Nosocomial infections caused by a contracted germ during a hospital stay allow Life Accident Insurance to appear. Then the infection is considered an accident, not a disease.
Mr. S has a Life Accident Insurance (GAV) contract. While in the hospital, he contracted a type of staphylococcus aureus and died as a result of this infection. According to Inserm, approximately 5% of hospitalized patients develop nosocomial infections.
Then his wife asked his insurance company to implement the death guarantee stipulated in the contract. The insurance company did not respond to his request, on the grounds that the cause of death was not accidental, but caused by illness, an event excluded from the guarantee.
Hospital infection is an accident, not a disease
The Life Accident Guarantee, called GAV in the language of insurance companies, covers bodily injury related to domestic accidents (burns, falls, manual work, gardening, poisoning, etc.), accidents occurring in the course of recreational activities (sports, trip…), disasters Natural (storms, avalanches …) or technological disasters, medical accidents, assaults or attacks. Please note that this warranty does not cover bodily injuries related to road accidents and work accidents that are covered by other insurance companies.
Dans le contrat souscrit par le défunt, les conditions générales définissent l’accident comme une « atteinte corporelle, non intentionnelle de la part de l’assuré, provenant de l’action soudaine et impréd d’une cause à l’extérieure, ‘illness “.
Judges who have already had to rule in such a case, retain the concept of accident only if the infection was caused by an external element, so as to fulfill the criterion of outward appearance set forth in the contractual definition of accident.
However, the medical expert’s report indicated that the death of the insured was due to the presence of a contracted germ inside the hospital. Bacteria were involved in the death and were already an outside element. Therefore, there is no objection to the insurance company paying death benefits to the wife of the deceased. Accordingly, the insurance broker called on the insurance company to pay the entire capital stipulated in the contract to the widow.
If hospitals are injured, the courts rule in favor of life accident coverage. It is clear that insurance companies are still trying to avoid this.
To avoid litigation in the future, insurance broker Arnaud Schneuys calls on insurance companies to “express clearly what the accident is within the meaning of the contract and bring this idea to the insured’s attention at the time of underwriting.”