case of insurance

Insured event (also called damage event or benefit event depending on the context ) is a term from insurance law and describes a damage event that triggers an insurer's obligation to provide benefits . It applies to both private insurance and statutory social insurance , regardless of whether it is composite or personal insurance .

General

In many provisions of the Insurance Contract Act (VVG), the term insured event is mentioned, but there is no legal definition of it. The official justification for § 100 VVG contains a clarifying remark, according to which the definition of the insured event in the insurance contract can be freely agreed. Among other things, the damage event (e.g. general liability insurance), legal infringement (e.g. lawyer and notary liability insurance), planning error (e.g. architect's liability insurance), the placing on the market of a product (e.g. product liability insurance) are agreed as insured events ), the initial determination of the damage (e.g. environmental liability insurance) or the notification of the damage.

With the occurrence of the insured event, the insurer's obligation to provide benefits is established. The occurrence of the insured event is therefore a prerequisite for insurance to provide benefits. Conversely, this means that an insured event does not exist if an event does not result in a performance obligation. An insured event always occurs when an insured risk actually materializes. Conversely, not every insurance claim results in a liability insurance (s. U. Power of freedom ).

Notification requirement

The policyholder must immediately notify the insurer of the occurrence of the insured event after becoming aware of it ( Section 30 (1) VVG). The policyholder must provide any information that is required to determine the insured event or the scope of the insurer's obligation to provide benefits ( Section 31 (1) VVG). It is one of the contractual obligations of the policyholder to truthfully and completely inform the insurer of all damage-related circumstances.

Individual types of insurance

The insured event of illness gives rise to claims from statutory health insurance . There are also pregnancy and motherhood , which are not diseases - these are so-called non- insurance benefits , as well as z. B. also for preventive medical check-ups - as well as the illness of a child and represent an insured event which triggers the benefits of maternity allowance , maternity care and ( child ) sickness benefit , for example .

In the statutory accident insurance , the accident at work and the occupational disease are the insured events that trigger benefits.

In statutory and private accident insurance , an insured event is an 'accident' in the sense of an event that suddenly affects the body from the outside and as a result of which the insured person involuntarily suffers damage to his health. In addition, other circumstances can be equated to accidents in private accident insurance through contractual agreements.

In the statutory pension insurance , on the one hand, illness may be the insured event for rehabilitation measures to be initiated (but must then be distinguished from the obligation to provide benefits from health or unemployment insurance , and the principle: "Rehabilitation before retirement" applies) and, on the other hand, reaching a certain age ( Old-age pensions ), the occurrence of reduced earning capacity ( disability pension ) or the death of the insured person ( survivor's pensions or child-raising pensions ) the insured event. The technical term in pension law has been benefit case since 1992.

The insured event in household contents insurance is the destruction, damage or loss of insured items due to an insured risk at the insured location during the material duration of the insurance cover.

In liability insurance , in addition to the damaging event, legal violations, planning errors, the placing on the market of products or the notification of damage can be the reason for the insurer's obligation to take effect.

Time of entry

It is difficult to determine the exact time of the insured event, especially in the case of damage that occurs or becomes apparent with a delay. But it is decisive if the insurance only existed for a certain period of time. The insurance conditions stipulate the following possible points of contact for the occurrence of the insured event:

Time of the first damaging event (e.g. the first drop of poison that seeps into the ground)
Period of the damaging event with proportional liability (e.g. the entire infiltration process)
Realization of the damage (e.g. exceeding the limit value for soil pollution )
Discovery of the damage
Mobilization of the insurer ( Claims Made )

Freedom to perform

The practically most important cases of exemption from performance relate to the breach of contractual obligation ( Section 28 VVG), the breach of the duty to provide information after the occurrence of the insured event ( Section 31 VVG, a lex imperfecta , i.e. the legal consequence only results from the insurance conditions) and the causing of the insured event by the policyholder.

In § 81 para. 1 VVG, is determined that the insurer is released if the policyholder intentionally causes the insured event. If the insured event is caused by gross negligence, the insurer can reduce its benefits in proportion to the severity of the fault of the policyholder (Section 81 (2) VVG). This means that there is an obligation to perform in the event of slight negligence.

"Bringing it about" can also happen through omission instead of active action. The BGH understands this to mean the behavior of someone “who allows the imminent realization of the insured risk, although he has the appropriate means to protect the insured interest in his hands and, if his interests are reasonably perceived, could and should make use of them just like an uninsured person Person, provided that he only has knowledge of circumstances from which it emerges that the occurrence of the insured event has moved into the area of the possibilities to be taken directly into consideration. "

Individual evidence

↑ Draft law of the federal government - draft of a law to reform insurance contract law , BT-Drucksache 16/3945 of December 20, 2006, p. 85 (PDF; 1.7 MB)
↑ ^a ^b Véronique Wagner, The culpable bringing about of the insured event in the damage insurance after the VVG reform 2008 , 2010, p. 58 f.
↑ Horst Dietz, Household Insurance 84: Conditions, Clauses, Premium Guidelines, Insurance Technology , 1988, p. 76.
↑ Philipp Stoecker, The intent of the policyholder in bringing about the insured event within the meaning of Section 103 VVG , 2011, p. 29 f.
↑ BGH, judgment of April 14, 1976 - IV ZR 29/74 - VersR 1976, 649 f.

[1] Draft law of the federal government - draft of a law to reform insurance contract law , BT-Drucksache 16/3945 of December 20, 2006, p. 85 (PDF; 1.7 MB)

[wagner-2] Véronique Wagner, The culpable bringing about of the insured event in the damage insurance after the VVG reform 2008 , 2010, p. 58 f.

[3] Horst Dietz, Household Insurance 84: Conditions, Clauses, Premium Guidelines, Insurance Technology , 1988, p. 76.

[4] Philipp Stoecker, The intent of the policyholder in bringing about the insured event within the meaning of Section 103 VVG , 2011, p. 29 f.

[5] BGH, judgment of April 14, 1976 - IV ZR 29/74 - VersR 1976, 649 f.