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Social Security Law: Traffic accident during a walk can be considered an occupational accident

Social Court Düsseldorf, Judgment of 20.06.2017- S 6 U 545/14

Background

The present case is about the question of the existence of an occupational accident in the case of a car accident in the context of a walk that was taken in relation to a rehabilitation. The plaintiff is a diabetic and was undergoing inpatient rehabilitation at a clinic of a rehabilitation centre in the Lower Rhine region in 2013. On a Sunday at the time of this rehabilitation, the plaintiff went for a walk and was hit by a car while passing a pedestrian crossing and as a result suffered a lung contusion and multiple tooth fractures.

The defendant was an employers‘ liability insurance association from which the plaintiff now sought compensation under the statutory accident insurance. He argued that he was on his way from the spa house to the spa square during the walk and that this walk was a means of weight reduction, i.e. that he had fulfilled his obligation to actively participate in the success of the rehabilitation measures.

The rehabilitation clinic confirmed that although there was no explicit prescription for walks, physical activity in the fresh air had been recommended. The clinic did not plan any treatment for the plaintiff on the specific Sunday of the accident.

The defendant refused to pay compensation on the grounds that the accident was not an insured event under the statutory accident insurance. Although the plaintiff was legally insured because he had received inpatient services for medical rehabilitation at the expense of a statutory pension insurance, the walk was not connected to the rehabilitation measure, it was rather a self-economic, uninsured activity, so that the health insurance company had to pay for the treatment costs.

Furthermore, the defendant argued that a mere local and temporal connection with the hospital stay was not sufficient to trigger an insured event, especially since the walk took place on a Sunday without treatment and a walk would also have been recommended to the plaintiff as a diabetic by any other medical authority, irrespective of a rehabilitation measure.

The plaintiff challenged in court the defendant’s finding that the traffic accident was not an insured event and sought the corresponding finding before the Düsseldorf Social Court. The action was successful.

Reasons

The Social Court of Düsseldorf affirmed the existence of an occupational accident, so that an insured event is present which is covered by the statutory accident insurance. § Section 8 of the Seventh Book of the German Social Code defines an accident as a temporary event affecting the body from the outside, which leads to damage to health or death. Significant damage to the plaintiff’s health was present.

Moreover, the social court recognised the opening of the scope of insurance coverage within the framework of the statutory accident insurance, since the walk took place as a result of an activity that was insured thereafter. The walk was therefore intrinsically and factually connected to the rehabilitation stay. A connection between the accident and the insured rehabilitation measure based purely on temporal or local factors of proximity would not suffice.

In the present case, however, the court assumed a causal connection between the damaging event and the rehabilitation in the clinic. The mere fact that this walk took place on a Sunday without treatment does not eliminate this causal connection.

The decision of the Social Court of Düsseldorf is thus congruent with past decisions of the Federal Social Court, which already affirmed an insured event in the context of spa stays in the event that the insured person assumed that the measure during which the accident occurred would serve his inpatient treatment. The Federal Social Court concretised this case law in later decisions, stating that the activity carried out should not be detrimental to the purpose of rehabilitation. These parallel decisions also concerned walks by patients on Sundays.

Evaluation

The fact that an accident during a walk in the course of a stay at a health resort can be considered an occupational accident covered by the statutory accident insurance was affirmed by the Social Court of Düsseldorf in accordance with the previous supreme case law.

Diabetes patients undergoing rehabilitation treatment promote their health – and thus the goal of the rehabilitation cure – by engaging in physical activity, such as walking. Behaviour on the part of the patient that would be detrimental or contraindicated to the purpose of rehabilitation would therefore not be in the context of inpatient treatment in a clinic. In the case of a walk, however, there is a sufficient causal connection. This also applies if the accident occurs during a walk on a treatment-free Sunday.

Dr. iur. Christoph Roos
Specialist lawyer for social law

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