No insurance coverage on the way from the doctor to work? This or a similar headline appeared in newspapers regarding a decision by the Federal Social Court (BSG). The court had refused to cover the costs of an accident involving an employee who was driving to work after a doctor’s appointment.
The term “statutory accident insurance” is misleading. Statutory accident insurance protects employees from the health risks associated with their employment. It therefore only applies to illnesses and accidents related to the workplace. If there is no connection to work, an employee is covered by their statutory health insurance.
The benefits provided by accident insurance are generally more comprehensive and better than those of health insurance. The purpose of this insurance is to prevent workplace accidents and to maintain or restore employees’ ability to work. It has been in effect since 1884 and is regulated by the Social Code.
What does “direct” mean?
Statutory accident insurance protects employees not only at the workplace but also while commuting between home and work. In the case decided by the Federal Social Court (BSG), the employee was indeed on his way to work. However, he was coming from a doctor’s appointment that took place before the start of his workday. According to case law, only the direct route between home and the workplace is insured; private detours, on the other hand, are not. The question of what “direct” means has frequently occupied the court. When is a detour permitted, and when is it not? Is an interruption allowed, and if so, for how long?
In exceptional cases, therefore, detours are also covered. Specifically, this applies when the route between home and the workplace is interrupted for at least two hours by a stop at a so-called third location, such as a doctor’s office. In that case, the trip from that third location back to work is again covered as a commute. In the present case, the employee had spent less than two hours at the doctor’s office, so there was no coverage under statutory accident insurance.
Narrow Limits
The BSG’s decision appears rather arbitrary. However, case law is subject to very narrow limits when interpreting the laws governing the liability of the employers’ liability insurance associations. Given the extensive benefits they provide, these associations rely on a clear definition of their liability. Since the detour for the doctor’s visit lasted less than two hours, the BSG was unable to classify the trip as a commute to work.
More Information
The DGB Legal Protection Service has compiled online information on how courts have ruled on other issues related to workplace accidents and statutory workers’ compensation insurance. In addition to rulings on questions such as whether employees are insured during their lunch break, there are reports and guides available at:
