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Accident in the hospital: BSG checks insurance cover in the event of a toilet fall
The BSG examines accident protection for patients in clinics based on the risk of falls; important decision about insurance in the hospital.
Accident in the hospital: BSG checks insurance cover in the event of a toilet fall
A remarkable ruling by the Federal Social Court (BSG) is currently causing lively discussions in the area of accident insurance in hospitals. The decision concerns an incident that occurred in a Berlin clinic and highlights the question of whether and when patients are insured against accidents in the event of falls in the hospital. How Haufe reports, the case of a patient who was injured in a bathroom during her stay in the stroke ward is examined.
The patient was admitted to the clinic in 2019 due to a cerebral hemorrhage with speech disorders and hemiplegia. While going to the toilet, she fell and injured her right arm. This misfortune happened when an orderly accompanied her to the bathroom but left the room while she was sitting on the toilet. Despite her request for the fall to be recognized as an accident at work, the administrative trade association rejected the application. The Social Court in Berlin and subsequently the State Social Court (LSG) Berlin-Brandenburg argued that going to the toilet must be viewed as an uninsured private act.
Clarified demands and structural requirements
However, the BSG made it clear that accident insurance claims must be examined if there are typical hospital risks. The crucial question that the LSG now has to clarify is whether the sanitary facilities on the ward were designed in such a way that they could be used by patients without risk. These include, among other things, handles or non-slip materials that help patients move more safely, as the DGUV emphasized.
The court will continue to analyze whether there were any particular dangers in this particular case due to the spatial situation in the clinic. The case also raises questions about what exactly is meant by “hazards typical of hospitals” and what structural safety precautions are actually necessary.
Legal framework
Similar cases in the past have shown that the legal framework surrounding fall-related injuries in hospitals is often unclear. For example, in a similar case, the Hessian State Social Court decided that accidents related to going to the toilet during an inpatient stay are not covered by insurance coverage as long as no particular dangers can be proven, as was the case with plaintiff G.B. documented in 2006 (Hessian State Social Court, ra-vomit ).
In any case, it remains to be seen what criteria the LSG will ultimately use. The discussion about accident protection care in hospitals remains explosive and raises many questions that affect both the healthcare system and the rights of patients.