the other party involved in the accident after taking out your own comprehensive insurance, taking into account the preferential quota