Social insurance recourse after a ski accident: how the statutory cession under section 332 ASVG works, what the quota priority protects and what stays with you.
Mag. Christopher Angerer, Rechtsanwalt
Your lawyer for ski and alpine accidents
Ski and alpine accidents are complex and emotional. One lawyer you know, from the first question to the courtroom. Strong practical background (former ski instructor, mountain rescuer and dog handler).
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After a ski accident the statutory social insurance usually first covers the treatment costs, from the medical treatment through the hospital to rehabilitation. Many injured people then ask whether they can claim these costs against the tortfeasor at all. The answer lies in the recourse of the social insurance carrier.
Under section 332 ASVG the compensation claim passes to the carrier by operation of law, to the extent the carrier provides benefits, already at the moment of the accident. This statutory cession means the carrier recovers the costs assumed from the tortfeasor. The injured person remains entitled for the heads not covered, above all for damages for pain and suffering.
This post explains the statutory cession, the quota priority and the distinction of claims. Which own heads of loss exist alongside the treatment costs is covered in the post on loss of earnings and household management damage.
Two short questions on the cost carrier and the liability place the recourse and your remaining claims.
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If the statutory social insurance paid, the compensation claim passes to it by operation of law to that extent.
Costs you bore yourself and that no social insurance carrier reimbursed you can assert directly against the tortfeasor. These include, for instance, deductibles, private co-payments or services the insurer does not cover. Collect all receipts, because only documented costs can be enforced.
Next steps: document all self-borne costs, separate them from those settled through the insurer and assert them against the tortfeasor.
If the social insurance bore your treatment costs and a third party is liable, your compensation claim passes to that extent to the carrier under section 332 ASVG already at the moment of the accident. The carrier takes recourse against the tortfeasor. Your own claim remains for the heads not covered by the insurer, for instance for damages for pain and suffering. With only partial liability the quota priority additionally protects you.
Next steps: distinguish your own and the passed claims, observe the quota priority and pursue pain and suffering as well as own costs separately.
As long as fault or the tortfeasor are not established, the recourse cannot be placed either. First clarify whether a third party is liable, for instance a collision opponent under the FIS rules or the slope operator. Only then is it established whether the social insurance carrier can take recourse and which claims remain with you.
Next steps: clarify the course of the accident and the fault, identify possible tortfeasors and only then assess the recourse question.
Where the statutory social insurance provides benefits, for instance for medical treatment, hospital or rehabilitation, the injured persons compensation claim against the tortfeasor passes to the carrier to that extent. This transfer takes effect under section 332 ASVG already at the moment of the harmful event, not only with the payment. The carrier can therefore demand the costs assumed from the tortfeasor itself.
For the injured person this means a split. The treatment costs covered by the insurer can no longer be demanded by them, because the claim belongs to the carrier to that extent. The position is different for heads the insurer does not cover, for instance damages for pain and suffering or deductibles. These remain with the injured person and are to be pursued separately.
If the tortfeasor is liable only in part because of contributory fault, the compensation often does not suffice for all claims. Here the quota priority protects the injured person. It ensures that the limited liability sum first satisfies their own loss not covered by the carrier, before the carrier accesses the remainder. The injured person should not be worse off through the transfer of the claim.
In practice the clean distinction between own and passed claims is therefore decisive. How a liability quota is formed at all, for instance in a collision under the FIS rules, is shown in the post on the apportionment of fault under the FIS rules.
Pain and suffering stays with you. The recourse of the carrier concerns only congruent benefits such as treatment costs. The social insurance does not cover damages for pain and suffering, they remain with you. Separate these heads cleanly from the outset.
To the extent the statutory social insurance paid, no longer. The claim has passed to the carrier to that extent under section 332 ASVG. Self-borne costs and deductibles, however, you can still assert yourself.
Already at the moment of the harmful event, not only with the payment. This statutory cession means the carrier is the holder of the congruent compensation claim from the start.
With only partial liability it ensures that the limited liability sum first satisfies your own uncovered loss before the carrier accesses it. You should not be placed worse off through the transfer of the claim.
Yes. The social insurance does not cover damages for pain and suffering, it is not a congruent head. The claim for pain and suffering therefore remains with you and is to be pursued separately against the tortfeasor.
Then the recourse cannot be placed yet. First it must be clarified whether and who is liable, for instance a collision opponent or the slope operator. Only then is it established which claims belong to the carrier and which to you.
Which own heads of loss exist alongside the treatment costs.
Which insurance pays the rescue and how the reimbursement runs.
How the liability quota is formed in a collision.
The sooner we secure the evidence, the better we can enforce your claim. Call us directly or send an email, callback within one business day.
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BRANDAUER Rechtsanwälte GmbH Giselakai 51 5020 Salzburg
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