German court slashes payout over pre-existing condition in fatal fall case
A German court has upheld an insurance company’s decision to reduce a payout after a man’s death in January 2022. The man, whose name was not disclosed, suffered a fatal brain haemorrhage following a fall. His pre-existing blood clotting disorder played a role in the outcome, leading to a partial payout of just 70% of the agreed sum.
The incident occurred when the man fell while taking anticoagulant medication. The blood-thinning drugs, prescribed for his Factor-V-Leiden mutation coagulation disorder, increased the risk of uncontrollable bleeding after the accident. He later died from complications linked to the haemorrhage.
The car insurance policy included a clause allowing reduced payouts if pre-existing conditions contributed to the accident’s consequences. The company initially paid around €17,900 instead of the full €25,500 death benefit, citing a 30% contribution from the man’s health condition. Germany’s Federal Court of Justice (BGH) ruled that the clause was clear to an average consumer. It confirmed that the policy covered accidents and their direct consequences—not unrelated health factors. The court found the reduced payout justified, as the man’s disorder had worsened the outcome of the fall.
The ruling means the insurance company will not pay the remaining 30% of the claim. The decision sets a precedent on how pre-existing conditions affect car insurance payouts in Germany. Future cases involving similar clauses may now follow this interpretation.
