Freezing rain, trampled snow, a shady stretch of pavement where nobody had gritted by eight in the morning – and a broken wrist or ankle in front of the entrance. Every winter the same two questions reach me: does accident insurance pay for this, and can compensation be claimed from whoever should have kept the pavement in order? The answer to both is that it may – accident insurance for an insured event under your own contract, compensation if the party that failed in its duty was at fault – but the two routes work on completely different logic, and the second depends largely on what you do in the first few hours. This article sets the two routes side by side – without promising figures, because the amount of compensation is decided case by case.
Slipping on a pavement is a textbook example of the definition of an accident in policy conditions: a sudden, external event, independent of your will, that causes injury. In such cases, under Section 6:487 of the Hungarian Civil Code (Ptk.), accident insurance pays the sum specified in the contract – a fixed amount for a fracture, a daily benefit for days in hospital, a benefit for surgery and, where there are lasting consequences, a percentage-based amount for permanent impairment. Two things are worth seeing clearly. First, the insurer does not ask who is responsible for the ice: fixed-sum insurance is not compensation; it is payable under the contract, and compensation received through the other route does not reduce it. Second, the insurer pays only for what is an insured event under your contract – the limits of cover are shown in the article what accident insurance covers. The primary route for reporting a claim is the insurer's claims line, and the process is described in reporting an accident claim step by step; the most common outcome, a fracture claim, is walked through in the article fracture claims in practice.
The basic principle is old and simple: keeping the stretch of pavement in front of a property clean is the task of the property's owner. This is laid down in Section 6 of Joint Ministerial Decree 1/1986 (II. 21.) ÉVM–EüM, while the detailed rules for clearing snow and ice in winter – when, with what and over what width the pavement must be gritted and cleared – are set out in the public-cleanliness decrees of the local municipalities; in Budapest this is Decree 48/1994 (VIII. 1.) of the Budapest City Assembly (Főv. Kgy.) on public cleanliness in the capital. Who is responsible in a given municipality can therefore be read from the local decree, but the division of roles is typically as follows:
The general rule on compensation is Section 6:519 of the Ptk.: anyone who unlawfully causes damage to another must compensate for it, and is released from liability only if they prove that their conduct was not culpable. Failing to clear ice is damage caused by omission: the party responsible may be released from liability if it proves that it acted as could generally be expected in the given situation – for example, during sudden freezing rain, when even with the care that could be expected it was not yet possible to clear it. The burden of proof is therefore split: you prove the accident, the place, the time, the injury and the loss; the party responsible proves its own exoneration. Besides pecuniary loss – medicines, medical aids, travel, private care, loss of income not covered by sick pay – harm to physical integrity and health is a violation of personality rights, for which non-pecuniary damages (sérelemdíj) can be claimed under Section 2:52 of the Ptk.; in a dispute, the amount is assessed by the court.
Two limits must honestly be mentioned here. Under Section 6:525 of the Ptk., the injured person's own culpable contribution – footwear unsuited to the conditions, inattention, deliberately choosing an obviously icy patch instead of the gritted one – can lead to the loss being shared. And the claim is subject to the general five-year limitation period under Section 6:22 of the Ptk. – but the evidence lasts not five years but only a few hours. If the party responsible has liability insurance – the liability section of a home insurance policy, or a condominium or municipal liability policy – a well-founded compensation claim is typically paid by that insurer; this does not mean less has to be proved, only that someone else pays.
Compensation cases are lost not on the law but on the evidence. What is worth doing at the scene, or as soon as possible:
The list in the article on documents for an accident claim collects the same papers – the good news is that the insurance claim and the compensation claim largely need the same bundle of documents.
First, treatment and documentation. Second, reporting the claim on the accident insurer's claims line – this has to go ahead regardless of the question of liability, and it is not worth waiting for the end of the compensation dispute before doing so. Third, a written claim to the party responsible; if they pass it on to an insurer, that insurer will assess it under the liability rules of the Ptk. and may likewise ask for the evidence listed above. If there is a dispute – the party responsible denies liability, their insurer declines the claim or offers to share the loss – the compensation claim goes to court, where it is advisable to involve a legal adviser. As a broker, I help where I can in the accident-insurance strand: in preparing the claim notification, in interpreting the policy conditions and in a stuck or disputed case. Enforcing the compensation claim is a legal task, not mine – but I can help make sure that the papers you will also need there are in order from the very first day.
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