Accidents in everyday life: compensation by insurance

Verified 09 April 2024 - Directorate for Legal and Administrative Information (Prime Minister)

You're a victim of a accident of everyday life (injuries during DIY, falling down stairs)? You may be compensated under certain conditions by your assurance accidents of life or by your insurance life accident guarantee. If the accident was caused by a third party who is identified, that person must compensate you, directly or through his assurance civil liability. We present the applicable rules.

General case

An accident of everyday life is any accident that can happen to you in your private life, except in the event of a traffic accident.

FYI  

The accident that occurs in the workplace is a accident at work. It does not fall into the category of everyday accidents.

The accident of everyday life can occur at home or outside, as part of your domestic, sports or leisure activities:

  • Tool injury during home crafts
  • Sliding or falling in the street
  • Accident during sports (gymnasium, stadium) or leisure activities (dance club, theater)

The everyday accident can also be caused by specific events, such as a natural or technological disaster, hospitalization, an attack or a infringement :

  • Injuries due to flooding or earthquake not covered by home insurance
  • Injuries caused by medical error
  • Injuries caused by an attack
  • Injuries caused by physical aggression or a sexual assault

Yes, it is possible to insure against the consequences of everyday accidents.

If you want to insure yourself against everyday accidents, you must subscribe to a life accident insurance.

The contract life accident insurance is a contract by which the insurer undertakes to provide you with material and financial support when you are the victim of a privacy accident that has caused you harm.

The accident of life contract is not a regulated contract, whereas the home insurance contract and the car insurance contract are.

Each insurer is therefore free to offer its own life accident insurance contract, taking care not to include clauses contrary to the law. Thus, the essential elements of life insurance contracts may vary from one insurer to another.

These include:

  • Conditions for the subscription of the contract (age, place of residence of the insured, price, etc.)
  • Types of privacy accidents covered by the contract
  • Types of privacy accidents not covered by the contract
  • List of damages compensable
  • Nature of the compensation provided for each damage (provision of services, single or periodic financial allowance, etc.)

To simplify the situation, insurers have created a label Accidents of Life (GAV) Guarantee, which groups accident-of-life contracts the terms of which correspond to the specifications for that label.

Accidental life contracts with the GAV label are called life accident guarantee.

These contracts must offer at least the conditions for compensation in the specifications for the GAV label.

However, they may offer more favorable compensation conditions than those of the minimum base of the GAV label.

This is why the vast majority of contracts for accidents of life are labeled GAV.

The Accident Insurance (AVG) covers you, as a subscriber.

The contract may also cover your family members for whom you are seeking insurance.

You can therefore take out the GVA contract on your own or for you and your household members (spouse, Civil partnership partner, partner, children).

But at the time of enrollment, insured persons must be 65 years of age at the most.

The Accidents of Life (AVM) warranty covers accidents that occur in your daily life and accidents that are caused by certain events: natural or technological disaster, medical accident, attack, infringement.

These accidents are covered when they occur in France, in the the European Union or in Switzerland.

Accidents occurring in the rest of the world may be covered when the length of your stay in the foreigner country is less than 3 months.

Warning  

The contract may provide that some accidents will not be compensated. For example, accidents caused by a medical experiment or by a dangerous sporting activity.

The damage which can be compensated by the GAV insurance is indicated in the contract.

It's about the damage caused by the accident: your injuries or your death, and the impact on your life or on the lives of your loved ones.

Please note that the GAV label provides that compensation for the damage indicated in the contract is subject to the condition that the accident has caused a minimum invalidity 30% or the death of the victim.

However, each insurer may provide for a lower invalidity rate than that of the GAV label.

The harm caused by injury is different from the harm caused by death.

Injury-related injuries

Injuries caused by a life-threatening accident can result in the following:

  • Suffering (pain)
  • Permanent functional impairment (inability to move)
  • Permanent impairment of physical and mental integrity (reduction of physical and intellectual abilities)
  • Aesthetic damage (distortion of the face or physical appearance)
  • Damage to the enjoyment (impossibility to engage in certain leisure activities)
  • Loss of affection (for your loved ones)
  • Economic damage (loss of professional income, costs of permanent assistance by a third party, costs of adapted accommodation, costs of adapted vehicles, child care costs, etc.)

The insurer has the right to provide a guarantee ceiling, which limits the amount of compensation.

The GAV label provides that the ceiling may not be less than EUR 1 million per victim.

FYI  

insurance compensation does not overlap with benefits paid to you by other organizations (sickness, mutual insurance, third party liability insurance, etc.).

