Definition of Accident (Unfallbegriff)
The definition of accident is the contractual or statutory description of an accident as a sudden, involuntary event acting externally on the body and causing bodily injury, which delimits the insured event in accident insurance from illness and wear and tear.
Concept and Constituent Elements
The definition of accident determines which event triggers an insured event under an accident policy at all. Across the three German-speaking markets it rests on the same elements: an event acts suddenly and externally on the insured person’s body and involuntarily causes bodily injury. Under the German model wording (section 1.3 AUB 2020, section 178 (2) VVG) involuntariness is presumed until the contrary is proven. Swiss social insurance law defines an accident in Art. 4 ATSG as the sudden, unintended harmful effect of an unusual external factor on the human body resulting in impairment of physical, mental or psychological health or in death; the element of “unusualness” is an additional test there. The Austrian model conditions (Art. 1 AUVB 2022) follow the German formulation.
Delimitation and Extensions
The counterpart of accident is illness: internal processes, gradual wear and tear or degenerative changes do not satisfy the requirement of an external cause and remain the domain of health or disability insurance. Because the boundary is hard to draw in individual cases, policy wordings extend the concept: the extended definition in the AUB 2020 (section 1.4) covers dislocations, strains and tears caused by increased physical exertion, injury from vapours and gases, accidents under water and injuries sustained during rescue actions. The Swiss UVG contains a statutory list of “accident-like bodily injuries” that are covered even without an unusual external factor.
Market Practice
Swiss collective wordings adopt the ATSG definition verbatim and refer to the UVG rules for accident-like bodily injuries (example: AXA AVB Accident Insurance Supplementary to the UVG, clause D1). Austrian wordings expressly list dislocations, strains, meniscus injuries, drowning and the swallowing of small objects by children as accidents in Art. 6 AUVB; sports group contracts go further and cover strains and tears caused by mere own movement (ARAG sports insurance, clause I.1.2.3). International wordings use the shorter formula “sudden, unforeseen and fortuitous event” and require the injury to be caused “solely and directly” by accidental means.
Relevance for Underwriting and Claims
In claims handling, the definition of accident is regularly the first and often decisive test, for instance in falls without an identifiable cause, cardiovascular events, infections or psychological consequences. Wording comparisons should therefore look beyond benefit amounts to the reach of the accident definition (exertion, own movement, impaired consciousness, insect bites), since this is where tariffs differ most.
Legal basis
- CH: Art. 4 ATSG