Long-term accident effects: who pays?

The cast was removed long ago – and suddenly there are chronic complaints as long-term effects of the accident.

Not all consequences of an accident manifest themselves immediately. Often, health problems that have to be treated are noticed years later. In such a case the question arises of who covers the new treatment costs.

As a basic principle, the occupational accident insurance covers long-term accident effects. However, the health problems must be directly linked to the accident. If, for example, a knee has to be operated because the accident caused the growth of heavy arthrosis, the health problem can be directly traced back to the accident. But if the policyholder already had heavy arthrosis before the accident, it is assumed that the knee also would have to be operated if the accident had not taken place. In such a case, the health insurance would have to pay for the arthrosis treatment, not the accident insurance.

It also has to be clarified who paid for the first treatment at that time. As a general rule and according to accident insurance law (UVG), the insurance that paid the first treatment steps in. If the first treatment costs were covered by a health insurance, the current health insurance of the accident patient pays – and not the occupational accident insurance.