The problematic nature of medico-legal opinions on fatal auto-erotic accidents made for private accident insurance companies is outlined in a survey based on our own records. Taking the "General Insuranc Terms for Accident Insurance" (AUB) into consideration, guidelines for the forming of such opinions are given. One is warned not to form summary opinions. Decisive is the insured's state of conciousness when the accident was triggered. Only in exceptional cases can an insurance covered accident be rejected because of a body injury inflicted by the insured on himself (see article). These actions do not usually result in external injury to the body. Experience proves that "ideal conditions" for forming an opinion are rarely given. Also, the nature of the death situation is such that often the corpse is discovered only days after death. From the outset, forming a medical opinion is beset with varying degrees of difficulty depending upon which category of auto-erotic activities the accident falls into: 1. direct stimulation of the erotic regions, 2. stimulation of sexual centers in the central nervous system, 3. the creation of fear and anguish in the context of masochistic perversion. According the presently valid insurance terms (AUB), cases of auto-erotic electrocution are to be regarded as covered. A disturbance of consciousness--with the exception of such disturbances following the influence of alcohol, medicines or narcotics--cannot be assumed for the moment in which the accident was triggered. At this moment body "integrity" was also intact. Accidents through strangulation, respectively asphyxiation (plastic bags etc.), usually occur during a disturbance of consciousness of the victim. This disturbance is the result of cerebral hypoxia, that is a result of strangulation, respectively external respiratory obstruction. The forming of a medical opinion for insurance purposes on auto-erotic accidents with clearly recognizable masochistic tendency is particularly difficult. A medical decision is only possible when an exact examination and description of the scene of the accident are available. In these instances, mechanical devices rigged by the victim often do not permit with sufficient probability to exclude the possibility of an accident without disturbance of consciousness on the part of the insured.