Leistungsfall

Leistungsfall is a term used in German insurance and social security to denote a specific event or circumstance that triggers the obligation to provide benefits. It marks the moment when a policy or statutory regulation recognizes entitlement to benefits and the insurer or payer must perform the agreed services.

The term is applied across private and public systems, including health, life, pension and disability insurance as well as unemployment and accident schemes. A Leistungsfall can result from illness, accident, death, retirement, or loss of eligibility to work, depending on the type of insurance or benefit program.

When a Leistungsfall occurs, the insured or beneficiary must notify the insurer and submit the required documentation, such as medical certificates, certificates of incapacity to work, death certificates, or proof of employment and contribution periods. The insurer then assesses whether the event fulfills the policy terms and legal requirements, including waiting periods, exclusions, and benefit limits. If eligible, the corresponding benefits are provided, either as payments or as services.

It is important to distinguish between the Leistungsfall and related concepts. The Leistungsfall is the triggering event; the actual payments or services are the Leistungen; a possible right to claim is called an Anspruch. The term thus helps structure the process from event to payout within insurance and social security systems.