German Supreme Court Upholds Insurer’s 30% Cut in Fatal Fall Payout Over Blood Disorder
A German court has upheld an insurer’s decision to reduce a payout after a man’s fatal fall was worsened by a pre-existing blood disorder. The man, who suffered a brain injury while on anticoagulants, had his accident insurance claim cut by 30 percent. His family challenged the ruling but lost in both lower and higher courts.
The case centred on a man with a known blood clotting disorder, Factor V Leiden mutation, which required medication to prevent clots. Before his accident, he already had disseminated intravascular coagulation (DIC), a serious condition marked by low fibrinogen levels. His treatment included blood coagulation drugs, which later played a role in his fatal injury.
After a fall, the man died from a brain haemorrhage. His insurer argued that his medication contributed 30 percent to the fatal outcome. Under the policy terms, payouts could be reduced if pre-existing conditions accounted for at least 25 percent of the harm. The insurer paid €17,900 instead of the full €25,500 death benefit. The man’s widow and daughter sued, but the Osnabrück Regional Court and Oldenburg Higher Regional Court both sided with the insurer. The Bundesgerichtshof (BGH) later confirmed that his illness had directly worsened the accident’s effects. Uncontrollable bleeding made his brain haemorrhage untreatable, the court ruled. It also found that the insurance clause clearly allowed for reduced payouts when unrelated health issues played a significant role.
The ruling means the insurer’s decision stands, with the family receiving only 70 percent of the original benefit. The BGH’s interpretation of the policy reinforces that pre-existing conditions can legally reduce accident claims. The case sets a precedent for how similar disputes may be handled in future.
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