Federal Court of Justice (BGH), judgment of November 11, 2026, IV ZR 214/25: Legal expenses insurer was not allowed to refuse coverage for lawsuit against BioNTech
The Federal Court of Justice has ruled on the rights of vaccine victims vis-à-vis their legal expenses insurance The legal position of insurers has been significantly strengthened. In June 2023, an insurer was not permitted to deny coverage for legal action against the manufacturer of the COVID-19 vaccine, Comirnaty, on the grounds that the vaccine had a positive benefit-risk ratio and the lawsuit was therefore hopeless. This was decided by the Fourth Civil Senate, responsible for insurance contract law, on November 11, 2026 (IV ZR 214/25).
The case
The plaintiff was vaccinated with Comirnaty on May 11, June 15, and December 15, 2021. He claims to suffer from an autoimmune deficiency as a result of the vaccination. Following an injury in 2022, his feet swell and become severely painful whenever he stands for more than an hour or walks for more than half an hour.
His legal expenses insurance covers the assertion of claims for damages. In June 2023, he requested coverage for the out-of-court pursuit of damages against the vaccine manufacturer. The insurer refused, stating that the action had no reasonable prospect of success.
The Kleve Regional Court (6 O 117/24) dismissed the coverage claim. The Düsseldorf Higher Regional Court (4 U 33/25) upheld this decision: Based on the unanimous case law, there was no negative benefit-risk ratio for the vaccine, and therefore liability under Section 84 Paragraph 1 of the German Medicines Act (AMG) was precluded.
The decision of the Federal Court of Justice
The plaintiff's appeal was successful. The Federal Court of Justice (BGH) overturned the judgment of the Higher Regional Court of Düsseldorf and remanded the case for a new trial. The key reasons were:
- Low barrier to success: A sufficient prospect of success exists if the policyholder's legal position appears tenable and evidence can be presented. Excessive requirements are inadmissible.
- The decisive factor is the time of rejection: It basically depends on the point in time at which the insurer decides on coverage, in this case June 2023. At that time, there were still no court decisions regarding the manufacturer's liability for Comirnaty.
- Difficult questions do not belong in the cover process: The assessment of the benefit-risk ratio depends on complex, unresolved legal and factual issues. The insurer may not decide these issues in advance, to the detriment of the insured, during a coverage dispute.
- Later court rulings do not count: The judgments issued after the rejection at best establish a temporary prevailing opinion among the lower courts. They do not constitute a definitive ruling by the highest court to the detriment of the injured parties, especially since the Federal Court of Justice (BGH) strengthened the rights of injured parties on March 9, 2026 (VI ZR 335/24).
- Expert opinion instead of prejudgment: If a negative benefit-risk ratio is sufficiently demonstrated, the court must obtain an expert opinion. It is not apparent that the taking of evidence would most likely be unfavorable to the plaintiff.
The Higher Regional Court of Düsseldorf must now examine whether the plaintiff's submissions meet the requirements. In cases of pharmaceutical liability, the requirements for substantiation are not excessive. The details are summarized in the Press release of the Federal Court of Justice No. 220/2026 together.
What the verdict means for those injured by vaccines
Many legal expenses insurers have rejected coverage requests for lawsuits against vaccine manufacturers, citing the approval of the vaccines and a positive benefit-risk ratio. This justification is no longer valid following the ruling. This establishes a precedent set by the highest court, which had already been emerging in the jurisprudence of the higher regional courts: Even the Higher Regional Court of Karlsruhe and that Saarland Higher Regional Court have ordered legal expenses insurers to cover the costs.
Together with the ruling of the Sixth Civil Senate of March 9, 2026, a clear picture emerges. Courts may not dismiss vaccine injury claims without an expert opinion, and legal expenses insurers may not refuse to finance such claims on the same grounds. As the Higher Regional Court of Cologne has ruled in several cases, The approval of the vaccine does not replace a medical assessment..
New data on side effects has also emerged. SafeVac 2.0 study by the Paul Ehrlich Institute The results, with almost 740,000 participants, have now been published and play a role in assessing the benefit-risk ratio.
Was your application rejected? Here's what to do.
- Check the rejection letter: If the insurer bases the rejection on a lack of prospects for success due to a positive benefit-risk ratio, this justification is contestable according to the BGH ruling.
- Use of tie-breaking decisions or expert review procedures: According to Section 128 of the German Insurance Contract Act (VVG), the insurance contract must include a procedure by which you can have a rejection due to lack of prospects of success reviewed. Many policies include a binding decision by your lawyer for this purpose.
- Submit a new coverage request: If coverage was rejected, a renewed request citing the current case law of the Federal Court of Justice (BGH) may be advisable.
- File a cover action: If the insurer maintains its refusal, coverage can be enforced through legal action.
- Keep an eye on deadlines: Claims against the vaccine manufacturer expire three years from the end of the year in which you became aware of the damage and the liable party.
Rogert & Ulbrich: Your lawyers for vaccine injuries
Rogert & Ulbrich represents vaccine victims nationwide against vaccine manufacturers and Legal expenses insurers. The partners Dr. Marco Rogert and Tobias Ulbrich They conduct numerous proceedings under the Medicines Act, from the action for information under Section 84a AMG to the appeal, and enforce coverage with legal expenses insurers if they refuse to cover the costs.
Has your legal expenses insurance refused to cover the costs of a lawsuit against the vaccine manufacturer? Take contact and secure your claims.