Death-related injuries

Death caused by a life-threatening accident can result in the following harm to your loved ones:

  • Funeral expenses and miscellaneous expenses of relatives
  • Damage to personal health
  • Loss of income

The insurer has the right to provide a guarantee ceiling, which limits the amount of compensation.

The GAV label provides that the ceiling may not be less than EUR 1 million per victim.

When you are the victim of a life-threatening accident, you must notify your insurer within the time limit set out in the contract.

This period is freely set by insurance companies, but it is generally 5 working days.

You must notify the insurer in accordance with the procedure set out in the contract: online, by mail, by telephone or on site.

You can notify the insurer yourself or ask your broker to do it for you.

The claim statement must contain the elements allowing the insurance company to identify you, to take note of your losses and to determine whether the conditions for its intervention are fulfilled or not.

These are:

  • Your contact details (name, first name, address)
  • Number of your insurance contract
  • Description of the circumstances of the accident (nature, date, time, place)
  • Description of the damage suffered (injuries, incapacity for work, loss of income, etc.)
  • Identity and contact details of victims other than you

Before compensating you, the insurer will first check if the conditions for compensation are met.

So the insurer will first look to see if you have been the victim of an accident covered by the contract.

If this is the case, the insurer will check whether the accident resulted in a disability for you at least equal to the rate provided for in the contract, or death, then it will assess the various damages for which compensation is provided by the contract.

He will appoint an expert doctor to establish all these elements.

The situation varies depending on whether you are injured, disabled or deceased.

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You are injured and/or disabled

If you are injured and disabled or not, the expert doctor appointed by the insurer will summon you to examine you.

You can have your own doctor assist you with this examination, but you have to pay for it yourself

After the exam, the medical expert must write a report that describes the nature and severity of your injuries, and whether your health is consolidated or not.

Until your condition is consolidated, the medical expert cannot assess your harms.

After consolidation, the medical expert will be able to indicate your disability rate and evaluate your various damages.

If you disagree with the findings of the expert report, you can request a second opinion with the medical expert of your choice, but you will have to pay the costs of the second opinion.

Death

If you have died, the designated medical expert must rely on the forensic report to determine whether your death was caused by the accident.

If so, the medical expert must assess the various injuries reported by your loved ones.

If your loved ones disagree with the findings of the expert report, they can request a second opinion from the medical expert of their choice, but they will have to pay for the second opinion.

To determine the total amount of your compensation, the insurer proceeds in stages.

First, it lists the various types of damage for which compensation is provided for in the contract.

The insurer shall then assess the seriousness of each of those losses on the basis of the medical report drawn up after theconsolidation or death.

Once this assessment has been made, the insurer calculates the amount of compensation for each type of damage, based on the scale used by the courts.

In order to find the total amount of compensation, the insurer adds up the compensation corresponding to each type of damage, and deducts from this total the amounts paid to you by other bodies (social security, mutual insurance, third party liability insurance, court, etc.).

The GAV label provides that the insurer may limit the amount of its compensation to a ceiling which may not be less than EUR 1 million per victim.

The rest of the procedure depends on whether you are injured and/or disabled or deceased.

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You are injured and/or disabled

The insurer must send you the compensation proposal with the total amount within the time limit set out in the contract.

The GAV label provides for a maximum period of 5 months following consolidation.

If the insurer cannot make a final offer within this period, it must submit a provisional offer, provided that the level of your disability reaches the minimum level provided for in the contract for triggering the compensation.

If you accept the offer, the insurer must pay the amount of the compensation no later than 1 month after your agreement.

If you decline the offer, you must seek new medical expertise to hope for more compensation.

You passed away

The insurer must send your beneficiaries the compensation proposal with the total amount within the time limit provided by the contract.

The label provides for a maximum period of 5 months following death.

If the insurer cannot make a final offer within this period, it must submit a provisional offer.

If your beneficiaries accept the offer, the insurer must pay the amount of the compensation no later than 1 month after their agreement.

If your rights holders refuse the offer, they must request a new medical expertise to hope to obtain more compensation.

Accident caused by an identified third party

An accident of everyday life is an accident that can happen to you in your private life. except in the event of a traffic accident.

FYI  

If you have an accident in the professional setting, it is a accident at work.

