BGH strengthens the rights of those in need of care: nursing pension does not depend on the level of care!

BGH strengthens the rights of those in need of care: nursing pension does not depend on the level of care!

In a recent ruling, the Federal Court of Justice (BGH) provided clarity on an important question of long-term care insurance. The judgment concerns the nursing pension, which is related to the care levels and the care levels that have been in effect since 2017. The judgment has the file number IV ZR 126/23 and was published on April 30, 2025. It states that insurance companies are not obliged to cover new claims from the care levels introduced by the care reform. This regulation is viewed as an unplanned gap in the conditions of the insurance contracts, as the old contracts are based on care levels that have no longer been in force since 2017. This comes from a report by Against Hartz out.

The aim of the care reform was to expand the demands of people in need of care. The new system of care levels offers additional services compared to the old care levels. Even if the old contracts guarantee a nursing pension in the context of the care levels, the BGH does not recognize that these regulations can be transferred to the new care levels. Instead, the BGH emphasizes the importance of calculability for insurance companies and speaks out against an obligation to accept new claims.

Legal disputes

The case, which reached the BGH, involves a complex legal dispute. The Saxony-Anhalt Higher Regional Court had previously decided in 2023 that an insured person with a care level of at least 2 was entitled to the care pension. This decision was based on a supplementary interpretation of the contract. The Higher Regional Court closed the loophole and determined that the insurer was obliged to pay the nursing pension for care level 2 or higher. This decision-making process began in the Dessau-Roßlau regional court and continued through several instances.

In the course of the appeal, the Federal Court of Justice overturned the contested judgment and referred the matter back to the appeal court. The appeal court will now have to examine whether an adjustment to the insurance contract is possible due to a disturbed business basis. The judgment particularly emphasizes that the insured event is defined by the need for care, which is determined by the nursing care insurance company.

Effects for insured persons

The decision could have far-reaching consequences for many insured people with old contracts who find themselves in a similar situation. In order to clarify which level of care your need for care should be assigned to, a medical report may be necessary. The ruling makes it clear that people in need of care who have been assigned a new care level may require state support, while their claims from older contracts are not necessarily covered.

In summary, it should be noted that the legal framework in the area of ​​nursing care insurance is changing. With the transfer of care levels into care levels and the associated regulatory gap, it is important to carefully examine the claims of the insured. The BGH's decision could help bring clarity to the confusing situation. Further information on this is also available NWB available.