ACCIDENT INSURANCE POLICY. Lower back pain (lumbago) claim against the insurance company.

Posted on by Carlos Baos

Dear Sirs,

I tried to move a piece of furniture at home and have since then suffered from lower back pain (lumbago) that does not allow me to work or have a normal life. I have an accident insurance policy but the insurance company refuses to pay, claiming that I caused the injury to myself by over exerting myself and since they do not consider this an accident my insurance policy does not cover it.

Dear Reader,

Thank you for your consultation.

We understand from your letter that you took out an accident insurance policy that would allow you to claim compensation for the days that you are unable to work whilst recovering from an accident. (This type of insurance should not be confused with motor vehicle insurance).

Firstly, we have to inform you that it is impossible for us to give you full and exact legal advice without seeing the general and specific conditions of your policy.

Secondly, if we take it that this type of injury (e.g. ‘back pain (lumbago) is not specifically mentioned in your policy, the key is to determine whether the effort made by you, as the insured person, can be considered an accident or not, and therefore whether there is a valid case for compensation.

If we refer to Spanish Insurance Law 50/1980 article 100 we find that an accident is defined as: “Without prejudice to the limitation of risk made by the parties on the contract, an accident is understood to be any damage or injury to the body caused by a sudden violent cause without awareness or intention of the insured, which produces temporary or permanent disability or death