A client of around sixty who has lived with diabetes for years falls on the stairs and breaks an ankle; the wound heals poorly, and after months of treatment a permanent restriction of movement remains. The insurer accepts that an accident happened and pays – but for the permanent disability it pays only part of the percentage set by the medical expert. One word stands at the centre of the reasoning: contribution (közrehatás). As a broker, I see that this is one of the most common points of dispute in payouts under the permanent disability table, and most people first come across it in the middle of a claim. Yet the rule is in the policy conditions and can be read in advance – and if you understand its logic, you can make better decisions both when taking out a policy and when making a claim.
- Accident insurance pays for consequences of accidental origin: if an illness that already existed before the accident also contributed to the resulting condition, Hungarian policy conditions typically reduce the benefit in proportion to that contribution – in several policy conditions this applies only where the contribution is at least 25%.
- If the insured person already had a permanent disability before the accident, the insurer typically pays only for the additional disability caused by the accident: it deducts the degree of the earlier disability, and the percentages added up from several accidents cannot exceed one hundred per cent either.
- The insurer determines the degree of contribution on the basis of a medical expert's opinion; if you dispute it, ask for the medical reasoning in writing, obtain your own expert opinion, and after the insurer's complaints procedure you can turn to the Financial Arbitration Board (PBT) or a court.
Why does such a rule exist at all?
Under the rule of the Hungarian Civil Code (Ptk.) on accident insurance contracts, accident insurance pays an amount set in the contract in the event of the insured person's accidental death, injury to health or disability. The key word is “accidental”: the insurer takes on liability for what results from an accident, not for the consequences of illness – the boundary between the two worlds is explained in the article on the dividing line between accident and illness. The contribution rule fine-tunes this boundary: in reality the two causes are often intertwined. The same fall causes a bruise in a healthy forty-year-old, but a fracture, prolonged healing and a permanent consequence in someone with osteoporosis or diabetes. The policy conditions respond to this by saying that the insurer pays for the accident's “own” share, not for the contribution of the illness.
The distinction matters: this is neither an exclusion nor an exemption of the insurer. The insurer is not saying that no insured event occurred, nor that you breached anything – but that part of the consequence cannot be attributed to the accident. That is precisely why the dispute here is almost never legal but medical: the question is whether the pre-existing condition really contributed, and to what extent.
Two separate rules that many people confuse
Policy conditions typically contain two independent provisions side by side, and in claims they often come up at the same time.
- Contribution of a pre-existing illness. If an illness or pathological condition that already existed before the accident also played a part in how the consequences of the accident developed, the insurer reduces the benefit in proportion to that contribution. Several Hungarian policy conditions also set a threshold: the reduction applies only if the degree of contribution reaches a specified level – typically at least 25% – and below that the insurer pays the entire percentage determined. The threshold and the method of calculation vary from insurer to insurer, so it is worth checking your own policy conditions.
- Deduction of an earlier permanent disability. If the insured person already had a permanent disability before the accident – for example, the function of a limb was reduced after an earlier accident or operation – the insurer determines the degree of disability caused by the current accident by deducting the earlier degree. In other words, it pays not for your entire present condition but for the additional disability caused by the accident. The counterpart of this is the rule that the percentages added up from several accidents cannot exceed one hundred per cent either: one set of Hungarian supplementary accident insurance conditions in force from 2026, for example, expressly states that the aggregate degree of disability cannot exceed one hundred per cent.
The difference between the two is that with contribution an illness “helped” bring about the consequence, whereas with deduction there is a measurable impairment that already existed beforehand. In the first case the benefit is reduced proportionally; in the second, the earlier degree is subtracted. Osteoporosis is a typical case of the first group – there is a separate article on osteoporotic fractures – while an old, healed injury is a typical case of the second.
