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Insurance company will cover costs of treatment of the victim not financed by public funds

Insurance company will cover costs of treatment of the victim not financed by public funds

Dodano: 2016-05-31
Publikator: The Supreme Court

The Supreme Court in its resolution of 19 May 2016 held in a panel of seven judges (ref. no III CZP 63/15) that the benefit from an insurance company paid under an MTPL insurance contract also covers reasonable and expedient costs of treatment and rehabilitation of the victim not financed by public funds.

The resolution was made on the basis of a request of the then Insurance Ombudsman, who directed to the Supreme Court the following question: „Does the liability of the insurer resulting from an MTPL insurance contract in respect of a claim to cover private medical care expenses on the basis of art. 444 § 1 of the Civil Code depend on the lack of possibility for the victim to use public health care or rehabilitation or an extended waiting period for treatment or rehabilitation, having a negative impact on the health of the victim? „.

The then Insurance Ombudsman referred to the provision of Article 444 par. 1 of the Civil Code, according to which in the event of bodily injury or health disorder, remedy of damage includes all resulting costs. At the aggrieved party’s demand, the person obliged to remedy the damage should pay in advance the sum necessary for medical costs and, if the aggrieved party becomes disabled also the sum needed to train him for another occupation. The Ombudsman pointed out that an analysis of the case law of common courts and complaints proceedings shows that problems in pursuing these claims relate to the purposefulness of costs incurred being compensated, in particular in respect of using private health care. The Ombudsman highlights that there is no clear line of jurisprudence in this respect.

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