Accident insurance benefits: your comprehensive guide to financial security after an accident
03/05/25
6
Minutes
Katrin Straub
Managing Director at nextsure
An accident can change your life in an instant. Do you know which financial benefits you are entitled to under accident insurance and how to make the most of them? This article explains everything you need to know.
The topic in brief and concise terms
The statutory accident insurance (GUV) covers workplace accidents, commuting accidents and occupational diseases, while private accident insurance (PUV) provides cover for leisure accidents and worldwide protection.
Key benefits of the PUV include disability benefit, accident pension and death benefit; the scale of benefits and progression determine the amount paid out.
In the event of a claim, an immediate consultation with a doctor, accurate documentation and timely notification to the insurer are crucial for claims processing.
Understand accident insurance benefits at a glance
Accident insurance provides financial support after an accident, although the type and scope of benefits vary greatly. In principle, a distinction is made between statutory accident insurance (GUV) and private accident insurance (PUV). Statutory accident insurance primarily covers workplace accidents, commuting accidents and occupational diseases. Private accident insurance, on the other hand, comes into play in leisure time and household accidents, where around seventy per cent of all accidents occur. Both systems offer different benefit components, which can range from medical treatment and pension payments to survivor benefits. A basic understanding of these differences is the first step towards comprehensive cover. Contributions to statutory accident insurance are borne solely by employers.
Statutory accident insurance: basic cover for employees and other groups
The statutory accident insurance (GUV) is an important pillar of the German social security system and protects a broad group of people. Insured persons include not only employees, but also pupils, students and children in daycare facilities. The GUV provides benefits in the event of accidents at work, accidents on the direct way to or from work (commuting accidents) and recognised occupational diseases. A key advantage is that benefits are generally determined ex officio; an application is usually not necessary. The costs of medical treatment and medical rehabilitation are covered in order to restore health and ability to work. This includes, for example, medical treatment, medicines and dressings, as well as physiotherapy. The statutory accident insurance is therefore a fundamental form of protection. However, this protection does not apply to leisure accidents, which underlines the need for additional private provision.
Financial benefits of the GUV: From injury benefit to accident pension
If an insured person is temporarily unable to work after a work accident or due to an occupational disease, the GUV pays injury benefit. This amounts to eighty per cent of regular gross earnings, but must not exceed net earnings. If earning capacity is reduced for the long term — beyond the 26th week after the accident — by at least twenty per cent, there is entitlement to an accident pension. The amount of this pension is based on the degree of reduction in earning capacity (MdE) and the insured person’s annual earnings (JAV) before the accident. For example: with a JAV of 36,000 euros and an MdE of thirty per cent, the monthly partial pension amounts to 600 euros. It is important to know that the GUV does not pay compensation for pain and suffering. However, the accident pension is also intended to partially compensate immaterial damage. For comprehensive protection, which can also cover claims for compensation for pain and suffering, private accident insurance is often essential. The GUV also provides benefits in the event of need for care and for surviving dependants, such as funeral grants and widows’ or orphans’ pensions.
Private accident insurance: essential protection for leisure and home
Because statutory accident insurance primarily applies in a professional context, there is a significant gap in coverage in the private sphere. Most accidents, around two-thirds, happen during leisure time or at home. This is where private accident insurance (PUV) comes in, offering individual protection 24 hours a day worldwide. It is particularly important for groups of people who have no, or only limited, statutory cover, such as homemakers, pensioners and the self-employed who are not compulsorily insured. The core benefit of PUV is invalidity benefit, a lump-sum payment, the amount of which depends on the agreed sum insured and the degree of disability caused by the accident. The degree of disability is assessed by a doctor, often with the help of a limb tariff. This accident insurance can be supplemented with additional modules. This enables you to protect yourself against the financial consequences of an accident, which can quickly become an existential threat.
Additional benefit modules of private accident insurance
Besides the central invalidity benefit, private accident insurance policies often offer a range of other useful benefit modules. These can be selected individually according to need in order to optimise the cover:
Accident annuity: A monthly pension payment in the event of severe disability, often from a degree of disability of fifty per cent.
Death benefit: A lump-sum payment to the surviving dependants if the insured person dies as a result of the accident within one year.
Hospital daily allowance and convalescence benefit: Financial support during a hospital stay and the subsequent recovery period.
Interim benefit: Rapid financial assistance if determining the final degree of disability takes longer.
Rescue costs: Covering the costs of search, rescue or recovery operations.
Cosmetic surgery: Coverage of medically necessary cosmetic procedures following an accident.
The exact costs of accident insurance depend on the selected benefits and the sum insured. A careful comparison and needs analysis are therefore essential.