The accident of everyday life can occur at home or outside, as part of your domestic, sports or leisure activities:

  • Tool injury during home crafts
  • Sliding or falling in the street
  • Accident during sports (gymnasium, stadium) or leisure activities (dance club, theater)

The everyday accident can also be caused by specific events, such as a natural or technological disaster, hospitalization, an attack or a infringement :

  • Injuries due to flooding or earthquake not covered by home insurance
  • Injuries caused by medical error
  • Injuries caused by an attack
  • Injuries caused by physical aggression or a sexual assault

If you are the victim of a life-long accident caused by a known third party, you must claim compensation for the damage caused to you by the accident.

It is the application of the principle of civil liability.

If the person who caused the accident has civil liability insurance, this insurance can compensate you in their place.

Third-party liability insurance is a contract under which the insurer undertakes to make good any damage caused to third parties by the insured's wrongful or non-wrongful acts.

Liability insurance covers all damage caused by the insured or persons for whom he is civilly liable.

These are personal injury, property damage and non-property damage.

You can therefore claim compensation from the civil liability insurance for the damage caused to you by the accident (injuries, disability and their consequences).

Your loved ones can do the same if the accident resulted in your death.

Unlike life accident insurance, compensation is not subject to the condition that the accident caused the disability or death of the victim.

You must be compensated even for minor injuries that do not result in incapacity for work or disability.

Injuries caused by a life-threatening accident can result in the following:

  • Suffering (pain)
  • Permanent functional impairment (inability to move)
  • Permanent impairment of physical and mental integrity (reduction of physical and intellectual abilities)
  • Aesthetic damage (distortion of the face or physical appearance)
  • Damage to the enjoyment (impossibility to engage in certain leisure activities)
  • Loss of affection (for your loved ones)
  • Economic damage (loss of professional income, costs of permanent assistance by a third party, costs of adapted accommodation, costs of adapted vehicles, child care costs, etc.)

Death caused by a life-threatening accident can result in the following harm to your loved ones:

  • Funeral expenses and miscellaneous expenses of relatives
  • Damage to personal health
  • Loss of income

Warning  

The third-party liability insurance contract may provide that certain damage will not be compensated, for example, the damage that the insured caused to you intentionally.

It is the person responsible for the accident who has to make the claim with his insurance.

But if you have life insurance, you can file a claim with your insurer as soon as possible.

This will allow him to contact the civil liability insurance of the perpetrator directly.

Before compensating you, the insurer will first try to find out whether you have been the victim of an accident caused by its insured.

Then, he will check whether the various damages you have declared were actually caused by the accident.

The insurer will appoint an expert doctor to assess your damages and determine whether they are causally related to the accident.

The situation varies depending on whether you are injured or deceased.

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You're hurt

The insurer's designated medical expert will call you in to examine you.

You can have your own doctor assist you with this examination, but you have to pay for it yourself

After the examination, the medical expert must write a report that describes your health and specifies whether the harm can be assessed or whether it should be delayed until the consolidation.

If an assessment of harm is possible, the medical expert will do so and present the results in his report.

If the evaluation is not possible at the time of the examination, the medical expert will wait for consolidation before doing it.

If you disagree with the findings of the expert report, you can request a second opinion with the medical expert of your choice, but you will have to pay the costs of the second opinion.

You passed away

If you have died, the designated medical expert must rely on the forensic report to determine whether your death was caused by the accident.

If so, the medical expert must assess the various injuries reported by your loved ones.

If your loved ones disagree with the findings of the expert report, they can request a second opinion from the medical expert of their choice, but they will have to pay for the second opinion.

To determine the total amount of your compensation, the insurer proceeds in stages.

First, he draws up a list of the various injuries whose causal link with the accident has been established by the medical expert.

The insurer shall then assess the seriousness of each of those losses on the basis of the medical report drawn up after the consolidation or death.

Once this assessment has been made, the insurer calculates the amount of compensation for each type of damage, based on the scale used by the courts.

To find the total amount of compensation, the insurer adds up the compensation for each type of damage, and deducts from this total the amounts paid to you by other bodies (social security, mutual insurance, insurance, court, etc.).

The insurer must make you an offer of compensation with this total amount within the time limit provided by the contract.

If the insurer cannot make a final offer within this period, it must submit a provisional offer to you.

If you accept the offer, the insurer must pay the amount of the compensation no later than 1 month after your agreement.

If you decline the offer, you must seek new medical expertise to hope for more compensation.

Warning  

If the expertise or counter-expertise reveals that you have made false statements, the insurer may refuse to compensate you. Indeed, most contracts provide for a loss of guarantee clause in the event of false declarations by the insured.

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