Comprehensive insurance doesn’t pay: When your comprehensive coverage can refuse a claim and how you can protect yourself
17 Jun 2025
8
Minutes
Katrin Straub
CEO at nextsure
You rely on your comprehensive insurance, but what happens if it doesn’t pay out in case of damage? Find out what pitfalls exist and how to ensure your coverage is effective when you need it most.
The topic in brief and concise terms
Comprehensive insurance does not cover intentional acts, war, nuclear energy, and often excludes gross negligence such as driving under the influence or serious traffic violations.
Breaches of contract (obligations violations), such as hit-and-run or false statements, can lead to losing insurance coverage.
Details of the tariff are crucial: workshop binding, the type of coverage for wild animal damage, or the exclusion of the plea of gross negligence affect the performance.
Understanding Exclusions: The Most Common Reasons for Refusal to Pay
Comprehensive insurance is an important component for protecting your vehicle. However, there are clearly defined scenarios where the comprehensive cover does not apply. A common reason is intentional conduct, meaning when damage is deliberately caused – in this case, the insurance cover is generally void. Damages due to war events or nuclear energy are also typically excluded. Another point is unauthorized modifications to the vehicle that lead to the revocation of its operating license. Wear and tear are also not covered under comprehensive insurance. It is crucial to thoroughly check your contractual conditions, as exclusions can vary in detail. Understanding these fundamentals helps to avoid unpleasant surprises in the event of a claim.
Gross negligence: A fine line with costly consequences
Gross negligence is one of the main reasons why comprehensive insurance may refuse or at least reduce a payment. It occurs when the required care has been ignored to an exceptionally severe degree. A classic example is driving under the influence of alcohol: from as little as 0.3 per mille, benefits may be reduced by fifty to one hundred percent, and above 1.1 per mille, the insurance often refuses to pay at all. Using a mobile phone while driving or running a red light can also be considered grossly negligent. The consequences are significant: the insurer can proportionally reduce the payment according to the severity of the negligence. In some policies, the waiver of the defence of gross negligence can be insured against for an additional premium of around five to ten per cent. This aspect should be considered when comparing third-party, fire and theft with comprehensive cover.
Here are some examples of gross negligence in road traffic:
Driving at significantly excessive speed, especially in adverse weather conditions (e.g., one hundred kilometres per hour instead of the permitted sixty on cobblestones).
Dangerous overtaking manoeuvres, for example, at one hundred and forty kilometres per hour on a wet road in a curve.
Ignoring stop signs or red lights.
Operating the navigation device while driving.
Parking the vehicle on a slope without applying the handbrake and engaging a gear.
Leaving the ignition key in the vehicle or parking it unsecured.
Driving despite fatigue, when signs such as yawning have been ignored.
Distraction due to searching for a radio station or handling objects while driving.
The exact assessment always depends on the individual case, but these examples illustrate the risks. A conscious approach to these sources of danger is essential.
Taking contract obligations seriously: breaches of duty and their consequences
In addition to gross negligence, so-called breaches of obligations can also lead to the comprehensive insurance not paying out. Obligations are contractually stipulated duties of the policyholder. A central duty is the prompt and truthful reporting of a claim. Providing false information or missing deadlines puts your insurance coverage at risk. Particularly critical is leaving the scene of an accident without permission (hit and run). This constitutes a serious violation of the obligation to clarify the facts and can lead to the insurer being completely discharged from liability, as court rulings confirm. Even if you are in shock, it does not exempt you from the duty to stay at the scene of the accident and allow the necessary determinations to be made. Using a garage not arranged by the insurer when a workshop bonus has been agreed can also lead to reductions, often only eighty percent of the damage is reimbursed. Find out about the General Terms and Conditions for Motor Vehicle Insurance to understand your obligations.
Specific Exclusions and Tariff Details: What is Often Overlooked
Some exclusions from coverage are of a specific nature and can be easily overlooked. This includes damage caused by unauthorized drivers if the driver group is restricted in the contract. Technical issues such as heavily worn tires or an expired MOT can also become problematic if they were the cause of the accident. In such cases, the insurer may reduce their payout due to gross negligence. When it comes to wildlife damage, it's important to carefully check which animal species are covered in the contract – some policies only cover accidents with game, while others include all types of animals. Consequential damages, for example after a marten bite, are often only covered up to a certain amount or not at all if not explicitly included in the policy. Therefore, it is essential to look into the details of your comprehensive damage policy.