How does the insurer calculate? An example – in percentages
Suppose the sum insured for permanent disability is the amount stated in the policy, and the medical expert assesses the lasting restriction of ankle function as a 30% disability. If, on the basis of the documentation, the insurer's doctor judges that poor wound healing due to diabetes is responsible for half of the resulting condition, the contribution is 50% and the basis for payment is 15%. If the same client's ankle already had a 10% disability from an earlier accident, the insurer may deduct that as well. The method of calculation – whether the deduction comes first and the proportional reduction afterwards, or the other way round, and which band of a progressive table the final result falls into – is set out in the policy conditions and may differ from insurer to insurer. The example only shows the logic; in your own case, the amounts in your policy and the wording of the policy conditions are what count.
Timing matters too. Under the policy conditions, the degree of permanent disability typically has to be determined within a specified period after the accident – in the 2026 conditions referred to, within two years of the accident – and the same conditions state that a change in working capacity or giving up a sport does not in itself play any role in the degree. The process up to the point when the condition stabilises is described in the article on how permanent disability is determined.
What does the insurer look for in the documents – and what role does the duty of disclosure play?
To assess contribution, the insurer examines the medical history: it requests GP records, earlier test results and hospital discharge summaries, and some policy conditions expressly state that they look back over a specified period before the start of cover to see whether the illness already existed. This is not bad faith but the way the rule works: the insurer is trying to separate what stems from the accident from what stems from the illness.
A separate question is the health declaration made when the policy is taken out. Under the rule of the Ptk. on the duty of disclosure (Section 6:452), if the policyholder does not disclose material circumstances, the insurer's obligation does not arise – unless the contracting party proves that the insurer knew of the undisclosed circumstance when the contract was concluded, or that it did not contribute to the occurrence of the insured event. In practice, therefore, two separate routes must be distinguished: if you properly disclosed the illness when taking out the policy, at most a proportional reduction for contribution can come into play; if you concealed it in the declaration, the insurer may go further than that. This is another argument for answering the questions asked when taking out the policy accurately and for reporting any changes that arise in the meantime and must be notified – this is the insured person's non-transferable duty.
What can you do if you dispute the reduction?
The primary route for reporting a claim is the insurer's claims line, and that is also where the decision comes from. If you consider the reduction too large, as a first step ask in writing for the medical reasoning behind the decision: which illness was taken into account, what degree of contribution was established, and which documents it was based on. After that, it is worth asking your own treating doctor or an independent medical expert for an opinion on whether the pre-existing condition really played a role and, if so, to what extent – here the dispute is decided by medical arguments, not by emotion. After the insurer's complaints procedure, the Financial Arbitration Board (PBT) or a court can decide; the MNB (Hungary's central bank and financial supervisor), as the supervisory authority, does not rule on individual claims disputes. If a case gets stuck or disputed, I help where I can: in interpreting the wording of the policy conditions and in formulating the questions, acting on your behalf – the details are in the article on stuck and disputed claims.
And before taking out a policy, do three things: find the clause in the policy conditions headed “contribution” (közrehatás), “pre-existing impairment of health” (előzetes egészségkárosodás) or similar, and check whether there is a threshold; answer the health questions accurately; and if you live with a known chronic illness, think through what protects you on the illness side alongside the permanent disability element. The insurer pays only for what is an insured event under your contract – but for that it pays according to the policy conditions, and these rules can be known in advance.
Do you have a question about your own health situation and policy? Run the numbers in minutes with the online calculator (in Hungarian), or book a free 20-minute consultation →
Sources
- Hungarian Civil Code (Ptk., Act V of 2013) – rules on the accident insurance contract (chapter on insurance contracts), duty of disclosure and duty to report changes (Section 6:452)
- Alfa Vienna Insurance Group: Special conditions of the supplementary insurance for permanent disability caused by accident (BR–21, BRE–24, BRU–24; from 1 January 2026) – determination within two years, upper limit of one hundred per cent
- CIG Pannónia Életbiztosító Nyrt. General Life Insurance Conditions – definition of accident and events not regarded as accidents
- MNB – Financial Arbitration Board (Pénzügyi Békéltető Testület)
- Balázs Tőkey: Health insurance in the Civil Code (Biztosítás és Kockázat, Vol. V, No. 1, 2018, MABISZ) – Ptk. Section 6:487: the health insurance contract
