Travel health insurance refuses to pay
The case of a woman from Windeck who was seriously injured in an accident in Costa Rica in early 2024 has led to a legal dispute with her travel health insurance. The woman says she fell while hiking, whereas the insurer suspects that the injuries were sustained in a paragliding accident, which would be excluded from cover. The treatment costs came to around 145.000 euros, which she initially had to finance herself, among other things by pledging her holiday home. The insurer refuses to reimburse the costs, citing the findings of a private detective and an emergency call log that refers to an "injured German paraglider". The case is currently being heard at the Bonn Regional Court (Landgericht), where the 21st civil chamber intends to decide on taking further evidence by the end of May.
How to avoid something like this
Before travelling abroad, it is advisable to ask your insurer about specific requirements (including the insurer's exclusion criteria) and recommended documents. Expand here for a few tips:
For illness abroad there is form E116, which is used within the EU.
This form is used to transmit medical information in cases of incapacity for work and is completed by the treating doctor in the country of stay.
It contains details of the diagnosis, the expected duration of the incapacity for work and further medical details.
The form is sent to the responsible health insurance fund in the home country in order to claim sickness benefit or other benefits.
In addition to the accident report, you should take photos of the accident site and the damage and make a sketch to document what happened.
Note down the contact details of witnesses who saw the accident so that statements can be taken later
Special situations
✒ Hiking or sports accidents: particularly relevant in countries such as Switzerland or Austria, as rescue operations there can be very expensive. Many insurers therefore require detailed evidence. ✒ Accidents at work abroad: here the statutory accident insurance may be responsible, possibly in connection with the "posting principle" (Ausstrahlungsprinzip, § 4 SGB VII).
Tip: checklist for documenting an accident abroad (not traffic-related)
expand to learn more
Document
Purpose
medical report
securing medical evidence
Your own account of the accident
What happened, place, time, people involved
Photos of the accident site
Securing evidence
Witness statements (if any)
Supplementary evidence
Police or authority report
if involved
Contact details of treating doctors
for queries from the insurer
If needed, you can use this form as an aid: incapacity for work E116 in English (available from us on request)
This article draws on various sources: rundschau-online.de eur-lex.europa.eu procontra-online.de krankenkassen.de
this text was read on online pages and summarised with AI (Copilot/ChatGPT)