Accident insurance is obligatory for all Swiss residents. For most of us it is managed by our employer. For those without an employer, it is usually added to your health insurance as an “extra” product for a few francs per year. It is obligatory for every employer in Switzerland to provide accident insurance for their employees unless their working time is less than 8 hours per week.
The key differences between accident,sickness and health insurance cover are:
- Accident insurance covers medical costs incurred as a result of an accident. If you are an employee, the insurance also covers 80% of your salary in the case absenteeism from work as a result of the accident.
- Sickness insurance covers potential loss of salary as a result of absence through illness.
- Health insurance covers medical costs linked to the treatment of an illness.
Accident insurance claims process
If you suffer an accident, you must inform your employer as soon as possible, even if the accident does not cause any loss of work time. The employer then has to file a report to their accident insurer. You require this report to be handed over to the medical professionals treating you. This also enables any resulting costs from medical institutes to be forwarded to your insurer.
The report contains references that all parties require to attach documentation associated to the accident such as invoices and medical reports. If further treatment is required by another practitioner, they will require the same report to add the costs of their services to it. If for some reason the employee receives an invoice for accident treatment they should be able to forward this to the insurer with their accident reference number from the report directly to the insurer or through their employer.
- In the event of the employee being unable to work as a result of an accident they receive 80% of their salary from the third day of absence.
- For the first two the employer pays 100%.
- From the third day, an employer may choose to top up the extra 20% if they so wish.
- As in the case of sickness, a medical note is required determining the percentage of absenteeism and for what period of time.
The cost of accident insurance varies from provider to provider and once set up may vary each year depending on the provider and the history of accidents in your industry. The employer always pays the professional accident insurance and the employee usually pays the non-professional insurance from their salary.
Professional accident insurance is engaged as a result of an accident at work or going to and from work. Non-professional accident insurance is used as a result of an accident that happens during private, non-work time
The employer’s costs for accident insurance may vary considerably depending on how risky the work is. The chances of an accident sitting behind a laptop filling in data and writing blogs is much lower than for a fire-person or a football player!
Perhaps we might expect the cost of non-professional accident insurance to be the same for everyone, as theoretically we are all just as likely to fall off our bikes at the weekend or break our ankles on the ski-slopes. However this is not the case!
- This is because it is linked to potential time off from work and the insurance needs to pay the salary due to through absence.
- A window cleaner who breaks their leg falling off a bike at the weekend, is likely to be away from work much longer than somebody with a desk job who may be able to return after a few days from the same accident with the same treatment costs.
- As with sick pay insurance, accident insurance lasts for up to 720-days, and in addition to medical and salary costs, it can also start to cover rehabilitation and professional reintegration expenses.
- Reintegration may mean re-training in another job because the insured person is no longer able to carry out the previous occupation as a result of the accident.
- This is a complex subject, but simply put, if a firefighter broke their back falling from a ladder and could not carry out their role anymore, they might retrain as a bookkeeper, to hopefully be engaged for the fire service or when not possible, elsewhere with their new skill set
- In the event that you, the employee are partially unable to work due to an accident, the accident insurance may pay a pension based on salary and degree of disability.
Accident insurance can often cover a wider range than one would perhaps initially think, including trauma, illness due to work and death.
Frequently asked Questions
Was it an accident?
That should be simple shouldn’t it? If you have had an accident then the accident insurance pays you and if you are ill, then the sickness insurance pays you. If only it was that easy!
Unfortunately disagreements between the employer’s sick pay provider and the accident insurance, can mean delays and frustrations whilst they decide which insurer has to pickup the costs of the treatment and/or salary.
- Did the employee have an underlying condition that was triggered by the accident?
- Was the employee already ill in someway, but didn’t know about it until they had an accident?
In these events, instead of the accident insurer picking up the tab, it might be the employee’s health insurance and sick pay insurer.
What about going abroad ?
Yes, you are covered for accidents going abroad. This is usually for emergency treatment only and up to twice the value of the most expensive costs in Switzerland. Employees need to inform their employer about any trips to potentially expensive locations (USA) and possibly more complicated areas (Middle East/Asia) about processing and reporting accidents in locations abroad.
What about extreme sports?
In principle, employees are insured against accidents caused through extreme situations, but there may be caveats attached to certain situations, which might be classified as “negligence”.
- Did the accident happen when skiing on an unmarked piste, with an avalanche warning at the start. If so, then this may well be perceived as being negligent.
- Racing a vehicle when not qualified, may also be seen as negligent.
- If someone is qualified to do things, that may on the surface seem very dangerous, such as aerobatic flying shows, then they are covered. Some insurers may provide coverage for “negligence” at an extra cost.
What if I lose my job?
When losing a job, the person insured remains insured with their previous employer for one month after finishing the current contract. If this happens – it is worth speaking to the health insurance provider during this period, about adding “accident” to the health policy or contacting the employer’s provider to extend their coverage. This can be done directly, or working together with the HR department. Knowing what the process is when an accident happens is key.
For more information about personal coverage and level of coverage against accidents, we advise all employees to speak to their employer, health insurance provider and insurance broker.
Swissroll GmbH was founded over 20 years ago. During this time our team of experts has worked with hundreds of companies and literally thousands of contractors. Beyond our core function of payroll management, we offer advice to contractors coming to work in Switzerland for the first time. This includes advice on accident insurance. Swissroll: “More than just payroll specialists”
Contact us now on: firstname.lastname@example.org