Our expert tip: Review your insurance contract at least once a year or whenever your life circumstances change. Pay special attention to the following points:
The insured driver group and any age restrictions.
The rules regarding free choice of garage or designated repair shops.
The extent of coverage for animal collisions (all animals or just game).
The amount of the excess for different types of damage.
The inclusion of waiver of the objection of gross negligence.
The coverage amounts for special equipment and consequential damages.
This review can save you a lot of trouble and costs in case of damage. If anything is unclear, you should always consult with your insurer.
Recommendations: How to best secure your comprehensive insurance coverage
To ensure your comprehensive insurance provides coverage in the event of a claim, there are some important behavioural rules to follow. Avoid grossly negligent behaviour such as drunk driving or using your phone while driving. Report every damage promptly and truthfully to your insurer. Never leave an accident scene unlawfully. Keep your vehicle in a roadworthy condition, which includes tyres with sufficient tread depth and a valid MOT. Know the details of your insurance policy, especially exclusions and policy obligations. If you are uncertain, when comprehensive insurance is no longer worthwhile, or if you have questions about your policy, we are here to offer advice. Careful driving and knowing your policy are the best protection against coverage reductions.
Expert Knowledge: Understanding Legal Foundations and Recent Judgments
The Insurance Contract Act (VVG), particularly Section 28, regulates the consequences of breaches of duty. In the case of intentional breaches, the insurer can be released from liability, and in the case of gross negligence, the insurer may reduce the benefits. The insurer must prove the gross negligence and causality for the damage or the difficulty in its assessment. Conversely, the policyholder can attempt to provide counter-evidence of causality, that is, prove that the breach of duty did not impact the determination of the damage or the scope of benefits. However, this is often challenging. Recent court decisions show that the demands on policyholders are high. For instance, operating a navigation device while driving (LG Potsdam) or insufficiently securing a vehicle on a slope (OVG Lüneburg) was deemed grossly negligent. Knowing these legal frameworks and current jurisprudence helps you better assess your position and avoid pitfalls, such as when considering switching from comprehensive to third-party, fire and theft insurance.
Request your individual risk analysis now: Have your insurance situation reviewed for free and receive concrete optimization suggestions.
More useful links
The insurance magazine highlights specific cases and judgments related to car insurance in an article.
The Federal Statistical Office (Destatis) provides detailed tables on the causes of road traffic accidents involving personal injury in Germany.
The ADAC offers comprehensive information on fully comprehensive insurance, including coverage scope and important aspects for vehicle owners.
The German Insurance Association (GDV) explains the importance of obligations in insurance contracts and their consequences in the event of a breach.
FAQ
What damages are typically not covered by comprehensive insurance?
Generally not covered are damages due to intent, war, nuclear energy, normal wear and tear, operational damages (e.g., engine failure without an accident), as well as damages when participating in races or if the operating permit has expired.
My comprehensive insurance won't pay out, what can I do?
Check the reasons for the rejection and your contract. Submit a written objection and provide a justification. If necessary, you can contact a conciliation body or seek legal assistance.
Is it advisable to include gross negligence in comprehensive insurance coverage?
Yes, that is often advisable. Many insurers offer policies that waive the 'defence of gross negligence.' This usually costs an extra five to ten percent, but provides better protection.
What are breaches of obligation in comprehensive insurance?
These are breaches of contractual obligations, such as late or incorrect damage reports, leaving the scene of an accident without permission (hit and run), or failing to adhere to an agreed workshop binding.
Does the fully comprehensive insurance pay out if an unregistered driver causes the accident?
That depends on the contract. If the circle of drivers is restricted and the driver involved in the accident is not covered, the insurance may reduce the benefits, demand a contractual penalty, or, in the worst case, refuse to provide the benefits.
How does an overdue MOT affect the fully comprehensive insurance?
If a technical defect, which would have been discovered in good time by the MOT, is the cause of an accident, the insurance may reduce the payout due to gross negligence.