Expert depth: Understanding the body-part schedule, progression and important deadlines
In the event of a claim under a private accident insurance policy, technical terms such as the body part scale and progression play a decisive role in the amount of the payout. The body part scale is a table that specifies the degree of disability applied in the event of loss or loss of function of certain body parts or sensory organs. For example, the loss of a thumb may be assessed at twenty per cent disability. Progression is an agreement that leads to a disproportionately higher increase in benefits at higher degrees of disability. A progression of, for example, 350 per cent means that in the event of full disability, 3.5 times the basic sum insured is paid out. Our expert tip: Make sure you choose a sufficiently high basic sum and a good progression so that you are genuinely covered in an emergency. It is also important to observe the deadlines for reporting an accident and asserting disability claims; these are set out in the insurance terms and conditions and are often several months to more than a year. The question of whether accident insurance is compulsory is answered in the negative for the private variant, but its importance is undisputed. A careful review of the contract details is crucial here.
Recommendations for action: How to secure your entitlement to benefits
After an accident, quick and correct action is important to secure your benefit claims under accident insurance. Document the course of the accident and any injuries as precisely as possible, ideally with photos and witness statements. See a doctor immediately, even if the injuries seem minor; in the case of work-related accidents, this is usually a designated accident doctor. Report the accident to your insurer without delay – both the statutory insurer (usually through your employer or doctor) and the private one. Observe all deadlines stated in your insurance terms, especially for medical confirmation and notification of disability. Our expert tip: Keep a detailed health diary covering the healing process and all doctor visits. This can be very helpful during the later assessment. Also find out to what extent you can claim tax relief on your accident insurance. Careful preparation and documentation make the smooth processing of benefits much easier.
Checklist: What to do in the event of a claim
To be optimally prepared in the event of an accident and to be able to assert your claims for benefits from accident insurance as effectively as possible, you should note the following points:
Immediate medical treatment: See a doctor straight away (for work-related accidents, a designated accident doctor).
Accident documentation: Secure evidence of how the accident happened (photos, witnesses).
Accident notification within the deadline: Inform your private accident insurance immediately and, if applicable, your employer (for statutory accident insurance).
Accurate details: Provide complete and correct information about how the accident happened and the injuries sustained.
Observe deadlines: Comply with all contractually agreed deadlines for asserting disability claims.
Collect medical records: Keep all medical reports, diagnoses and treatment records safe and organised.
Communicating with the insurer: Maintain regular contact and submit any requested documents promptly.
These steps will help you speed up the process and receive your legitimate benefits from accident insurance.
Choosing the right personal accident insurance and understanding the wide range of benefits can be complex. At nextsure, we see ourselves as your partner, helping you find the right cover for your individual life situation. We analyse your needs and show you which benefits from personal accident insurance are actually relevant to you. With our digital approach, we make insurance simple and transparent. Benefit from our expertise in the field of niche insurance and secure yourself with the best possible protection. Good cover gives you the necessary financial security so that you can focus on what matters most: your recovery. The question, do you need personal accident insurance, can be answered with a clear yes for most people in order to minimise financial risks.
Request an individual risk analysis now: Have your insurance situation reviewed free of charge and receive specific recommendations for improvement.
More useful links
The DGUV offers a comprehensive overview of German Social Accident Insurance.
The DGUV University provides detailed information about the insurance and benefits offered by German Social Accident Insurance.
Here you will find information on the rehabilitation services of the DGUV.
The DGUV answers frequently asked questions about benefits for insured persons in its FAQ section.
The DGUV provides information on the financial aspects of statutory accident insurance.
Find out more about the responsibilities within the DGUV.
Wikipedia offers a comprehensive article on statutory accident insurance in Germany.
The Federal Ministry of Labour and Social Affairs (BMAS) provides information on workplace accidents and occupational diseases.
FAQ
What deadlines do I need to observe in the event of an accident in order to receive benefits?
Report the accident to your private accident insurer immediately. For claiming disability benefits, there are deadlines for the medical determination of the disability (often within one year of the accident) and for notifying the insurer (often 15 to 18 months). The exact deadlines are set out in your policy terms.
What is the difference between statutory and private accident insurance?
Statutory accident insurance is compulsory insurance for employees, school pupils, etc. and provides cover for accidents at work, commuting accidents and occupational diseases. Private accident insurance is voluntary and covers accidents in private life (leisure, household) worldwide.
Does accident insurance also pay if you were partly at fault for the accident?
The benefits of statutory accident insurance are not dependent on fault, meaning they are also paid in cases of contributory negligence, provided the accident was not caused intentionally. In private accident insurance, it depends on the exact terms and conditions of the contract, but as a rule a certain degree of personal fault (negligence) is also covered; however, gross negligence or intent can lead to exclusion of benefits.
Are children also covered by statutory accident insurance?
Yes, children are covered by statutory accident insurance during attendance at day-care centres and schools, as well as on the direct journeys to and from them. However, they need private accident insurance for accidents during leisure time.
