Private health insurers must fund 24-hour around-the-clock nursing care even for policyholders enrolled in emergency tariff plans, according to a ruling by the Coburg Regional Court. The decision, handed down in a case involving a paralyzed motorcycle accident victim requiring continuous vital-function monitoring, establishes that cutting off funding for essential life-support supervision compromises the core purpose of health insurance contracts.
The Coburg Court Ruling and Case Details
According to the Coburg Regional Court in case Az: 24 O 267/22, a policyholder who fell into arrears and was downgraded to the restrictive emergency tariff (Notlagentarif) remains entitled to funding for life-sustaining medical supervision. The underlying dispute involved a motorcycle accident survivor who required round-the-clock monitoring by specialized medical staff to prevent oxygen drops and life-threatening aspirations, generating monthly costs reaching up to 25,000 euros, according to court documents.
Although the private health insurer initially covered the expenses, it later cut off payments by arguing that the emergency tariff limits coverage strictly to acute illnesses and acute pain states. The Coburg judges rejected this defense. While continuous 24-hour observation does not explicitly appear in the standard catalog of emergency tariff benefits, excluding it entirely compromises the basic purpose of the contract, according to the court. Because the supervision protects vital functions and safeguards the medical minimum existence, the health insurer must bear the high costs.
Appellate Decision from Bamberg
Following the initial defeat at the trial level, the private health insurer filed an appeal against the ruling. According to the court records, the Bamberg Higher Regional Court subsequently dismissed the appeal, locking in the determination that emergency tariff restrictions cannot override the contractual necessity of funding life-saving medical oversight.
Despite this obligation regarding vital-function monitoring, the court clarified the boundaries between welfare systems. The private health insurer remains exempt from paying for general nursing care and household management services, which fall under the separate jurisdiction of private long-term care insurance, according to the legal findings.
Legal Separation of Health and Care Insurance
The division between medical treatment and everyday care underpins the German social security system, separating statutory and private frameworks alike. Statutory and private health funds finance medical nursing care—such as injections, wound care, and medication administration—under specific legal provisions, whereas daily living assistance requires separate long-term care coverage.
While the Coburg decision specifically addresses a private health insurance emergency tariff (Notlagentarif) dispute where coverage is normally pared down to acute pain and emergency treatments, it carves out an absolute floor for vital-function safeguards. Insurers cannot cite low-cost tariff limitations to deny funding when a policyholder’s immediate survival depends on continuous mechanical or professional medical observation.
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